Efficacy of telaprevir and boceprevir in treatment-naïve and treatment-experienced genotype 1 chronic hepatitis C patients: an indirect comparison using Bayesian network meta-analysis

Abstract

Background and aims:

To indirectly compare the efficacy of telaprevir (TVR) and boceprevir (BOC) combined with peginterferon/ribavirin α-2a/2b (PR) in achieving sustained viral response (SVR) in treatment-naïve and treatment-experienced patients with genotype 1 chronic hepatitis C virus (HCV) infection.

Methods:

A systematic literature review was conducted to identify randomized controlled trials reporting the efficacy of PR-based treatment in genotype 1 chronic HCV patients. A Bayesian network meta-analysis was performed on the endpoint of SVR, assuming fixed study effects. For treatment-experienced patients, only previous relapsers and partial responders were included, as no results in prior null responders were available for boceprevir.

Results:

Eleven publications were included. In treatment-naïve patients, the odds ratios (OR) (posterior median [95% credible interval]) for telaprevir (12 weeks + response guided treatment [RGT] 24/48 weeks PR) and boceprevir (24 weeks + RGT 28/48 weeks PR) versus PR were respectively 3.80 (2.78–5.22) and 2.99 (2.23–4.01). The OR for telaprevir versus boceprevir was 1.42 (0.89–2.25), with a probability for telaprevir being more effective (P[OR > 1]) of 0.93. In treatment-experienced patients, the OR of telaprevir (12 weeks + 48 weeks PR) and boceprevir (32 weeks + RGT 36/48 weeks PR) versus PR were respectively 13.11 (7.30–24.43) and 5.36 (2.90–10.30). The OR for telaprevir versus boceprevir was 2.45 (1.02–5.80), with telaprevir having a probability of 0.98 of being more effective.

Limitations:

The main limitation of this study is the low number of trials included in the analysis, especially for the treatment-experienced patient population, which only allowed random-effect models to be explored. We tried to identify potential biases due to study heterogeneity.

Conclusions:

In the absence of direct comparative head-to-head studies between telaprevir and boceprevir for the treatment of chronic HCV genotype 1 patients, an indirect comparison based on Bayesian network meta-analysis suggests better efficacy for telaprevir than boceprevir in both treatment-naïve and treatment-experienced patients.

Key words::

• Bayesian
• Boceprevir
• Chronic hepatitis C
• Indirect comparison
• Network meta-analysis
• Telaprevir

Transparency

Declaration of funding

This study has been funded by Janssen. No restrictions have been placed on the design or results of the analysis. The authors take full responsibility for the contents of the manuscript. S.C., J.D. and S.G. conceived the study. S.C., F.B. and E.J. carried out the literature search and data extraction. S.C. and J.D. performed the statistical analyses and wrote the manuscript. S.G. and F.B. reviewed the manuscript. All authors read and approved the final manuscript.

Declaration of financial/other relationships

S.C., F.B. and E.J. have disclosed that they are employees of OptumInsight, Uxbridge, UK, a company that received funding from Janssen to conduct this study. J.D. and S.G. have disclosed that they are employees and shareholders of Johnson & Johnson. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

A poster of this material was presented at the International Society for Pharmacoeconomics and Outcome Research meeting in November 2011 in Madrid.