Therapy for HCV is in the midst of transition once again, almost as if triple therapy with peginterferon/ribavirin/telaprevir(boceprevir) is becoming obsolete. We are now well into phase 2 studies with triple and quadruple all-oral therapy and seeing tremendous results; SVR rates are >80% across the board.
Fortunately, it also appears that the most common side effects that plague the current triple therapy regimen (ie. anemia, rash) are not a part of these newer protocols. Whereas anemia is occuring >50% of the time with triple therapy, necessitating ribavirin dose reduction, transfusion or epogen administration, this is no longer an expected side effect. And, of course, without the need for peginterferon, side effects like depression, flu-like symptoms, and autoimmunity are obviated.
The timeline for approval of these new regimens may be as little as 1.5 to two years away from being FDA approved. For this reason, most patients with early, or even F3 disease should be given the opportunity to wait for approval of this therapy. As a side note, we also learned that difficult to treat populations, like those on dialysis or with HIV co-infection, are doing remarkably well on the current triple therapy. It is an exciting time for hepatologists and HCV patients alike.