A network meta-analysis to compare simeprevir with boceprevir and telaprevir in combination with peginterferon-α and ribavirin in patients infected with genotype 1 Hepatitis C virus

Abstract

Objective:

To conduct a network meta-analysis (NMA) to assess the relative efficacy and safety of simeprevir, a second generation oral protease inhibitor (PI), compared to telaprevir and boceprevir in combination with pegylated interferon-α and ribavirin (PR) in patients with chronic hepatitis C.

Methods:

A systematic literature review and NMA of randomized controlled trials involving anti-virals added to PR were conducted. Electronic database searches and hand searches were conducted to identify relevant publications. Outcomes of interest included sustained virologic response (SVR), incidence of adverse events (AEs), and discontinuation due to AEs. Networks were based on treatment-, dose-, and duration-specific nodes. Sub-group analyses were conducted to investigate heterogeneity, based on Metavir scores, sub-genotypes 1a/1b, and prior response.

Results:

A total of 15 publications were considered for the base case of the meta-analysis. Simeprevir was associated with higher SVR rates than PR alone. Compared to telaprevir and boceprevir, SVR rates tended to be higher for simeprevir, with odds ratios ranging from 1.27 [0.81–2.00] to 2.61 [1.44–4.74] in treatment-naïve and from 1.04 [0.78–1.38] to 1.74 [0.84–3.61] in treatment-experienced patients, respectively. In terms of safety, the risks of anemia and discontinuations due to AEs were lower for simeprevir compared to PR alone, telaprevir, and boceprevir. The risk of rash was lower for simeprevir compared to telaprevir, and similar compared to PR alone and boceprevir.

Conclusion:

This NMA in genotype 1 HCV patients suggests a similar or better efficacy and tolerability profile for simeprevir compared to telaprevir and boceprevir.

Keywords::

• Simeprevir
• Network meta-analysis
• Hepatitis C virus
• Genotype 1
• Protease inhibitors
• Treatment

Transparency

Declaration of funding

This work was supported by Janssen Pharmaceutica NV, Beerse, Belgium.

Declaration of financial/other relationships

VT, MPa, SH, and SP are employees of Amaris, consultancy company, which conducted the analysis for Janssen Pharmaceutica. SVS, MPi, and AM are employees of Janssen Pharmaceutica. AU has received speaker and advisory fees from Janssen, Gilead, Abbvie, MSD and BMS. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to thank Professor Keith Abrams for his technical advice, Urbano Sbarigia, MSc, for his contribution to the objectives and design of this study, and Dr Jonathan Belsey and Katie Pascoe, PhD, for critical review of earlier drafts of the NMA report.