Telaprevir with peginterferon/ribavirin for retreatment of null responders with advanced fibrosis post‐orthotopic liver transplant

Aggressive recurrence of hepatitis C remains problematic post‐orthotopic liver transplant ( OLT ). There are limited data on treatment of HCV infection with telaprevir/boceprevir therapy with peginterferon/ribavirin ( PR ) post‐ OLT . Aim To review our experience with telaprevir addition to peginterferon/ribavirin in treatment of aggressive hepatitis C in null responders to PR post‐ OLT . Methods Adult patients with recurrent HCV infection post‐ OLT with null response to peginterferon/ribavirin for 12 wk (<2 log reduction) received four‐wk lead‐in PEG ‐ IFN alfa‐2b (1.0 μg/kg/wk) plus RBV (600–1000 mg/d) followed by addition of telaprevir 750 q8. All patients were converted to cyclosporine from tacrolimus ( TAC ). Results Seven patients (3 M, 4 F), mean age 56 yr, were treated. Three were <1 yr post‐ OLT , six had cirrhosis and one bridging fibrosis. Three of seven achieved sustained virologic response. All patients required RBV dose reduction, 6/7 required erythropoietin, 5/7 required filgrastim, and 2/7 required eltrombopag for platelets <20 000 μL. There were no supratherapeutic/subtherapeutic CYA levels encountered, no episodes of renal insufficiency. Conclusions Conversion to CYA followed by four‐wk peginterferon/ribavirin lead‐in with addition of telaprevir can lead to significant clearance rates at week 24 in null responders with advanced fibrosis although high rates of anemia/ RBV dose reduction, growth factor, and transfusion requirements were noted.