Retreatment, switching and extended therapy with boceprevir and telaprevir for chronic hepatitis C infection

Two new protease inhibitors, boceprevir and telaprevir, were recently approved by Health Canada for treatment of chronic hepatitis C infection, genotype 1. By their current indications, these agents are to be added to peginterferon-ribavirin (PR) therapy. Although within the same drug class, the two new protease inhibitors were studied in different clinical trial programs, and it is not entirely clear what differences exist between the two agents. Evidence relating to prolongation of protease inhibitor therapy beyond the duration approved in the product monographs may also be of interest for patients experiencing inadequate response to therapy. There is also a dilemma as to where to position these new protease inhibitors with respect to existing PR therapy, particularly in treatment-naïve patients. It may therefore be important to understand the efficacy and safety of adding a protease inhibitor after initiation of a PR regimen. The information in this review is intended to support jurisdictions across Canada in their listing decisions on the protease inhibitors for hepatitis C. This report was reviewed by a clinical expert in hepatology.