Adverse Skin Reactions during Triple Therapy with Boceprevir in Chronic Hepatitis C Genotype 1

Boceprevir is a first generation serin protease NS3/4A inhibitor, formally available in Italy from 2013 and often used for the treatment of CHC genotype 1, always in combination with pegylated interferon and ribavirin; known as the triple therapy. The main advantages of using boceprevir are the higher SVR percentage and shorter treatment time; 28 weeks if eRVR-extended rapid virological response is reported in some categories of patients, principally naives with intermediated stage of fibrosis, comparing to those treated with dual therapy. Then, the lead-in, a phase using only peg-interferon and ribavirin for 4 weeks prior adding boceprevir, helps the clinician to understand the utility of triple therapy in some patients who are difficult to treat, such as null responders to previous dual therapy or poor responders to interferon. Unfortunately, some side effects frequently occur during therapy with boceprevir. Apart from anaemia, dysgeusia and neutropenia, adverse skin reactions are also reported, although these dermatological side effects are less distinctive from those presented during treatment with telaprevir. So we described our case reports with cutaneous toxicity of various severity in two different types of patients naive low fibrosis and previous null responder to the dual therapy with high fibrosis, treated with boceprevir. In fact, even if interferon free strategy and triple therapy with new second generation DAAs are becoming more prevalent, boceprevir and telaprevir with their positive and negative features represented the first step to revolutionizing the treatment of HCV-related chronic liver disease genotype 1.