To the Editor,
A newly used drug group of protease inhibitors (telaprevir [INCIVEK] and boceprevir [Victrelis]) increases the response rate in chronic hepatitis due to Hepatitis C (Pearlman, 2012). Nevertheless, untoward effects of those drugs, extensive drug interactions, and high pill burden that decreases patient compliance are emerging issues to be solved by practitioners. Dietary modifications such as fat content is another factor that increases bioavailability of telaprevir and subsequent response rates (Incivek [telaprevir] package insert, 2011).
In our clinic in 2012, three patients took triple therapy with telaprevir (Sarikaya, Dog[spacing breve]an, Ergul, & Filik, 2013). All three patients were observed as outpatients according to general guides for telaprevir; however, we faced several problems. One patient had severe anemia (hemoglobin: 3 g/dl), but she did not reach us in a timely manner because of geographical problems. She has completed therapy and is in sustained remission. One patient had relatively low social and economic resources and therefore did not attain an optimal dietary fat or drug adherence. Her 12th-week HCV RNA level was high and she was considered to be nonresponsive. The follow-up of the third patient was relatively uneventful.
In 2013, we gave triple therapy with telaprevir to four patients. We hospitalized the patients until they learned how to adhere to the drug or diet. The patients were allowed to stay at home during night or weekends if they wanted. We followed anemia and skin rash closely. One of these patients started to suffer from several hemorrhoidal bleeding due to telaprevir but was managed effectively. All of them showed response to triple therapy.
We propose inpatient care for patients who are candidates for triple therapy with telaprevir. The hospitalization, however, should not be strict and was explained well to patients. Inpatient care facilitates the teamwork of the physician, pharmacist, nurse, and dietitian so that optimal sustained response rates can be attained.
Sincerely,
Bilal Ergul, MD
Murat Sarikaya, MD
Zeynal Dog[spacing breve]an, MD
Levent Filik, MD
Department of Gastroenterology
Ankara Education and Research Hospital
Ankara, Turkey
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