telaprevir vs boceprevir

[kirk8]

I am about to start treatment for 1a hep c. My doctor is giving me the option of taking telaprevir or boceprevir. I am trying to determine which drug is right for me. If anyone has any insight please share it.  
First, let me tell u a little about myself for my specific case.  I am 25yo. About 220lbs. My viral load is about 500,000. I have never been treated before.  I am healthy and don’t think I’ve had the virus long. Thanks, anything helps.

[susan400]

I am glad to see that you've been able to decide which drug to go with.  I wish you only the best.  I am on treatment, but not with either on of those PI's.  I am on SOC + either the study drug(or placebo), of the trial that I'm in.  I was no eligible to retreat with Telaprevir as I was exposed to it in the earlier clinical trials and did not clear because I did not have Ribavirin in the randomized arm that I was in.  I only had the Peg + Telaprevir and that being said, did not clear.  So, Telaprevir retreatment is not something that I will be doing.  Susan400

[Mary4now]

I just finished 24 wks of tx. and I'm feeling great, the tx. was rough but it was like riding a wave you just go with it, unless of course you have severe sides.  I had low hgb, nausea, hair loss, lost taste, just enough energy to get through the day and into my bed.  I took antidepressants, and just started getting some rashes when I stopped.  The sides are mostly doable and well worth it.  Just take care of yourself.

[cubgirl]

Thank you.  The nurse comes tomorrow to train me.  I'm very anxious.  My kids have grown and I am single.  The only reason I'm doing this is that, after 20 years of having the virus, I am to the point where I don't want to get off the couch.  I fear that the treatment will make things worse but I feel I have to try to get my life back.  Does anyone ever go through treatment with no side effects?  I hear of depression, suicidal thoughts, flu, diarrhea, rashes, headaches, lethargy, etc. etc.  Will this happen to me too?  It's almost unbearable to think about.  Thanks for answering my questions...

[willing]

in above post, Merck FDA submission is:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252343.pdf

and Vertex FDA submission is:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252562.pdf

[willing]

great  questions.

>Has anyone heard that Boceprevir causes diarrhea?
sx vary between pts. I'm now in w10 of boce and though there is definite gastric upset it seems mild compared to what ifn/rbv/alinia  have caused (I added the boce after approval, around w30 of tx)

>Do both Telaprevir and Boceprevir use RGT?  
yes - though the RGT plan for boce includes more  variations. In the case of eRVR (und after 4w of PI) the difference in length is the 4w  lead-in.

>Does Telaprevir have a higher SVR in treatment-naive patients exhibiting eRVR?
no : check page  43 of the Merck FDA submission. In Sprint-2 (tx naives) the SVR rate among those UND after 4w of boce was 96%. You can compare this with page 72 of the Vertex submission describing the results of study 111(also tx naives). Among cEVRs SVR rates were 92% for T12PR24 and 90% for T12PR48.

Other comparisons of naives that combine both fast and slow responders can show a bigger spread between the two drugs but such comparisons are intrinsically very noisy and thus of limited value.  Each batch of naives will include a spectrum of fast/slow/medium responders. For example in SPRINT-1 boce saw a 75% response that dropped to 66% in SPRINT-2 with the same drug protocol.

A key difference between the two drugs are the sx,  Though more anemia is expected with VIC, INCI seems to have its share as you'll see in the posts here. Skin problems beyond those caused by soc do not seem an issue with VIC.

Also as a naive, you have no idea what your ifn response is and thus what triple can do to help your SVR odds. The results of the 4w lead in will answer that. All the best!

