Boceprevir and telaprevir for the treatment of chronic hepatitis C genotype 1 infection: an indirect comparison meta-analysis

Curtis L Cooper¹, Eric Druyts², Kristian Thorlund³, Jean B Nachega⁴, Antoine C El Khoury⁵, Christopher O'Regan⁶, Edward J Mills^2,3
1Division of Infectious Diseases, Faculty of Medicine, ²Faculty of Health Sciences, University of Ottawa, Ottawa, ³Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; ⁴Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, ⁵Merck and Co, Inc, Whitehouse Station, NJ, ⁶Merck Sharp and Dohme Ltd, Hoddesdon, Hertfordshire, United Kingdom

Background: The aim of this study was to examine the relative efficacy and safety of boceprevir and telaprevir, when used in combination with pegylated interferon alpha and ribavirin, using an indirect comparison meta-analysis.
Methods: Published phase II and phase III randomized placebo-controlled trials examining the efficacy of boceprevir and telaprevir in chronic hepatitis C virus genotype 1 infected adult populations were included. The primary outcomes were sustained virologic response, relapse, and discontinuation of all study drugs. Secondary outcomes included the adverse events of anemia, neutropenia, rash, and pruritus.
Results: Four boceprevir trials and six telaprevir trials were included. No significant differences were observed for sustained virologic response among either naïve (relative risk [RR] 1.14, 95% confidence interval [CI] 0.93–1.37, P = 0.20) or experienced patients (RR 0.81, 95% CI 0.52–1.23, P = 0.30). Similarly, for relapse among naïve (RR 0.80, 95% CI 0.18–3.45, P = 0.77) and experienced patients (RR 1.71, 95% CI 0.90–3.24, P = 0.10), or discontinuation of therapy for naïve (RR 0.80, 95% CI 0.28–2.29, P = 0.72) and experienced patients (RR 0.88, 95% CI 0.69–1.12, P = 0.30). Telaprevir was more likely to be associated with rash and pruritus, and boceprevir was more likely to be associated with neutropenia in certain patient populations.
Conclusion: Boceprevir and telaprevir appear comparable in terms of sustained virologic response, relapse, or discontinuation of therapy for patients treated with standard-dose therapy durations and response-guided therapy durations.

Keywords: direct-acting antivirals, boceprevir, telaprevir, hepatitis C, meta-analysis