tag:blogger.com,1999:blog-83585699974297918102024-03-18T05:46:09.286-04:00HCV New DrugsThis blog is all about current FDA approved drugs to treat the hepatitis C virus (HCV) with a focus on treating HCV according to genotype, using information extracted from peer-reviewed journals, liver meetings/conferences, and interactive learning activities.HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.comBlogger7882125tag:blogger.com,1999:blog-8358569997429791810.post-48161001948362907862020-01-05T18:03:00.000-05:002020-01-05T18:11:21.722-05:00Study: Unhealthy Alcohol Use After HCV Therapy<div>
HEPATOLOGY COMMUNICATIONS, VOL. 0, NO. 0, 2019 </div>
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<a href="https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep4.1464">Alcohol Use and Long-Term Outcomes Among U.S. Veterans Who Received Direct-Acting Antivirals for Hepatitis C Treatment</a></div>
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FIG. 3. Association of alcohol use (unhealthy vs. nondrinking) with mortality and liver-related outcomes by SVR and cirrhosis status.<br />
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In summary, this large retrospective study of veterans who received DAA therapy showed that unhealthy alcohol use is associated with a higher risk of mortality and decompensated cirrhosis, with the mortality risk seemingly greatest among patients who did not achieve SVR after DAA therapy. The increased risk of decompensated cirrhosis and HCC associated with unhealthy alcohol use was also greater among patients who did not achieve SVR and who had cirrhosis. After DAA therapy, unhealthy alcohol use appeared to decline, albeit by a small percentage. We recommend that clinicians providing HCV treatment consider the time period before and during antiviral therapy as an opportunity to engage patients in long-term abstinence from alcohol use, to minimize posttreatment mortality and morbidity.</div>
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<a href="https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep4.1464">Download available here....</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-63376217577471402632020-01-05T16:34:00.001-05:002020-01-05T17:13:34.234-05:00December 2019 Update -- AASLD has updated its Hepatitis C Guidance<b>UPDATE -- AASLD has updated its Hepatitis C Guidance</b><br />
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<span style="background-color: white; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">December 2019</span><i></i><u></u><sub></sub><sup></sup><strike></strike><b></b></div>
AASLD is the leading organization of scientists and health care professionals committed to preventing and curing liver disease. <br />
Read Updated Hepatitis C Guidance: <a href="https://www.aasld.org/publications/practice-guidelines">https://www.aasld.org/publications/practice-guidelines</a><br />
<b><br />Of Interest</b><br />
<a href="http://www.natap.org/2019/AASLD/AASLD.htm">AASLD</a><br />
<a href="http://www.natap.org/2019/AASLD/AASLD.htm"> The Liver Meeting</a><br />
Boston MA<br />
November 9-13 2019<br />
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December 24, 2019<br />
COMMENTARY<br />
<b>Updated Guidance for Hepatitis C Virus Treatment in Primary Care</b><br />
David E. Bernstein, MD<br />
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Achieving cure is easier now than in the past because DAA agents are highly effective, much easier to tolerate than older HCV treatments, taken for a short period of time, and have a low pill burden. Most DAA regimens can be administered as either a single tablet or three tablets taken once daily for 8, 12, or 16 weeks. Side effects are minimal, with approximately 10% of patients experiencing <a href="https://www.ncbi.nlm.nih.gov/pubmed/28319996">headache, nausea, or fatigue</a>. Most people receiving DAA treatment <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jvh.12554">report no side effects</a> or that they feel better than before starting treatment.</div>
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Curing HCV infection reduces morbidity by slowing or halting the progression of liver diseases, including cirrhosis or <a href="https://emedicine.medscape.com/article/197319-overview">liver cancer</a>. With DAA treatment, liver health improves to the degree that many patients experience a reversal of cirrhosis. Perhaps most exciting is that curing chronic HCV infection has been associated with an overall <a href="https://www.ncbi.nlm.nih.gov/pubmed/27577675">increase in survival</a> among patients with non–liver-related diseases, such as <a href="https://emedicine.medscape.com/article/1916852-overview">stroke</a> and heart disease.</div>
Free registration may be required: <a href="https://www.medscape.com/viewarticle/922855">https://www.medscape.com/viewarticle/922855 </a><br />
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Dec 5, 2019<br />
<b>Anti-hepatitis medicine Surprises</b><br />
New effective treatment of hep C not only combats the virus, but is also effective against complications<br />
