Background: In patients with chronic hepatitis C, triple drug regimens containing a protease inhibitor, peginterferon and ribavirin were found to significantly increase sustained virologic response rates compared to dual drug regimen containing pegylated interferon and ribavirin, especially in genotype 1.Objectives: In Turkey, TELAPREVIR has been used since March 2013. We aimed to evaluate results of patients with chronic hepatitis C treated with TELAPREVIR, peginterferon and ribavirin.Patients and Methods: We evaluated 28 patients with genotype 1 chronic hepatitis C infection treated with triple drug regimen containing TELAPREVIR, in three medical centers in Turkey, retrospectively. Demographic data of patients, treatment indications, adverse events and outcomes were recorded.Results: Of 28 patients intended to treat, 25 (89.2%) patients completed the treatment. Overall, 21 (82.1%) patients had relapse and five patients were non-responder. Regarding the treatment outcomes of TELAPREVIR based regimen, 20/26 patients achieved sustained virological response. Pruritus, rash, dysgeusia, anorectal discomfort and anemia were main adverse effects. Blood transfusion and ribavirin dose reduction required for 7 and 11 patients, respectively. Due to several adverse effects, 10 patients were hospitalized.Conclusions: Although more frequent and severe adverse effects, TELAPREVIR has been promising for patients with treatment-experienced hepatitis C.

Dear EditorWe have read with great interest the article entitled “TELAPREVIR experience from Turkey” by Komur et al. recently.First of all, we have applauded the efforts of the authors and the editors of journal for putting forward this controversial and wondered topic for us. Currently, the hepatitis C treatment is in a very dynamic situation, due to newly introduced potent drugs. Therefore, the most popular guidelines (AASLD, EASL and APASL) have constantly updated the treatment recommendations, based on the new evidences from the effects and side-effects of these drugs. Thereby, every comment on novel potent drugs is very important for the clinicians, who have insufficient experience with them. We firstly want to discuss the content of the article and present to our experience that selected patients are more difficult to treat as a group, with different and strange side-effects.

Background: Anemia is more frequent in patients receiving TELAPREVIR with PEGylated interferon/ribavirin (PEG-IFN/RBV) than in those receiving PEG-IFN/RBV alone.Objectives: The objective was to measure the impact of TELAPREVIR on RBV bioavailability and to assess the concomitant renal function.Materials and Methods: Thirty-seven hepatitis C virus (HCV) patients non-responders to a previous course of PEG-IFN/RBV therapy and re-treated with triple therapy combining PEG-IFN/RBV and TELAPREVIR were analyzed. RBV bioavailability was measured before the triple therapy initiation, during TELAPREVIR treatment at week (W) 4 and W8, and after TELAPREVIR cessation (post W16). The renal function was assessed by estimating the glomerular filtration rate (eGFR).Results: At W4, RBV bioavailability, expressed as mg/L/daily dose/kg body weight, was significantly increased (median increase = 0.06 mg/L/dose/kg; P < 0.001). In parallel, the renal function was impaired with a mean eGFR decrease of -6.8 mL/minutes/1.73 m2 (P = 0.109). Between W4 and W8, RBV bioavailability continued to increase (P < 0.001) but subsequently decreased slightly after TELAPREVIR discontinuation with a concomitant restoration of the renal function (eGFR increase of 6.34 mL/minutes/1.73 m2).Conclusions: Our results indicated a reversible increase in RBV bioavailability after TELAPREVIR exposure, which might be linked to the impairment of the GFR. This also suggests a RBV-TELAPREVIR pharmacological interaction, a possible source of severe anemia observed under triple therapy. These results suggest that RBV pharmacological monitoring may be clinically relevant, especially in the context of first-generation HCV protease inhibitor-based therapy.

Introduction: Dermatological adverse events are an existing concern during treatment of hepatitis C virus infection. Peginterferon/ribavirin treatment is associated with well-characterized dermatological lesions tending towards a uniform entity of dermatitis. New TELAPREVIR- or boceprevir-based triple-therapy has led to significant improvements in sustained virological response rates, although associated with an increase in cutaneous adverse events compared peginterferon/ribavirin alone.Case Presentation: We report a case of a patient who discontinued TELAPREVIR because of severe skin eruptions and who, during ribavirin and interferon treatment, after a period free of skin lesions, developed new dermatological lesions different than those experienced during TELAPREVIR treatment.Conclusions: Several adverse effects are associated to anti-HCV drugs, hence appropriate skin care management and follow-up are very important. A careful anamnesis before the initiation of triple therapy is necessary to identify previous dermatological diseases that could increase skin adverse effects incidence.

Background: The triple therapy including peginterferon, ribavirin and protease inhibitors was more effective compared to the combination of only peginterferon and ribavirin. This study aimed to assess the cost-effectiveness of triple treatment in either treatment-naï ve and treatment-experienced patients in Kazakhstan. Methods: A Markov model was created to assess long-term clinical advantages and the cost-effectiveness of the triple therapy from Kazakhstan payer perspective. Health state transition probabilities, pharmaceutical and other costs (according to the price in 2015), and utility rate were acquired from the published studies and pub-licly available sources. All used costs and benefits were discounted at 5% per year. Results: Despite treatment background, the patients, receiving boceprevir and TELAPREVIR, were estimated to experience less serious liver-disease complications, more life-years, and more QALYs compared to the patients having standard of care. For treatment-experienced group, boceprevir and TELAPREVIR were dominant, with more QALYs. For all the groups of patients, incremental costs per QALY gained were between USD14995 and USD18075. The total average cost of boceprevir is slightly more costly than a standard duration of treatment with TELAPREVIR, and so is the average cost per SVR. Extensive sensitivity analyses verified robust model results. Conclusion: The inclusion of protease inhibitors to standard management for the therapy of patients with genotype 1 chronic HCV infection in Kazakhstan is predicted to be cost-effective using a typically applied will-ingness to pay threshold of USD37805 (3 times GDP per capita).