A Multivariate Analysis of the Self-Determination of Adolescents

Self-determination, Quality of life, Self-efficacy, Adolescents, Assertiveness,

Effectiveness of Telaprevir and Boceprevir Triple Therapy for Patients with Hepatitis C Virus Infection in a Large Integrated Care Setting

BACKGROUND: In 2011, the FDA approved telaprevir (TVR) and boceprevir (BOC) for use with pegylated-interferon and ribavirin to treat hepatitis C virus (HCV) genotype 1. We aimed to evaluate the real-world application, tolerability, and effectiveness of TVR and BOC-based HCV treatment in a large integrated care setting. METHODS: We utilized Northern California Kaiser Permanente Medical Care Program (KPNC) electronic databases and medical records to study the experience of all KPNC patients who initiated TVR or BOC from June 2011-March 2012. RESULTS: Compared to the pool of 5,194 treatment-eligible patients, the 352 treatment initiators were more likely to be cirrhotic (24% vs 10%, p<0.001) and treatment-experienced (44% vs 22%, p<0.001). Among the treatment initiators, 211 received TVR and 141 BOC. Overall, 31% discontinued treatment prematurely; 16% of patients stopped treatment early because of side effects. One patient with cirrhosis died of sepsis during treatment. Premature discontinuation was highest among TVR-treated cirrhotic patients (58%). Sustained virologic response (SVR) was achieved in 55% overall and was similar comparing the TVR- (56%) and BOC- (53%) treated groups. The only independent predictors of treatment failure were cirrhosis at baseline [odds ratio (OR) for SVR 0.44, p=0.004] and prior partial or null response (OR for SVR 0.57, p=0.02). CONCLUSIONS: In the initial application of TVR and BOC, patients with cirrhosis and prior treatment failure were prioritized for treatment. In this real-world experience, most patients successfully completed a full treatment course. However, side effect-related premature discontinuations were common, and SVR rates were lower than reported in clinical trials