Wednesday, September 20, 2017

Glecaprevir/Pibrentasvir for HCV Genotype 3 Patients with Cirrhosis and/or Prior Treatment Experience

Hepatology. 2017 Sep 19. doi: 10.1002/hep.29541. 

Glecaprevir/Pibrentasvir for HCV Genotype 3 Patients with Cirrhosis and/or Prior Treatment Experience: A Partially Randomized Phase III Clinical Trial.
Wyles D1, Poordad F2, Wang S3, Alric L4, Felizarta F5, Kwo PY6, Maliakkal B7, Agarwal K8, Hassanein T9, Weilert F10, Lee SS11, Kort J3, Lovell SS3, Liu R3, Lin CW3, Pilot-Matias T3, Krishnan P3, Mensa FJ3.

Abstract
BACKGROUND:
This study assessed the efficacy and safety of ribavirin (RBV)-free coformulated glecaprevir/pibrentasvir (G/P) in patients with hepatitis C virus (HCV) genotype (GT) 3 infection with either prior treatment experience and/or compensated cirrhosis, a patient population with limited treatment options.

METHODS:
SURVEYOR-II, Part 3 was a partially-randomized, open-label, multicenter, phase 3 study. Treatment-experienced (prior interferon (IFN) or pegIFN ± ribavirin or SOF plus ribavirin ± pegIFN therapy) patients without cirrhosis were randomized 1:1 to receive 12 or 16 weeks of G/P (300 mg/120 mg) once daily. Treatment-naïve or treatment-experienced patients with compensated cirrhosis were treated with G/P for 12 or 16 weeks, respectively. The primary efficacy endpoint was the percentage of patients with sustained virologic response at post-treatment week 12 (SVR12). Safety was evaluated throughout the study.

RESULTS:
There were 131 patients enrolled and treated. Among treatment-experienced patients without cirrhosis, SVR12 was achieved by 91% (20/22; CI 72-97) and 95% (21/22; CI 78-99) of patients treated with G/P for 12 or 16 weeks, respectively. Among those with cirrhosis, SVR12 was achieved by 98% (39/40; CI 87-99) of treatment-naïve patients treated for 12 weeks, and 96% (45/47; CI 86-99) of patients with prior treatment experience treated for 16 weeks. No adverse events (AEs) led to discontinuation of study drug and no serious AEs were related to study drug.

CONCLUSIONS:
Patients with HCV GT3 infection with prior treatment experience and/or compensated cirrhosis achieved high SVR12 rates following 12 or 16 weeks of treatment with G/P. The regimen was well tolerated.

This article is protected by copyright. All rights reserved.
http://onlinelibrary.wiley.com/doi/10.1002/hep.29541/abstract
© 2017 by the American Association for the Study of Liver Diseases.

Tuesday, September 19, 2017

Blog Updates on Hepatitis - Inactivated Zoster Vaccine, Harvoni Cures Hep C patient & Opioids

Thanks for stopping by, here's your blog updates from around the web.

Harvoni Cures Hep C patient Brenda in Clinical Trial part 1
September 19, 2017
This week on Life Beyond Hep C we’re hearing Hep C patient Brenda’s courageous Hep C treatment fight and experience.
Continue reading....

All Swiss hepatitis C sufferers can access costly drugs like Harvoni
swissinfo.ch
All patients suffering from hepatitis C can be treated with the drugs Harvoni and Epclusa from next month, after the Federal Office of Public Health lifted ...

Opioid overdoses shorten US life expectancy by 2½ months
Opioid drugs -- including both legally prescribed painkillers such as oxycodone and hydrocodone, as well as illegal drugs such as heroin or illicit fentanyl -- are not only killing Americans, they are shortening their overall life spans. Opioids take about 2½ months off our lives, according to a new analysis published in the medical journal JAMA.

States expand investigation of opioid makers, distributors
Geoff Mulvihill, Associated Press - Houston Chronicle
Attorneys general from most states are broadening their investigation into the opioid industry as a nationwide overdose crisis continues to claim thousands of lives. They announced Tuesday that they had served subpoenas requesting information from five companies that make powerful prescription painkillers and demanded information from three distributors. Forty-one attorneys general are involved in various parts of the civil investigation.
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Addiction clinics need physician education, lifted restrictions to treat HCV
HCV Next - HEALIO - Meeting News
Opioid agonist therapy clinics represent an important conduit for people who inject drugs to receive information, screening and treatment for hepatitis C. Within these clinics, however, physicians and addiction specialists self-reported low competence regarding current HCV treatments. Additionally, policies that restrict treatment for current and recent drug users present an ongoing barrier.
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My 2 cents: College friend doing good work
Tom Blackwell - National Post 
Faced with a widow's legal challenge, Ontario will transplant livers into almost 100 alcoholic-liver-disease patients, as evidence suggests they do as well as others.

