Victrelis® 200 mg hard capsules
Each hard capsule contains 200 mg of boceprevir.
Excipient with known effect
Each capsule contains 56 mg of lactose monohydrate.
For the full list of excipients, see section 6.1.
Hard capsule.
Each capsule has a yellowish-brown, opaque cap with an "MSD" logo imprinted in red ink and off-white, opaque body with the code "314" imprinted in red ink.
Victrelis is indicated for the treatment of chronic hepatitis C (CHC) genotype 1 infection, in combination with peginterferon alfa and ribavirin, in adult patients with compensated liver disease who are previously untreated or who have failed previous therapy (see sections 4.4 and 5.1).
Treatment with Victrelis should be initiated and monitored by a physician experienced in the management of chronic hepatitis C.
Posology
Victrelis must be administered in combination with peginterferon alfa and ribavirin. The Summary of Product Characteristics of peginterferon alfa and ribavirin (PR) must be consulted prior to initiation of therapy with Victrelis.
The recommended dose of Victrelis is 800 mg administered orally three times daily (TID) with food (a meal or light snack). Maximum daily dose of Victrelis is 2,400 mg. Administration without food could be associated with a net loss of efficacy due to sub-optimal exposure.
Patients without cirrhosis who are previously untreated or who have failed previous therapy
The following dosing recommendations differ for some subgroups from the dosing studied in the Phase 3 trials (see section 5.1).
Table 1
Duration of therapy using Response-Guided Therapy (RGT) guidelines in patients without cirrhosis who are previously untreated or who have failed previous therapy to interferon and ribavirin therapy
|
Previously Untreated Patients
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ASSESSMENT*
(HCV-RNA Results†)
|
ACTION
|
|
At Treatment
Week 8
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At Treatment
Week 24
|
|
Undetectable
|
Undetectable
|
Treatment duration = 28 weeks
1. Administer peginterferon alfa and ribavirin for 4 weeks, and then
2. Continue with all three medicines (peginterferon alfa and ribavirin [PR] + Victrelis) and finish through Treatment Week 28 (TW 28).
|
|
Detectable
|
Undetectable
|
Treatment duration = 48 weeks‡
1. Administer peginterferon alfa and ribavirin for 4 weeks, and then
2. Continue with all three medicines (PR + Victrelis) and finish through TW 36; and then
3. Administer peginterferon alfa and ribavirin and finish through TW 48.
|
|
Patients Who have Failed Previous Therapy
|
Undetectable
|
Undetectable
|
Treatment duration = 48 weeks
1. Administer peginterferon alfa and ribavirin for 4 weeks, and then
2. Continue with all three medicines (PR + Victrelis) and finish through TW 36, and then
3. Administer peginterferon alfa and ribavirin and finish through TW 48.
|
|
Detectable
|
Undetectable
|
|
*Stopping rules
If the patient has hepatitis C virus ribonucleic acid (HCV-RNA) results greater than or equal to 1,000 IU/mL at TW 8; then discontinue three-medicine regimen.
If the patient has HCV-RNA results greater than or equal to 100 IU/mL at TW 12; then discontinue three-medicine regimen.
If the patient has confirmed, detectable HCV-RNA at TW 24; then discontinue three-medicine regimen.
† In clinical trials, HCV-RNA in plasma was measured with the Roche COBAS Taqman 2.0 assay with a limit of detection of 9.3 IU/mL and a limit of quantification of 25 IU/mL.
‡This regimen has only been tested in subjects who have failed previous therapy who were late responders (see section 5.1).
|
All cirrhotic patients and null responders
- Recommended treatment duration is 48 weeks: 4 weeks of bitherapy with peginterferon alfa+ ribavirin + 44 weeks of tritherapy with peginterferon alfa + ribavirin + Victrelis. (Refer to the stopping rule in Table 1 for all patients.)
o The duration of the tritherapy after the first 4 weeks of bitherapy should not be less than 32 weeks. Given the incremental risk of adverse events with Victrelis (anaemia notably); in case the patient cannot tolerate the treatment, consideration could be given to pursue with 12 weeks of bitherapy for the final 12 weeks of treatment instead of tritherapy (see sections 4.8 and 5.1). For additional information on use of Victrelis in patients with advanced liver disease, see section 4.4.
Poorly interferon-responsive patients
In poorly interferon responsive patients (defined as < 1-log10 decline in HCV-RNA at TW 4) the use of triple therapy should be considered on a case by case basis, as the likelihood of achieving sustained virologic response (SVR) with triple therapy is lower in these patients (see section 5.1).
Missed doses
If a patient misses a dose and it is less than 2 hours before the next dose is due, the missed dose should be skipped.
If a patient misses a dose and it is 2 or more hours before the next dose is due, the patient should take the missed dose with food and resume the normal dosing schedule.
Dose reduction
Dose reduction of Victrelis is not recommended.
If a patient has a serious adverse reaction potentially related to peginterferon alfa and/or ribavirin, the peginterferon alfa and/or ribavirin dose should be reduced. Refer to the Summary of Product Characteristics for peginterferon alfa and ribavirin for additional information about how to reduce and/or discontinue the peginterferon alfa and/or ribavirin dose. Victrelis must not be administered in the absence of peginterferon alfa and ribavirin.
