Boceprevir: interaction with HIV protease inhibitors highlighted

The European Medicines Agency (EMA) has recommended that patients receiving concomitant therapy with the hepatitis C protease inhibitor boceprevir (Victrelis) and HIV protease inhibitors be reviewed for potential virologic rebound, following reports of a pharmacokinetic interaction.

Victrelis was the first protease inhibitor to be launched in the UK for hepatitis C
Victrelis was the first protease inhibitor to be launched in the UK for hepatitis C

Pharmacokinetic study

A study in 39 healthy volunteers showed that blood levels of three ritonavir-boosted protease inhibitors (darunavir, lopinavir and atazanavir) were markedly reduced when given with boceprevir. In addition, levels of boceprevir were reduced when given with ritonavir-boosted darunavir or lopinavir, although this effect was not seen with ritonavir–atazanavir.

Recommendations

The EMA states that co-administration of boceprevir with ritonavir-boosted darunavir or lopinavir is not recommended. Co-administration of atazanavir–ritonavir with boceprevir may be considered on a case-by-case basis in patients with suppressed HIV viral loads and without any suspected resistance to the HIV regimen. Increased clinical and laboratory monitoring is recommended in this situation.

Licensed indication

Victrelis is indicated for the treatment of chronic hepatitis C genotype 1, in combination with peginterferon alfa and ribavirin. The safety and efficacy of Victrelis in HIV co-infected patients has not been established.

View Victrelis drug record

Further information: Merck Sharp & Dohme Ltd

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