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Lack of drug interaction between cyclosporine and telaprevir in a liver transplant recipient
Author(s) -
Lemaitre F.,
Jezequel C.,
Verdier M.C.,
Dermu M.,
BoglioneKerrien C.,
Boudjema K.,
Bellissant E.
Publication year - 2015
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12335
Subject(s) - telaprevir , medicine , pharmacology , drug , drug interaction , ribavirin , protease inhibitor (pharmacology) , pharmacokinetics , hepatitis c virus , immunology , virus , viral load , antiretroviral therapy
Telaprevir is a novel NS3A/4A protease inhibitor approved in combination with ribavirin and peg‐interferon alfa for the treatment of genotype‐1 chronic hepatitis C. This drug is also known to be a potent cytochrome P450 3A and drug efflux protein ATP‐binding cassette B1 (also called P‐glycoprotein) inhibitor, and could therefore interact with immunosuppressive drugs. For this reason, a decrease in cyclosporine (CsA) dosage has been proposed when combining this drug with telaprevir. We report herein the case of an unpredictable lack of interaction between CsA and telaprevir in a liver transplant recipient. The decrease in CsA dosage, conducted as recommended in the literature, did not result in stable CsA concentrations but decreased them. However, the decrease in CsA exposure could have been unseen without the measurement of CsA concentrations 2 h after the administration (C 2 ) of the drug, because it mainly resulted from the decrease in CsA peak. The mechanism leading to this lack of drug interaction in this patient has not been fully elucidated yet, but is likely to affect the absorption phase. Therapeutic drug monitoring using only CsA trough concentrations could be falsely reassuring, and the addition of the measurement of the C 2 may add useful information to adapt CsA dosage in patients co‐treated with telaprevir.