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Summary: A new effective treatment of hepatitis C not only combats the virus, but is also effective against potentially fatal complications such as reduced liver functioning and cirrhosis. <br />
Read More: <a href="https://www.sciencedaily.com/releases/2019/12/191205103351.htm">https://www.sciencedaily.com/releases/2019/12/191205103351.htm </a><br />
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<b><span style="color: #660000;">For Patients </span></b><br />
<b>Hep Winter 2019</b><br />
In every issue of Hep, you’ll find the hottest topics of interest to our readers along with cutting-edge health information.<br />
Read it here: <a href="https://www.hepmag.com/magazine/hep-winter-2019">https://www.hepmag.com/magazine/hep-winter-2019</a><br />
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<b>Support for Hepatitis C</b></div>
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<a href="https://hepatitisc.net/q-and-a/">Have a question?</a> Ask the community! <a href="https://hepatitisc.net/stories/">Share your story</a> or read about others living with hepatitis C. <a href="https://hepatitisc.net/forums/">Post in our forum boards</a> and join the conversation! You can also <a href="https://hepatitisc.net/living/talk-anonymously/">participate anonymously</a>.</div>
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Read all articles here: <a href="https://hepatitisc.net/page/2/?via=homepage-recents">https://hepatitisc.net/page/2/?via=homepage-recents</a></div>
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For people with hepatitis C, check out <a href="http://www.help4hep.org/">Help-4-Hep</a>, a peer counseling line.</div>
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<a href="https://www.hepatitisc.uw.edu/page/treatment/drugs">Learn about FDA approved drugs to treat hepatitis C</a></div>
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Prescribing Information, Drug Summary, Clinical Studies, and Slide Decks</div>
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<b>January 2020</b></div>
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<a href="https://hepatitiscnewdrugs.blogspot.com/2016/11/november-updates-liver-cancer-after.html">Liver Cancer After Treatment For Hepatitis C</a></div>
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HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-81197183472616293942020-01-05T16:34:00.000-05:002020-01-05T16:37:38.853-05:00Liver Cancer After Treatment For Hepatitis C<b></b><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPPpkdKwoqEM_1ZsCxTlo_Gvw1PA2be2Jhi2ScT4pDTH1ofQqkz43dh8c9QhrKbJCuRVI87WHNiAAIyWStQWxz0tLh-nrrHNYWghakvT-fJHoTCruNfsPjpJGHLfX1XZTHnJWXFHnDb1_b/s1600/liver-function.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPPpkdKwoqEM_1ZsCxTlo_Gvw1PA2be2Jhi2ScT4pDTH1ofQqkz43dh8c9QhrKbJCuRVI87WHNiAAIyWStQWxz0tLh-nrrHNYWghakvT-fJHoTCruNfsPjpJGHLfX1XZTHnJWXFHnDb1_b/s200/liver-function.jpg" width="150" /></a><br />
<i>Page updated: </i><span style="background-color: white; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">January 5, 2020</span><br />
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<b>Liver Cancer After Treatment For Hepatitis C</b><br />
Research demonstrates that while SVR markedly reduced liver-related complications and liver cancer, some long-term risk for liver cancer remained in those who were cured of Hepatitis C. But after direct-acting antiviral therapy does the risk of developing liver cancer increase?<br />
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<i>This page offers an index of links</i><i> to current data investigating the possible risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after direct-acting antiviral therapy in patients with hepatitis C.</i><br />
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<b>January 5, 2020</b><br />
The following research shared via Twitter by <a href="https://twitter.com/HenryEChang">Henry E. Chang</a><br />
<i>Intrahepatic immune changes after hepatitis c virus eradication by direct‐acting antiviral therapy</i><br />
This first-of-its-kind study performed in livers from hepatitis C patients shows minor intrahepatic immune changes are unlikely to favor Hepatocellular carcinoma (HCC) occurrence or recurrence after DAA‐induced SVR→<a href="https://t.co/CEn6S6GIbm?amp=1">https://jmp.sh/oBbi6LG</a><br />
<a href="https://onlinelibrary.wiley.com/toc/14783231/2020/40/1">Liver International</a>: Volume 40, Issue 1 Pages: i, 1-253 January 2020<br />
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<i>Systematic review with meta-analysis: effectiveness of direct-acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma.</i><br />
<a href="https://jmp.sh/cCfUllK">https://jmp.sh/cCfUllK</a></div>
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<b>Of Interest: </b><i>Hepatitis C Eradication With DAAs Reduces the Risk of Variceal Bleeding</i><br />
<a href="https://jmp.sh/ihI9ORm">https://jmp.sh/ihI9ORm</a></div>
