Hepatitis C genotype 1 virus with low viral load and rapid virologic response to peginterferon/ribavirin obviates a protease inhibitor

The new standard of care for treatment‐naïve patients with hepatitis C virus (HCV) genotype 1 includes triple therapy with peginterferon, ribavirin, and a protease inhibitor. However, patients who achieve a rapid virologic response after 4 weeks of peginterferon and ribavirin therapy are likely to achieve a sustained virologic response (SVR), and we hypothesized that protease inhibitor therapy may be unnecessary in these patients. Treatment‐naïve, noncirrhosis patients infected with genotype‐1 HCV and a low viral load at baseline were considered for inclusion (n = 233). After 4 weeks of lead‐in therapy with peginterferon α‐2b and ribavirin, 101 patients (48%) had a rapid virologic response (defined as undetectable levels of hepatitis C virus RNA at 4 weeks) and were eligible to participate. Patients were randomized 1:1 to 20 weeks of additional therapy with peginterferon α‐2b and ribavirin (double therapy) or to 24 weeks of peginterferon α‐2b, ribavirin, and boceprevir (triple therapy). There was no significant difference in rates of SVR‐12 in patients treated with double versus triple therapy. This similarity persisted regardless of viral subtype (genotype 1a or 1b), interleukin (IL)−28b genotype (CC or non‐CC), or ethnicity (African American versus non‐Hispanic white). Conclusion : Protease inhibitor therapy could be obviated in genotype 1‐infected treatment‐naïve patients with low viral load at baseline who achieve undetectable viremia after 4 weeks of peginterferon/ribavirin.(H epatology 2014;58:71–77)