In this study, we retrospectively analyzed data from the pivotal boceprevir trials with two related aims: (1) to establish the earliest possible stopping rules for boceprevir therapy in treatment-naive and treatment-experienced patients and (2) to determine whether uniform stopping rules could be applied to both patient populations. The overarching goal was to formulate straightforward and practical criteria enabling the discontinuation of therapy as early as possible in the maximum proportion of patients destined to fail without the premature discontinuation

of treatment in patients who might still attain SVR. In large part, these previously unpublished analyses formed the basis for the buy Decitabine recommendations addressing the early discontinuation of boceprevir-based therapy due to futility that are included in the US and European Union product labels and are reflected in the updated guidelines from the American Association for the Study of Liver Diseases.7 HCV, hepatitis C virus; LLD, lower

limit of detection; LLQ, lower limit of quantification; P/R, pegintron alfa/ribavirin; RESPOND-2, Retreatment With HCV Serine Protease Inhibitor Boceprevir and Pegintron/Rebetol 2; SPRINT-2, Serine Protease Inhibitor Therapy 2; SVR, sustained virological response. Hypothesis-generating http://www.selleckchem.com/products/r428.html analyses were retrospectively performed with the SPRINT-2 and RESPOND-2 databases to determine whether early stopping rules based on the absolute HCV RNA level

or its decline from the baseline level could be identified for boceprevir-containing regimens in order to minimize the toxicities and costs associated with continuing ineffective treatment, ensure that very few (if any) patients would be deprived of SVR by premature discontinuation, prevent the emergence of resistant HCV variants in the face of ultimately futile therapy, and harmonize (and thereby simplify) stopping rules across patient populations. SPRINT-2 and RESPOND-2 were phase 3 randomized, placebo-controlled studies conducted with HCV genotype 1–infected treatment-naive and treatment-experienced selleck compound patients, respectively; they compared standard therapy with peginterferon alfa-2b and ribavirin to two treatment regimens that added boceprevir after an initial 4-week lead-in period with peginterferon/ribavirin alone (Supporting Figs. 1 and 2).11, 14 The protocols were approved by the appropriate review committees prior to the enrollment of any patients. Participants were assigned to a control P/R arm or one of two boceprevir-containing arms. In SPRINT-2, patients entered either a nonblack cohort or black cohort according to self-identified race. In RESPOND-2, patients were stratified by their previous response to P/R therapy into partial responder and relapser groups; null responders by history were excluded. Further details are presented in the supporting information.