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Telaprevir with peginterferon/ribavirin for retreatment of null responders with advanced fibrosis post‐orthotopic liver transplant
Author(s) -
Kwo Paul Y.,
Ghabril Marwan,
Lacerda Marco A.,
Joseph Tector Alfred,
Fridell Jonathan A.,
Vianna Rodrigo
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12372
Subject(s) - telaprevir , medicine , ribavirin , boceprevir , gastroenterology , anemia , hepatitis c , hepatitis c virus , cirrhosis , pegylated interferon , immunology , virus
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.