Telaprevir: options of application in separate patient groups

The aim of review. To discuss potential of telaprevir application in patients with the 1-st genotype of chronic hepatitis C (CHC) representing certain difficulties in treatment, in patients having antiviral therapy experience, patients with liver cirrhosis, including, those, enrolled to liver transplantation waiting list, and after liver transplantation, in patients with human immunodeficiency virus coinfection, as well as nephrologic patients receiving renal substitution therapy.

Key points. Adding of NS3/4A protease inhibitor telaprevir to treatment mode for patients infected with 1-st genotype of hepatitis C virus for 12 wks allowed to increase treatment response rate considerably. The potential of decreasing of antiviral therapy (AVT) duration to 24 wks is proved, based on dynamics of viral load at AVT, at week 4 and 12 of treatment in patients who receiving no AVTs earlier, and in groups, representing as a rule, difficulty for treatment (patients with CHC relapse or absence the response/incomplete response to previous AVT). Patients with liver cirrhosis who represent quite heterogenic group require special approach. AVT in patients with compensated cirrhosis, those, enrolled to liver transplantation waiting list (if MELD index ≤18 and Child-Pugh score ≤8 points), with good efficacy and adequate treatment safety profile is now available. Known risk factors of death or severe adverse events are level of platelets under 100 Gi/L, serum albumin level less than 3,5 g/dl, and HVPG ≥10 mm Hg. Studying of telaprevir application options for treatment of patients with CHC relapse in post-transplantation period, patients with chronic renal disease, including those, receiving renal substitution therapy is still in progress. The primary data received in studies, devoted to these issues, enable to expect expansion of indications and options of three-componential AVT application.

Conclusion. According to data of original studies, inclusion of telaprevir in treatment mode of patients with 1-st genotype of chronic hepatitis C increases treatment response rate in group of patients with unsuccessful AVT experience, severe fibrosis or liver cirrhosis, and unseals new options of treatment of patients from the liver transplantation waiting list, after transplantation and in group of chronic renal disease.

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