Background The new protease inhibitors (PI) boceprevir and telaprevir have demonstrated improved outcomes in hepatitis C virus (HCV)-infected patients in combination with peginterferon and ribavirin. Both are substrates for and inhibitors of the drug transporter P-glycoprotein and the cytochrome P450 enzyme 3A4 and are, therefore, prone to clinically relevant drug interactions.
Purpose To identify potential drug interactions (PDIs) between PI (telaprevir and boceprevir) and the home medicines of hepatitis C patients treated with triple therapy (telaprevir, ribavirin and peginterferon), classify them according to the severity and analyse the therapeutic groups (ATC classification) most frequently involved.
Material and methods Prospective observational study performed from September 2012 to September 2013 of all patients treated with PI and home medicines. The following variables were recorded for each patient: sex, age, home drug treatment and PDIs. An online literature research was performed about PI interactions (PubMed/Medline), and interactions were classified according to the risk as Lexi-Interact Online classification: B (no action needed), C (monitor therapy), D (consider changing the treatment) and X (avoid combination).
Results Thirty-five patients were included (62.9% men). Median age 54 years [37–69]. The median number of drugs taken at home was 5 [1–10]. A total of 48 PDIs were detected (mean of PDIs of 1.37 per patient). 8.3% of PDIs were classified as risk B, 31.3% C, 58.3% D and 2.1% X. Therapeutic groups most frequently involved were: psycholeptics (22.9%), psychoanaleptics (8.3%), drugs for functional gastrointestinal disorders (8.3%), analgesics (8.3%), beta blocking agents (8.3%) and corticosteroids (8.3%).
Conclusion The incidence of PDIs was very high. In most of the interactions detected it was necessary to consider changing the treatment. Therefore, it would be advisable to monitor strictly chronic treatment of patients treated with telaprevir and boceprevir, to identify and assess the severity of the interactions.
References and/or Acknowledgements
Talavera Pons S, Lamblin G. et al. Drug interactions and protease inhibitors used in the treatment of hepatitis C: how to manage? Eur J Clin Pharmacol 2014; 70(7):775–89. doi: 10.1007/s00228-014-1679-9
References and/or AcknowledgementsNo conflict of interest.
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