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Protease Inhibitors for Recurrent Hepatitis C after Liver Transplantation-When Less is More

Sandeep Mukherjee

The approval of boceprevir and telaprevir, two protease inhibitors for hepatitis C (HCV) treatment earlier this year, was met with virtually universal optimism as the addition of these medications will lead to a significantly improved chance of viral eradication in HCV genotype 1 patients. However, this enthusiasm is yet to be embraced by the liver transplant community primarily due to the interaction between protease inhibitors and calcineurin inhibitors such as cyclosporine and tacrolimus. Boceprevir and telaprevir inhibit cytochrome P450 3A which metabolizes cyclosporine and tacrolimus leading to elevated and potentially lethal levels of these calcineurin inhibitors.