{"id":2457,"date":"2012-02-10T06:45:38","date_gmt":"2012-02-10T11:45:38","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2457"},"modified":"2012-02-10T06:45:38","modified_gmt":"2012-02-10T11:45:38","slug":"boceprevir-pi-interaction-a-dear-doctor-letter-we-didnt-want-to-get","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/boceprevir-pi-interaction-a-dear-doctor-letter-we-didnt-want-to-get\/2012\/02\/10\/","title":{"rendered":"Boceprevir – PI Interaction: A “Dear Doctor” Letter We Didn’t Want To Get"},"content":{"rendered":"

By now I’m sure that most of you ID folks out there have received the following letter from Merck<\/a>, the makers of boceprevir:<\/p>\n

URGENT — IMPORTANT DRUG WARNING: VICTRELIS (BOCEPREVIR)<\/p>\n

The purpose of this communication is to inform you of recent pharmacokinetic study results evaluating drug interactions between VICTRELIS, an oral chronic hepatitis C virus (HCV) NS3\/4A protease inhibitor, and ritonavir-boosted human immunodeficiency virus (HIV) protease inhibitors … VICTRELIS reduced mean trough concentrations of ritonavir-boosted atazanavir, lopinavir, and darunavir by 49%, 43%, and 59%, respectively. Merck does not recommend the coadministration of VICTRELIS and ritonavir-boosted HIV protease inhibitors.<\/strong><\/p><\/blockquote>\n

Boceprevir levels were also substantially lowered by lopinavir\/r and darunavir\/r.<\/p>\n

Yes, we already knew that the telaprevir-boosted PI interactions were tricky. It’s basically atazanavir\/ritonavir, no other options.<\/p>\n

(Outside of the boosted PIs, you can use raltegravir or efavirenz with telaprevir, but the latter requires, 1125 mg three times\/day, upping the cost by 50%. Gasp<\/a>.)<\/p>\n

The reason this “Dear Doctor” letter was so disappointing was that boceprevir was supposed <\/em>to be easier in this regard. In this study presented at IDSA<\/a> of peg\/ribavirin + boceprevir for co-infected patients, all boosted PIs were allowed, only NNRTIs excluded.\u00a0But that study was small (n=64), and in hindsight perhaps the slower-than-expected HCV RNA reduction had a pharmacokinetic explanation.<\/p>\n

For now, the bottom line is that there really is no optimal HCV protease inhibitor for HIV\/HCV co-infected patients, especially for those on a boosted PI.<\/p>\n

And why careful assessment of those with HIV\/HCV is critical, as many patients are stable enough to wait for the next wave of HCV drugs.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By now I’m sure that most of you ID folks out there have received the following letter from Merck, the makers of boceprevir: URGENT — IMPORTANT DRUG WARNING: VICTRELIS (BOCEPREVIR) The purpose of this communication is to inform you of recent pharmacokinetic study results evaluating drug interactions between VICTRELIS, an oral chronic hepatitis C virus […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,8,10],"tags":[119,408,423,457,485,905],"class_list":["post-2457","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-patient-care","category-research","tag-boceprevir","tag-hcv","tag-hiv","tag-hivhcv-coinfection","tag-idsa","tag-telaprevir"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2457","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2457"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2457\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2457"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2457"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2457"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}