Latest documents http://publikationen.ub.uni-frankfurt.de/index/index/ Tue, 28 Aug 2012 12:59:41 +0200 Tue, 28 Aug 2012 12:59:41 +0200 http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/24292 Background: In patients with genotype 1 chronic hepatitis C infection, telaprevir (TVR) in combination with peginterferon and ribavirin (PR) significantly increased sustained virologic response (SVR) rates compared with PR alone. However, genotypic changes could be observed in TVR-treated patients who did not achieve an SVR. Methods: Population sequence analysis of the NS3•4A region was performed in patients who did not achieve SVR with TVR-based treatment. Results: Resistant variants were observed after treatment with a telaprevir-based regimen in 12% of treatment-naïve patients (ADVANCE; T12PR arm), 6% of prior relapsers, 24% of prior partial responders, and 51% of prior null responder patients (REALIZE, T12PR48 arms). NS3 protease variants V36M, R155K, and V36M+R155K emerged frequently in patients with genotype 1a and V36A, T54A, and A156S/T in patients with genotype 1b. Lower-level resistance to telaprevir was conferred by V36A/M, T54A/S, R155K/T, and A156S variants; and higher-level resistance to telaprevir was conferred by A156T and V36M+R155K variants. Virologic failure during telaprevir treatment was more common in patients with genotype 1a and in prior PR nonresponder patients and was associated with higher-level telaprevir-resistant variants. Relapse was usually associated with wild-type or lower-level resistant variants. After treatment, viral populations were wild-type with a median time of 10 months for genotype 1a and 3 weeks for genotype 1b patients. Conclusions: A consistent, subtype-dependent resistance profile was observed in patients who did not achieve an SVR with telaprevir-based treatment. The primary role of TVR is to inhibit wild-type virus and variants with lower-levels of resistance to telaprevir. The complementary role of PR is to clear any remaining telaprevir-resistant variants, especially higher-level telaprevir-resistant variants. Resistant variants are detectable in most patients who fail to achieve SVR, but their levels decline over time after treatment. Tara L. Kieffer; Sandra De Meyer; Doug J. Bartels; James C. Sullivan; Eileen Z. Zhang; Ann Tigges; Inge Dierynck; Joan Spanks; Jennifer Dorrian; Min Jiang; Bambang Adiwijaya; Anne Ghys; Maria Beumont; Robert S. Kauffman; Nathalie Adda; Ira M. Jacobson; Kenneth E. Sherman; Stefan Zeuzem; Ann D. Kwong; Gaston Picchio article http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/24292 Tue, 28 Aug 2012 12:59:41 +0200