[cubgirl]

I am 57 yo female and was diagnosed with HCV 1994.  (I received plasma in 1989 after giving birth but not sure that's the cause.)  I'm treatment-naive.  My doctor chose Boceprevir + PR.  My viral load is 499,000.  Genotype 1a.  Not sure about the genes I've heard about (CC, CT or TT).  I'm supposed to start treatment this weekend -- it took 2 weeks for insurance to approve treatment.  For the last few days, I've perused the FDA hearings and saw my doctor testified for Merck/Boceprevir.  That was April 2011.  Two weeks ago, we decided to initiate treatment and my doc asked me which drug I wanted.  I was unsure and had done only minor research.  He steered me to Boceprevir.  He's a very well-known hepatologist; I like and trust him and I agreed.  Now, after doing my diligence, I'm not sure if I'm getting Peginterferon (2b) or Pegasys (2a).  (I have not seen a study where Boceprevir was used with Pegasys + Ribavirin.)  I'm not sure if I'm doing the 4 week of PR alone before the administration of Boceprevir (as I've read is their plan of treatment).  The nurse is coming Saturday to instruct me so I guess I'll find out then.  When I saw my doc, he said Boceprevir has high incidence of diarrhea but a higher response rate and uses RGT.  However, my subsequent research shows that Boceprevir has higher incidence of anemia than Telaprevir; that Teleprevir has higher SVR for treatment-naive; Telaprevir has shorter treatment duration (24 TW vs 28) for eRVR's and that both treatment plans use RGT.  Has anyone heard that Boceprevir causes diarrhea?  Do both Telaprevir and Boceprevir use RGT?  Does Telaprevir have a higher SVR in treatment-naive patients exhibiting eRVR?  Should I be concerned that my doc's loyalty is with Merck and not me? Thanks...

[Aaron57]

More on Tela vs. Boce , a pretty comprehensive overview of what we know and what we don't know ..

http://hepatitiscnewdrugs.blogspot.com/2011/06/new-treatments-for-hepatitis-c.html

[kirk8]

Ooops, ment SVR. Anyway, thanks again. I start treatment in August. I'll b back.

[kirk8]

Thanks, this was just the information I was looking for and after reading hours of research yesterday I decided to go with telaprevir. The prospects of a shorter treatment duration is a plus. Honestly, I was leaning towards telaprevir all along but after reading the side effects included anal itching, burning, and possibly even hemorhoids. I was reluctant. But I have to keep my eye on the goal of SVC and I just think that telaprevir may be slightly more effective.

[James10500]

They say if you treat the Tela rash immediately it's manageable.  And there's always procrit or the anemia side.  Tough choice but I'm so happy you have a choice to make, it's awesome  that these drugs are here and people have such a better chance for SVR now ,
Good luck !

[frijole]

Yes can do is right -- If you are undetectable at 8 weeks and 24 weeks you treat for a total of 28 weeks with victrelis

[frijole]

can-do is probably right.  I tend to focus on what is benficial to me as a relapser and don't have the labeling here with me to tell. You can rely on what can-do says.

frijole

[can-do-man]

Treatment naives treat for 28 weeks total with Victrelis, its relapsers that treat for 36 weeks total.......... Right?

[WriteItDown]

Great for you for knowing about HCV and getting yourself tested!

I forgot about the time difference, 24 weeks v  36. For me that would pretty much make up my mind -- I'd go with the shorter treatment. I think both boc and tel have similar success rates, and if you have no way of knowing whether the rash will be an issue for you, a few weeks less treatment would be a huge advantage.

[frijole]

bless your heart, coeric.  I seem to be chasing you around the forum.  Thanks for putting both of these links up for kirk.  I now have them saved on my hard drive so I can (ha ah - hopefully) find them.

frijole

[coeric]

SOC - i recently spoke with a hepatologist and she used SOC to describe triple therapy with either victrelis or incivek.

kirk - welcome the forum. glad to have you here.
eric

[coeric]

kirk - here are the links advisory committee briefings for both drugs.

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252562.pdf

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252343.pdf

[frijole]

Kirk -- welcome to the forum.  I think you are smart for taking care of this now while you are young and healthy and on your parents' health insurance.  

Being treatment naive with what is considered a low viral load (under 800,000 IU/mL) you do have options.  Both Victrelis (bocepevir) and Incivek (telaprevir)  have the option of response guided therapies.   That is, if you do well, you may be able to treat for a shorter period of time.  With Incivek you have the opportunity to treat for 24 weeks in total -- that is 12 weeks with the 3 drugs and 12 weeks with Interferon and ribavirin. With Victrelis, the total time treating may be 36 weeks -- 4 weeks of a lead in of interferon and ribavirin and 32 weeks of all 3 drugs.  