Stopping rules
Discontinuation of therapy is recommended in all patients with 1) HCV-RNA levels of greater than or equal to 1,000 IU per mL at TW 8; or 2) HCV-RNA levels of greater than or equal to 100 IU per mL at TW 12; or 3) confirmed, detectable HCV-RNA levels at TW 24.
Special populations
Elderly
Clinical studies of boceprevir did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other clinical experience has not identified differences in responses between the older and younger patients (see section 5.2).
Renal impairment
No dose adjustment of Victrelis is required in patients with any degree of renal impairment (see section 5.2).
Hepatic impairment
No dose adjustment of Victrelis is required for patients with mild, moderate or severe hepatic impairment. Boceprevir has not been studied in patients with decompensated cirrhosis (see section 5.2). For additional information on use of Victrelis in patients with advanced liver disease, see section 4.4.
Paediatric population
The safety and efficacy of Victrelis in children aged below 18 years have not yet been established. No data are available.
Method of administration
To obtain the hard capsules the foil of the blister should be peeled off. Victrelis is to be taken orally with food (a meal or light snack).
• Hypersensitivity to the active substance or any of the excipients listed in section 6.1.
• Patients with autoimmune hepatitis.
• Co-administration with medicines that are highly dependent on CYP3A4/5 for clearance, and for which elevated plasma concentrations are associated with serious and/or life-threatening events such as orally administered midazolam and triazolam, bepridil, pimozide, lumefantrine, halofantrine, tyrosine kinase inhibitors, simvastatin, lovastatin, quetiapine, alfuzosin, silodosin, and ergot derivatives (dihydroergotamine, ergonovine, ergotamine, methylergonovine) (see section 4.5).
• Pregnancy (see section 4.6).
Refer to the Summary of Product Characteristics for peginterferon alfa and ribavirin for additional information.
Anaemia
The onset of anaemia has been reported with peginterferon alfa and ribavirin therapy by Treatment Week 4. The addition of boceprevir to peginterferon alfa and ribavirin is associated with an additional decrease in haemoglobin concentrations of approximately 1 g/dL by Treatment Week 8 compared to standard of care (see section 4.8). In clinical trials with the combination of Victrelis, peginterferon alfa-2b and ribavirin compared to peginterferon alfa-2b and ribavirin alone, the median time from the initiation of therapy to onset of haemoglobin less than 10 g/dL was similar (71 days with a range of 15-337 days, and 71 days with a range of 8-337 days, respectively). Complete blood counts (with white blood cell differential counts) should be obtained at pretreatment, and at Treatment Weeks 2, 4, 8, 12 and should be monitored closely at other time points, as clinically appropriate. If haemoglobin is < 10 g/dL (or < 6.2 mmol/L) management of anaemia may be warranted (see section 4.8).
Ribavirin dose reduction is the preferred strategy for managing treatment-emergent anaemia (see section 5.1). Refer to the Summary of Product Characteristics for ribavirin for information regarding dose reduction and/or discontinuation of ribavirin. If permanent discontinuation of ribavirin is required, then peginterferon alfa and Victrelis must also be discontinued.
In a study comparing the use of ribavirin dose reduction and erythropoesis stimulating agents in the management of treatment-emergent anaemia, the use of erythropoesis stimulating agents was associated with an increased risk of thromboembolic events (see section 5.1).
Neutropenia
The addition of boceprevir to peginterferon alfa–2b and ribavirin resulted in higher incidences of neutropenia and Grade 3-4 neutropenia compared with peginterferon alfa–2b and ribavirin alone (see section 4.8).
The frequency of severe or life threatening infections tends to be higher in boceprevir-containing arms than the control arm. Complete blood counts (with white blood cell differential counts) should be obtained at pretreatment, and at Treatment Weeks 2, 4, 8, 12, and should be monitored closely at other time points, as clinically appropriate. Decreases in neutrophil counts may require dose reduction of peginterferon alfa or discontinuation of therapy. If permanent discontinuation of peginterferon alfa is required, then ribavirin and Victrelis must also be discontinued. Prompt eva luation and treatment of infections is recommended.
Combined use with peginterferon alfa–2a as compared to alfa–2b:
As compared to the combination of boceprevir with peginterferon alfa–2b and ribavirin, the combination of boceprevir with peginterferon alfa–2a and ribavirin was associated with a higher rate of neutropenia (including grade 4 neutropenia) and a higher rate of infections.
Please refer to the Summary of Product Characteristics for peginterferon alfa.
Pancytopenia
Cases of pancytopenia have been reported in patients receiving Victrelis in combination with peginterferon alfa and ribavirin. Complete blood counts (with white blood cell differential counts) should be obtained at pretreatment, and at Treatment Weeks 2, 4, 8, and 12, and should be monitored closely at other time points, as clinically appropriate.
Hypersensitivity
Serious, acute hypersensitivity reactions (e.g., urticaria, angioedema) have been observed during combination therapy with Victrelis, peginterferon alfa, and ribavirin. If such reaction occurs, combination therapy should be discontinued and appropriate medical therapy immediately instituted (see section 4.3 and 4.8).
Patients with advanced