What parents should know about tattoos
Posted September 19, 2017,
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications
These days, tattoos are increasingly common. According to a 2015 Harris poll, three in 10 American adults have a tattoo — up from two in 10 in 2012. They are particularly popular in young people; among Millennials, nearly half have a tattoo. To help parents make this tough decision, the American Academy of Pediatrics (AAP) released a clinical report entitled “Adolescent and Young Adult Tattooing, Piercing, and Scarification.” Here are some highlights — and some points parents and teens really need to talk about.
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Fighting Hepatitis in Cambodia: Beginnings and Endings
Theresa Chan - Theresa is an MSF doctor, currently working at a hepatitis C clinic in Cambodia.
Beginnings and endings have been leaking into my to-do list as well. Right now I’m working on writing the MSF guidelines for treating hepatitis C, which will be the basis for the Cambodian national guidelines one day when our clinic is turned over to the Ministry of Health, so even as we are recovering from the busy beginning of this clinic, we are contemplating its end.
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Inactivated Zoster Vaccine Soon to Be Approved — Should Patients Wait for It?
Paul E. Sax, MD - Contributing Editor NEJM Journal Watch 
For the last year or so, conversations with patients about getting the zoster vaccine have gone something like this:
Patient: So should I get the shingles vaccine? I saw an ad for it on TV.
Me:  Well, yes … and no.
Patient (confused — he/she has never heard me say anything but an enthusiastic “Yes!” to vaccines):  What does that mean?
Me:  There’s a better shingles vaccine coming soon, likely within a year. So I’d wait.
Now it looks like that wait is almost over.
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Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?
Kristine Novak - Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology.
Reducing dietary fructose for as little as 9 days decreases liver fat, visceral fat, and de novo lipogenesis and increases insulin sensitivity, secretion, and clearance in children with obesity and metabolic syndrome, researchers report in the September issue of Gastroenterology. These findings support efforts to reduce sugar consumption.
Read more 

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use
SEPTEMBER 19, 2017
Gail Connor Roche - MD Magazine
Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.
Continue reading....

Adolescents With HCV Achieve 98% Cure Rate in Direct-Acting Antiviral Study
Gail Connor Roche - MD Magazine
Adolescents treated for hepatitis C achieved a 98% cure rate with a direct-acting antiviral drug (DAA) therapy, a study has found.
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HCV Drug Resistance: Infrequent, and Frequently Overcome
Kenneth Bender - MD Magazine
Hepatitis C virus (HCV) mutations that can resist drug treatment are infrequent, and are unlikely to withstand longer treatment durations or the addition of a synergistic drug, according to new analysis of resistance testing, treatment response and re-treatment interventions. Resistance testing does appear to Wyles and Luetkemeyer to be indicated, however, in patients with genotype 1a before treatment with elbasvir/grazoprevir (Zepatier, Merck), and should be considered prior to treatment with ledipasvir/sofosbuvir (Harvoni) for those with genotype 1a and cirrhosis or with prior NS5A treatment failure...
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Hepatitis A: frequently asked questions
Paul Sisson Contact Reporter The San Diego Union-Tribune
In an effort to combat a deadly hepatitis A outbreak, San Diego will begin washing streets in ...
Q: If I've had hepatitis B or hepatitis C am I immune to hepatitis A?
Continuer reading.....

Cannabis in Gastroenterology: Physicians Lack Answers as Patient Interest Peaks
Healio Gastroenterology, September 2017
Despite a lack of high quality evidence due to federal regulations on research, many state medical marijuana programs have designated GI conditions like severe nausea, inflammatory bowel disease (IBD) and hepatitis C as qualifying conditions, and studies show that many patients are self-medicating with marijuana. Experts agreed physicians should equip themselves to explain the known risks and benefits to inquiring patients, and understand the legal frameworks of their state medical marijuana programs.
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On Twitter
Tweeted By Don Crocock, Follow here--->  @dcrocock   
Rationale for cannabis-based interventions in the opioid overdose crisis
Harm Reduction Journal https://doi.org/10.1186/s12954-017-0183-9
The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to consider the implementation and assessment of cannabis-based interventions in the opioid crisis.
Continue reading...

Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?

Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?
Kristine Novak
Reducing dietary fructose for as little as 9 days decreases liver fat, visceral fat, and de novo lipogenesis and increases insulin sensitivity, secretion, and clearance in children with obesity and metabolic syndrome, researchers report in the September issue of Gastroenterology. These findings support efforts to reduce sugar consumption. Consumption of sugar

Read more

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use
SEPTEMBER 19, 2017
Gail Connor Roche

Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.
          
But the authors conclude that treatment rates should improve in the interferon-free era, although the costs of DAA therapy could limit participation.
          
“The number of patients eligible for treatment will increase significantly as DAA therapies are recommended now in patients with decompensated cirrhosis,” Philip Vutien, MD, one of the study’s authors from Stanford University Medical Center, Palo Alto, California, said. “In addition, as DAA therapies are much better tolerated, we would expect patients and their providers to be much more willing to initiate treatment.”

