The critical role of medication adherence in the success of boceprevir and telaprevir in clinical practice.


To the Editor: The excitement about the new standard of care for the treatment of chronic hepatitis C virus (HCV) infection is warranted given the dramatically increased rates of sustained virologic response achieved with the addition of boceprevir or telaprevir to pegylated interferon and ribavirin in clinical trials. However, the success of these two new direct antiviral agents (DAAs) in the real world will depend on the ability of patients to adhere to them. Higher rates of psychiatric and substance use disorders and cognitive impairment in persons with chronic HCV, as compared to the general population, place them at risk for medication nonadherence. A similar development in the complexity of therapeutics occurred in the treatment of HIV infection in the late 1990s with the introduction of HIV protease inhibitors which led to an intensive focus on treatment adherence. The focus on adherence in HCV treatment to date has largely been on early treatment discontinuation and dose reduction rather than missed doses/injections [1] yet data collected through electronic monitoring indicate that patients do miss a significant number of doses of ribavirin and interferon [2]. The additional pill burden and treatment toxicity that DAAs will add to the considerable existing treatment burden will increase the adherence challenge for patients. Boceprevir and telaprevir must be taken three times daily (TID), 7–9 h apart, with food. We know from research that as dosing frequency increases, dose adherence decreases [3]. Five welldesigned studies report on both dose adherence (defined as the correct number of pills taken in an observed time period) as well as dose interval adherence (defined as the correct number of doses taken within 2 h of the scheduled dose time) to TID regimens as assessed by electronic monitoring (Table 1). Mean dose adherence ranges from 66% to 89% in these studies and mean dose interval adherence from 5% to 53%. Adherence data from clinical trials of telaprevir have not been reported. Clinical trial adherence data of boceprevir [9] suggest

DOI: 10.1016/j.jhep.2011.05.014

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@article{Weiss2012TheCR, title={The critical role of medication adherence in the success of boceprevir and telaprevir in clinical practice.}, author={Jeffrey J. Weiss and Marlene C Alcorn and Judith G. Rabkin and Douglas T . Dieterich}, journal={Journal of hepatology}, year={2012}, volume={56 2}, pages={503-4} }