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"The risk of variceal bleeding was lower in patients with or without previous cirrhosis who were treated with DAAs and achieved SVR, showing the real-world benefit of DAA treatment."</div>
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<b>December 31, 2019</b></div>
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<a href="https://hepatitiscnewdrugs.blogspot.com/2019/12/update-aasld-has-updated-its-hepatitis.html">UPDATE -- AASLD has updated its Hepatitis C Guidance</a></div>
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<strong>March 2019</strong></div>
<strong>Mar 7</strong><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2019/03/long-term-follow-up-after-cure-from.html">Long-term follow-up after cure from chronic hepatitis C virus infection shows occult hepatitis and a risk of hepatocellular carcinoma in noncirrhotic patients</a><br />
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<strong>February 2019</strong><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2019/02/clinical-outcomes-in-patients-with.html">Direct-acting antivirals reduce risk of premature mortality and liver cancer for people with chronic hepatitis C </a><br />
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<b>January 2019</b><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2019/01/liver-cancer-recurrence-not-linked-to.html">Liver Cancer Recurrence Not Linked to Hepatitis Treatment</a><br />
JANUARY 22, 2019<br />
Kevin KunzmannNew study results show that, despite recent international clinical analysis, direct-acting antiviral (DAA) therapy for <a href="https://www.mdmag.com/conditions/hepatitis-c?rel=0">hepatitis C virus (HCV)</a> is not associated with a greater recurrence of liver cancer in patients who have suffered from both conditions.<br />
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<a href="http://www.infohep.org/page/3426448/">HIV infection an independent risk factor for poorer survival from liver cancer</a><br />
Infection with HIV is associated with significantly worse survival for people with hepatocellular carcinoma (HCC, the most common type of primary liver cancer), according to findings from a large international cohort study published in...<br />
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<b>November 2018</b><br />
Nov 6, 2018<br />
<a href="https://www.healio.com/hepatology/hepatitis-c/news/online/%7Be554943e-f94f-4688-8069-fe88a24f854b%7D/hcc-recurrence-rates-do-not-differ-after-interferon-vs-daa-therapy">HCC recurrence rates do not differ after interferon vs. DAA therapy </a><br />
Kinoshita MN, et al. J Hepatol. 2018;doi:10.1016/j.jhep.2018.09.029. <br />
Hepatocellular carcinoma recurrence rates and patterns did not differ between patients who underwent interferon-based antiviral therapy for hepatitis C and those who received direct-acting antiviral therapy, according to a recently published study. <br />
<i>F<i>ree registration required</i></i><br />
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<b>October 2018</b><br />
<a href="https://www.healio.com/hepatology/hepatitis-c/news/print/hcv-next/%7Bfc5304d7-6ae8-4018-983b-937b63bd01d7%7D/research-continues-to-invalidate-link-between-daa-treatment-liver-cancer">Research continues to invalidate link between DAA treatment, liver cancer</a><br />
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<b>August 2018</b><br />
Aug 4, 2018<br />
<a href="https://www.medscape.com/viewarticle/900149">Direct Antiviral Therapy of Hep C May Not Boost Hepatocellular-Carcinoma Risk</a><br />
Treatment of hepatitis C (HCV) with direct-acting antiviral agents does not appear to increase the risk of hepatocellular carcinoma (HCC) in individuals with cirrhosis, researchers from France report.<br />
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Reuters Health Information, August 2018</div>
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<b>J</b><b>une 2018</b></div>
June 28, 2018<br />
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<a href="https://hepatitiscnewdrugs.blogspot.com/2018/06/hcv-clearance-by-direct-antiviral.html">HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma: still an issue? </a><br />
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<a href="http://www.clinicaloncology.com/Other-Solid-Tumors/Article/06-18/DAAs-Linked-to-Less-Liver-Cancer/50062">Study May Lessen Controversy Over DAAs’ Relationship to Liver Cancer</a></div>
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Washington—Eradication of chronic infection with the hepatitis C virus with the new class of antiviral agents is associated with a 71% reduction in the risk for de novo liver cancer, according to a large retrospective cohort study involving the Veterans Affairs health care system. The findings should provide some assurance for patients taking direct-acting antivirals (DAAs), according to lead study author George Ioannou, BMBCh, MS, the director of hepatology at Veterans Affairs Puget Sound Health Care System, in Seattle.<br />
