Boceprevir in the treatment of hepatitis C infection: rationale and clinical data

Author(s): Omer Khalid ,Bruce R Bacon

An estimated 1.8% of the population in the USA is infected with the hepatitis C virus (HCV). The standard of care treatment for HCV consists of pegIFN and ribavirin. Genotype is considered a strong predictor determining response rates to treatment. Patients infected with genotype 1 are more resistant to treatment with an estimated response rate of approximately 40–50%. The recent discovery of polymorphisms in the IL28-B gene has given new insight into response rates and is now being considered the strongest pretreatment predictor of response. Recent insights into the HCV lifecycle and structure have led to the development of drugs that inhibit the NS3 protease in the HCV virus molecule, thereby preventing viral replication and increased degradation, and thus increasing chances of achieving a sustained viral response to therapy. Two drugs – boceprevir and telaprevir – have recently been approved by the US FDA and have been shown to have increased efficacy for genotype 1 patients, increasing the sustained virologic response rates to 75%. These drugs will be the biggest advance in the field since the introduction of pegIFN and ribavirin.