Thyroid function starting at age 50 tied to life expectancy

Thyroid function starting at age 50 tied to life expectancy
Last Updated: 2017-09-18
By Anne Harding

NEW YORK (Reuters Health) - Low-normal thyroid function is associated with longer life expectancy in middle-aged people, according to data from The Rotterdam Study.

"At age 50, people with low-normal thyroid function live up to 3.5 years longer than those with high-normal thyroid function. Also, people with low-normal thyroid function live a longer life without cardiovascular disease (CVD) than those with high-normal thyroid function," Dr. Arjola Bano of Erasmus Medical Center in Rotterdam, the Netherlands, told Reuters Health by email.

The Rotterdam Study previously found that low-normal thyroid function was associated with an increased risk of diabetes or non-alcoholic fatty liver disease, while high-normal thyroid function was linked to an increased risk of atrial fibrillation or dementia, Dr. Bano noted. "The challenge for future research will be to integrate the associated risk of relevant adverse outcomes, in order to eventually define the clinically relevant normal ranges of thyroid function," she said.

Read the article, here...

Abstract
JAMA Intern Med 2017.

Monday, September 18, 2017

Costly drugs to weigh on U.S. employers' expenses in 2018: survey

Costly drugs to weigh on U.S. employers' expenses in 2018: survey
(Reuters) - U.S. employers are bracing for higher health care expenses in 2018 as spending on new drugs to treat diseases such as cancer, multiple sclerosis and hepatitis C is expected to rise more than 7 percent, according to consultancy firm Mercer.
Between 40 and 50 new specialty drugs are set to hit the market each year in the next five years, which could increase costs by $25 billion annually, Mercer said.

Sunday, September 17, 2017

Coverage OncLive - 2017 International Liver Cancer Association Annual Conference

Conference Website
2017 International Liver Cancer Association Annual Conference
September 15 - 17
Seoul, South Korea

Conference Coverage Available Online At OncLive 
http://www.onclive.com/conference-coverage/ilca-2017

Conference Multimedia
http://www.onclive.com/conference-videos/ilca-2017

Highlights
Study Shows DAAs Are Not Associated With Increased HCC Recurrence Risk
Angelica Welch
Published Online: Monday, Sep 18, 2017
Direct acting antivirals (DAA) are a novel and completely oral hepatitis C therapy that is associated with a high response rate. DAAs are used in most patients being treated for hepatitis C, including those with decompensated cirrhosis.

This type of treatment has now completely replaced interferon-based therapy for patients with hepatitis C, a therapy which was also associated with a decrease in hepatocellular carcinoma (HCC) incidence in 40% to 50% of patients.

Danielle Bucco
Published Online: Friday, Sep 15, 2017
“[At ILCA] we not only cover all of the clinical disciplines involved in the management of liver cancer but the presentations at this meeting include surgical oncology, transplant surgery, hepatology, interventional radiology, pathology, as well as medical oncology,” explained Richard Finn, MD, an associate professor of medicine at David Geffen School of Medicine at University of California, Los Angeles. “One of the most important things the audience will take away from the meeting is the latest data in not only systemic treatments, but also the role of treating hepatitis C in the setting of advanced and early-stage liver cancer. They will go home with some practice-changing observations.”

Danielle Bucco
Published Online: Saturday, Sep 16, 2017
Hepatocyte pERK-positive immunostaining and microvascular invasion were independent prognostic factors of recurrence-free survival (RFS) for patients with hepatocellular carcinoma (HCC) treated with adjuvant sorafenib (Nexavar); however, a predictive biomarker for recurrence was not uncovered, according to an analysis of the phase III STORM study presented at the 11th International Liver Cancer Association Annual Conference

Precision Screening May Improve Surveillance in HCC
Angelica Welch
Published Online: Saturday, Sep 16, 2017
“The highest rates of HCC are in east Asia and Africa, primarily driven by high rates of hepatitis B in those areas. While the incidence of HCC is lower in the United States and Europe, it is gaining a lot of attention because HCC has the largest increasing incidence among all solid tumors over the past 10 years as assessed by SEER,” said Singal, medical director of the Liver Tumor Program at UT Southwestern Medical Center. “Some projections have HCC becoming a top 5 cause of cancer-related death over the next decade in the United States. One of the key ways to curb this increased mortality is to increase rates of early tumor detection and curative treatment.”

Begin here..........

International Liver Cancer Association (ILCA) 
Patient information
What is liver cancer?
Liver cancer is defined by an abnormal and uncontrolled growth of cells within the liver. These altered cells progressively substitute the normal cells, collapsing the normal function of the liver, and invading other organs. These events irremediably lead to the death of the patients affected from this disease. We should distinguish liver cancer from benign tumors, that are also the result of an altered cellular growth, but they lack the invasiveness capacities of the malignant tumors (cancer). Therefore, the prognosis of benign tumors is excellent and in the majority of cases there is no need of treating them.
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