Boceprevir: an oral protease inhibitor for the treatment of chronic HCV infection

Abstract

Chronic hepatitis C (CHC) virus infection affects more than 170 million people globally. The aim of treatment of CHC is to affect sustained elimination of the virus (a sustained virological response [SVR]). The success and duration of therapy with interferon is dependent on HCV genotype. The current standard of care comprises combined treatment with pegylated interferon and ribavirin. Rates of SVR in patients with genotype 1 infection, the least responsive group, are less than 50%. Boceprevir is a ketoamide protease inhibitor that binds reversibly to the HCV nonstructural NS3 protease active site inhibiting intracellular viral replication. Phase III clinical studies have demonstrated that, in combination with the current standard of care, boceprevir significantly increases the SVR rate in both treatment-naive and previously treated patients with genotype 1 CHC. Both the US FDA and EMA have approved boceprevir for the treatment of genotype 1 CHC: the first directly-acting antiviral drug to be licensed for this indication. This article will review the pharmacology and pharmacodynamics of boceprevir, the efficacy and safety of the drug, and explore possible future developments in the management of CHC.

Keywords::

• boceprevir
• hepatitis C
• pegylated interferon
• protease inhibitors
• ribavirin

Financial & competing interests disclosure

GM Dusheiko is on the advisory board, is involved in protocol development and acts as investigator in studies for Vertex, Abbott, Boehringer Ingelheim, Bristol Myers, Gilead Sciences, GlaxoSmithKline, Novartis, Pharmasett, Merck and Tibotec. He has also received consulting fees from Abbott, Boehringer Ingelheim, Bristol Myers, Gilead Sciences, GlaxoSmithKline, Human Genome Sciences, Novartis, Pharmasett, Pfizer, Roche/Genentech, Schering Plough/Merck and Tibotec. His institution has received funding for research studies from the above groups. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.