Selecting a Treatment Regimen For Treatment-Experienced Patients
ÎRe-treatment with boceprevir or telaprevir, together with PegIFN alfa and weight-based RBV, can be recommended for patients who had virological relapse or were partial responders after a prior course of treatment with standard interferon alfa or PegIFN alfa and/or RBV (I-A).
ÎRe-treatment with telaprevir, together with PegIFN alfa and weight-based RBV, may be considered for prior null responders to a course of standard interferon alfa or PegIFN alfa and/or weight-based RBV (IIb-B).
ÎConsider response-guided therapy of treatment-experienced patients using either a boceprevir- or telaprevir-based regimen for relapsers (IIa-B for boceprevir, IIb-C for telaprevir) for partial responders (IIb-B for boceprevir, III-C for telaprevir), but
ÎWithdraw from all therapy patients re-treated with boceprevir plus PegIFN alfa and RBV who continue to have detectable HCV RNA > 100 IU/mL at week 12 because of the high likelihood of developing antiviral resistance (I-B).
ÎWithdraw from all therapy patients re-treated with telaprevir plus PegIFN alfa and RBV who continue to have detectable HCV RNA > 1000 IU/mL at weeks 4 or 12 because of the high likelihood of developing antiviral resistance (I-B).
Genotype 2 or Genotype 3 HCV Infection
ÎTreatment with PegIFN plus RBV should be administered for 24 weeks, using a RBV dose of 800 mg (I-A).
ÎPatients whose treatment continues through 24 weeks and whose measurement of HCV RNA with a highly sensitive assay is negative should be retested for HCV RNA 24 weeks later to evaluate for an SVR (I-A).
ÎPatients with HCV-related cirrhosis who achieve an SVR, regardless of the genotype, should continue to be monitored at 6 to 12 month intervals for the development of HCC (IIa-C).
Genotypes 4 HCV Infection
ÎTreatment with PegIFN plus RBV should be planned for 48 weeks; the dose for PegIFN alfa-2a is 180 mcg subcutaneously per week together with RBV using doses of 1000 mg for those ≤ 75 kg in weight and 1200 mg for those > 75 kg. The dose for PegIFN alfa-2b is 1.5 mcg/kg subcutaneously per week together with RBV using doses of 800 mg for those weighing < 65 kg, 1000 mg for those weighing > 65 kg to 85 kg, 1200 mg for > 85 kg to 105 kg, and 1400 mg for > 105 kg (I-A).
for null responders (III-C).
4
N
OT
