Valuable antiviral therapeutic options for the treatment of chronic hepatitis C patients with thrombocytopenia

[Clinical Implication of Insulin Resistance in Chronic Hepatitis C Patients]

Chronic hepatitis C virus (HCV) infection is the leading cause for the development of liver cirrhosis and hepatocellular carcinoma, however, it also causes metabolic disorders. Insulin resistance is representative of these metabolic disorders, and not only leads to the development of diabetes but also affects the outcome of antiviral treatment with interferon. Historically, the standard of care for chronic HCV infection was pegylated interferon and ribavirin, but only 40-50% of HCV genotype 1 patients achieve a sustained virological response (SVR). We successfully established a pretreatment prediction model for the treatment outcome using a homeostasis model assessment of insulin resistance (HOMA-IR) and the interleukin 28B genotype (rs 8099917). In recent years, antiviral agents targeting viral proteins critical for HCV replication have become available. Of these, telaprevir, an HCV NS3/4A serine protease inhibitor, has been available in Japan since 2011. As a result, about 80% of patients with HCV genotype 1 can achieve SVR. Nonetheless, insulin resistance is associated with treatment failure, especially for difficult-to-treat patients. In the near future, almost all patients with chronic HCV infection will achieve virological clearance with combined direct antiviral agents, however, insulin resistance will remain a risk for hepatocellular carcinoma. Therefore, the prevention of obesity and avoidance of excessive alcohol intake are very important after achieving SVR.

Influence of low-density lipoprotein cholesterol on virological response to telaprevir-based triple therapy for chronic HCV genotype 1b infection

Elevated serum low-density lipoprotein cholesterol (LDL-C) level has been associated with sustained virological response (SVR) by chronic hepatitis C patients treated with pegylated-interferon (PEG-IFN) α and ribavirin (RBV). The aim of this study was to investigate the relation between the baseline LDL-C level and the treatment outcome from telaprevir (TVR)-based triple therapy. This prospective, multicenter study consisted of 241 treatment-experienced patients infected with HCV genotype 1b. All received 12 weeks of TVR in combination with 24 weeks of PEG-IFNα2b and RBV. The SVR rate was 81.3% (196 of 241) by intention-to-treat analysis. Higher LDL-C level was strongly associated with SVR (P=1.3×10⁻⁸). The area under the receiver operating characteristic curve for predicting SVR was 0.78 and the cutoff value for the LDL-C level at baseline was 95 mg/dL. In multivariable logistic regression analysis of predictors of SVR, LDL-C ≥95 mg/dL (odds ratio [OR] 3.60, P=0.0238), α-fetoprotein ≤5.0 ng/mL (OR 5.06, P=0.0060), prior relapse to PEG-IFNα and RBV (OR 5.71, P=0.0008), and rapid virological response (HCV RNA undetectable at week 4) (OR 5.52, P=0.0010) were extracted as independent predictors of SVR. For prior partial and null responders, the SVR rates of the groups with LDL-C ≥95 mg/dL were significantly higher than those of the <95 mg/dL groups with IL28B TG/GG and pretreatment platelet count <150×10⁹/L (both P<0.05). The baseline LDL-C level exerted a potent influence on the SVR of treatment-experienced patients treated with TVR-based triple therapy, especially for prior partial and null responders to PEG-IFNα and RBV.