The Health Benefits Of Coffee
More evidence coffee may slow liver disease
Last Updated: 2010-11-03 17:30:03 -0400 (Reuters Health)
"There's definitely a relationship, we don't know exactly what it is yet," between coffee and fibrosis, Dr. Harrison said. He called the findings "provocative" and "hypothesis-generating," noting that a prospective interventional study would be needed to determine a causal relationship. "
By Anne Harding
NEW YORK (Reuters Health) - Drinking coffee could help slow the progression of fibrosis in patients with fatty liver disease, according to new research presented at the American Association for the Study of Liver Diseases' annual meeting in Boston.
And a separate study presented at the same meeting found that patients with chronic hepatitis C who drank the most coffee and had failed standard treatment fared much better with retreatment.
Since the early 1990s, several studies have suggested benefits of coffee drinking for liver health, Dr. Jeffrey W. Molloy and Dr. Stephen A. Harrison and their colleagues at Brooke Army Medical Center in San Antonio, Texas, note in their report. In 2009, Dr. Harrison noted in an interview, two studies showed drinking about 2.5 cups of coffee daily reduced the risk of hepatic steatosis in patients with hepatitis C.
For the current study, the Texas researchers used a group of asymptomatic individuals whom they had initially screened for liver disease with ultrasound, giving them a "nice clean cohort of patients" with no liver disease who served as controls, Dr. Harrison told Reuters Health. Patients with ultrasound tests suggesting fatty liver disease underwent percutaneous liver biopsies.
Their analysis included 177 controls, 89 patients with simple steatosis, 31 patients with nonalcoholic steatohepatitis (NASH) and stage 0-1 fibrosis, and nine patients with NASH and stage 2-4 fibrosis.
Among the NASH patients, the researchers found, those with less severe disease drank significantly more coffee than those with more severe fibrosis. The patients with NASH stage 0-1 fibrosis consumed an average of 413 mg of caffeine and 312 mg of coffee, compared to 189 mg of caffeine (p=0.035) and 79 mg of coffee (p=0.03) for the NASH stage 2-4 fibrosis patients.
The 75th quartile for daily coffee consumption was 343 mg, or about 2.5 cups, the researchers found. Ten percent of patients who consumed this much coffee had NASH stage 2-4 disease, compared to roughly half of the patients who didn't drink coffee at all. Logistic regression analysis showed that the risk of severe fibrosis declined as caffeine and coffee consumption rose (p=0.023 for both).
"There's definitely a relationship, we don't know exactly what it is yet," between coffee and fibrosis, Dr. Harrison said. He called the findings "provocative" and "hypothesis-generating," noting that a prospective interventional study would be needed to determine a causal relationship.
Nevertheless, he and his colleagues conclude, "moderate caffeine and/or coffee consumption may be a benign adjunct to the comprehensive management of NASH patients."
In the second study, Dr. Neal D. Freeman of the National Cancer Institute and his colleagues found that among 885 patients with chronic hepatitis C who failed standard treatment with interferon, those who drank more coffee responded better to retreatment with peg interferon alfa 2a and ribavirin.
The median log10 drop from baseline to week 12 of retreatment was 1.7 among non-coffee drinkers, compared to 3.7 for those who drank three cups or more daily (p for trend across categories less then 0.0001).
There also were "highly statistically significant trends" in early virologic response (EVR, defined as a two log10 drop in HCV RNA at week 12), undetectable HCV RNA at week 20 of treatment, and sustained virologic response (SVR, at week 72, 24 weeks after the end of treatment).
For example, 11.3% of non-coffee drinking patients had an SVR, compared to 25.8% of patients who drank at least three cups a day. The EVR rate was 45.7% in non-coffee drinkers and 72.7% in the heaviest coffee drinkers. And among the non-coffee drinkers, 26.3% had undetectable levels of HCV RNA at week 20 of the study, compared to 52.3% of people who drank three or more cups daily (p for trend in all three categories less then 0.0001).
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Johnson & Johnson's protease inhibitor OLYSIO (Simeprevir) is approved for the treatment of HCV genotype 1, in combination with peginterferon alfa and ribavirin in adults with compensated liver disease, including cirrhosis, who are treatment-naïve or who have failed previous interferon therapy (pegylated or non‑pegylated) with ribavirin.
Simeprevir was approved in Japan this past September , and in Canada on November 20th.
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OLYSIO (Simeprevir) Cost? - Janssen has priced Olysio at a wholesale acquisition price of $22,120 per bottle of 28 capsules (150 mg capsules), which is an approximately one-month supply. That's roughly $66,360 for a three-month course.
Lessons Learned - An important lesson we learned from these drugs may serve as a reminder for future DDAs, that is, once telaprevir and boceprevir were used in larger groups of patients, or in "real-life" settings - outside clinical trials, new response rates and adverse effects began to emerge.
Simeprevir drug–drug interactions - Simeprevir has a list of medications that can cause drug–drug interactions Other medications can interfere with the way DDAs are metabolized. The drug–drug interactions can either increase drug concentrations which may cause toxicity and lead to side effects, or decrease drug concentrations leading to a loss of efficacy.
Off Label Use - Simeprevir and Sofosbuvir? - Paul Sax, Editor-in-Chief at NEJM Journal Watch wrote an article this past summer on the possibility of combining simeprevir and sofosbuvir with or without ribavirin, to create an off label interferon-free regimen....
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In October the Antiviral Drugs Advisory Committee recommend the approval of Gilead's Sofosbuvir, a nucleotide analog NS5B polymerase inhibitor in combination with just ribavirin for treating adult HCV genotypes 2/3 and in combination with pegylated interferon/ribavirin for genotype 1 and 4 treatment-naive patients.
The FDA does not have to follow the advice of its panels, but most often does. The U.S. health regulators are scheduled to decide whether to approve sofosbuvir by December 8th 2013
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How Soon Should I Get Tested After Exposure ?
After the exposure (especially if the blood exposure involved another person known to have the hepatitis C virus), it is recommended that testing for the hepatitis C antibody be performed at 4 to 6 months after the exposure OR that testing for the hepatitis C virus itself (a test often called an HCV PCR or hepatitis C viral load test) be performed 4 to 6 weeks after the potential exposure. These tests are done to determine whether or not hepatitis C infection has occurred as a result of the exposure.;
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- New HCV Drugs
- Keeping current on the potential arrival of new improved hepatitis C drugs. As once a hepatitis C patient myself (I successfully treated the virus with standard HCV therapy in 2000) I understand the difficult decisions and overwhelming fear that ensues after being diagnosed with this serious and life-changing disease. This blog serves as a starting point for information on the rapidly evolving number of new agents in development to treat hepatitis C. Tina