Although Incivek may cause skin rashes in up to 50% of the patients, there does not seem to be any rhymne or reason.  I don't think there is any correlation between previous skin issues and those who got the rash - at least not from what I have read on this forum from trial participants.  Victrelis may cause more anemia than Incivek but Incivek does cause more anemia too -- maybe just not as much as .

I am actually trying to make the same decision myself (I am a relapser).  What I am doing is reading all the material that both companies submitted to the FDA for approval.  They are both lengthy but worth the read , to me.  I will look for the links.  I know I can find the boceprevir link, but I will hve to look for the telaprevir link.

I am excited to have you on the forum since I read in your profile that you are a biochem student.  Who knows -- you may decide to go into Hep C reasearch and be the one who discovers the one-drug cure with no side effects!

frijole

[flcyclist]

Also, andy posted the following link which might be useful.

http://www.youtube.com/user/melissapalmermd#

[flcyclist]

I agree with Aaron.  With current insurance with a small copay and a chance to get this ugly virus out of your system now, I'd suggest to get it done.  You might be in a very different financial situation and might find it difficult to find health insurance due to pre-existing conditions.  Treatment is very expensive.  Also, you put it off too long and your liver might not be as healthy as it is now.

There are many factors that go into this decision so choose wisely.  Best of luck.

[Aaron57]

After rereading your earlier post concerning Insurance ... if it were me & this is only my opinion Kirk .. nobody in this forum is a doctor ....  
I would try Tx while you are covered by insurance , young, low VL , probably little if any liver damage ... Positive treatment response factors most of us here wish we had !

You did not specify what type of doctor you are seeing ... Gastroenterologist or Hepatologist ?  

If you do decide to treat ... a Hep C specialist might be a prudent choice as compared to a family/general doc.

The new drugs do require close monitoring due to several factors , fast onset of anemia , rash, slow response/resistance associated with producing viral mutations .. only to name a few of the more serious ones....

There are rules/guidelines to follow concerning these new drugs and you should make yourself aware of their guidelines before treating ..

Search those sites and you will find all your answers .. and more ...

[kirk8]

Thanks for your post. I will check those web sites. Hopefully they will have some of the answers I seek.

[Aaron57]

You might consider checking your liver condition ie: Fibrosure, Fibroscan or Biopsy & IL28b "genotype" before deciding if or which treatment you will proceed with ...

If you have little or no liver damage & are lucky and carry the CC gene... SOC or Peg-Interferon/Riba might be the choice as there is a good chance at clearing without adding a third drug .. allot less $ and less Sx for most folks ..
Sorry to say , but, there is no treatment that has 100% odds for success at this time .. and the treatment can have  .. challenges ...

There is plenty of info/data in this forum or online about all these considerations ..

The following refer to CC , CT, TT genotype:
http://www.medhelp.org/posts/Hepatitis-C/cccttt/show/1533188
http://people.chgv.lsrc.duke.edu/~dg48//L8464-0710-Service-Announcement-FINAL.pdf
http://www.medscape.com/viewarticle/743298

At the end of the day , it's a very personal choice , my suggestion is to take a bit of time and educate yourself before deciding how to proceed ....

CCO - Clinical Care Options - free registration
PubMed
EASL
Are just a few of the free and very complete up to date data bases.

Liver condition, Risk Vs. Reward , Sx (side effects) , cost of treatment, living/working situation etc.. are all important considerations.

It's great that at your age you have taken the initiative to get checked & are considering your options !

Good luck & Good health

[kirk8]

I know most of the other patients my doctors treat r in there 40s and 50s.  I feel very fortunate that I was diagnosed at a young age before having any complications.  I think that there r a lot of other young people out there with HCV that aren’t diagnosed until much later in life. I asked for the test a 3 years ago because I knew I had risk factors. I think many young people don’t ask because of the stigma attached to new HCV infection. Many people think that HCV will just show up on tests but it is my understanding that it will take years or decades for signs of HCV infection to show up on other tests. Thanks again.