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June 27, 2018<br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2018/06/should-we-cure-hcv-in-patients-with.html">Should we cure HCV in patients with hepatocellular carcinoma while treating cancer?</a></div>
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Syed T, Fazili J, Ali I, et al. (June 19, 2018)<br />
<a href="https://www.cureus.com/articles/12396-hepatocellular-carcinoma-occurrence-and-recurrence-in-hepatitis-c-infected-patients-treated-with-direct-acting-antivirals">Hepatocellular Carcinoma Occurrence and Recurrence in Hepatitis C-infected Patients Treated with Direct-acting Antivirals</a>.<br />
Cureus 10(6): e2843. doi:10.7759/cureus.2843<br />
<i>This work was presented as poster presentation at Digestive Disease Week 2018.</i><br />
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June 15 2018</div>
Alimentary Pharmacology & Therapeutics<br />
<a href="http://www.medscape.com/viewarticle/895479">Direct-acting Antiviral Treatment for Hepatitis C Virus Infection and Risk of Incident Liver Cancer</a> <br />
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Does DAA-based HCV treatment reduce the risk of incident liver cancer compared to untreated HCV or interferon-based treatment?</div>
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<b>May 2018</b></div>
May 12, 2018<br />
Nature reviews gastroenterology & hepatology<br />
<a href="https://jumpshare.com/v/PAnSunSpBpEcc4ByR5EK">HCV therapy and risk of liver cancer recurrence: who to treat?</a><br />
Article shared and download by <a href="https://twitter.com/HenryEChang">Henry E. Chang</a> on Twitter<br />
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May 4, 2018<br />
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<a href="https://hepatitiscnewdrugs.blogspot.com/2018/05/high-efficacy-of-direct-acting-anti.html">High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma</a></div>
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This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.</div>
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<b>April 2018</b></div>
April 21, 2018<br />
Editorial<br />
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<a href="https://hepatitiscnewdrugs.blogspot.com/2018/04/hepatocellular-carcinoma-as-consequence.html">Hepatocellular carcinoma as a consequence of hepatitis C direct-acting anti-virals-the great urban myth of hepatology</a> <br />
Aliment Pharmacol Ther. 2018 May;47(10):1418-1419. doi: 10.1111/apt.14634.<br />
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April 17, 2018</div>
<a href="https://hepatitiscnewdrugs.blogspot.com/2018/04/does-interferon-free-therapy-for.html">Does interferon-free therapy for hepatitis C after curative treatment for hepatocellular carcinoma lead to unexpected recurrences of HCC?</a><br />
PLOS ONE | https://doi.org/10.1371/journal.pone.0194704<br />
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April 11, 2018</div>
<a href="https://hepatitiscnewdrugs.blogspot.com/2018/04/new-at-healio-8-reports-on-liver-cancer.html">New At Healio: 8 reports on liver cancer outcomes with HCV, DAA therapy</a> <br />
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April 5, 2018<br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2018/04/hepatitis-c-interferon-free-therapy-did.html">Hepatitis C - Interferon-free therapy did not increase the risk of liver cancer</a><br />
LAY SUMMARY: We examined the risk of liver cancer among 857 patients with cirrhosis in Scotland who received hepatitis C antiviral therapy and achieved a cure. We compared the risk of first-time liver cancer in patients treated with the newest interferon-free regimens, to patients treated with interferon. After accounting for the different characteristics of these two treatment groups, we found no evidence that interferon-free therapy is associated with a higher risk of liver cancer.<br />
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Mar 19, 2018<br />
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<a href="http://www.clinicaloncology.com/Other-Solid-Tumors/Article/03-18/-DAAs-Protect-Against-HCC-When-SVR-Achieved/48200">Large Study Confirms DAAs Protect Against HCC When SVR Achieved</a></div>
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Patients with hepatitis C who are successfully treated with direct-acting antiviral agents experience a dramatic reduction in their risk for liver cancer, new data show. However, the decrease is much lower for those diagnosed with cirrhosis before starting a DAA.</div>
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Mar 13, 2018</div>
<a href="http://jmp.sh/JwqjExK">Persistence of hepatocellular carcinoma risk in hepatitis C patients with a response to IFN & cirrhosis</a><br />
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<a href="https://hepatitiscnewdrugs.blogspot.com/2018/03/stagnation-of-fibrosis-regression-is.html">Stagnation of fibrosis regression is associated with a high risk for HCC after SVR</a> <br />
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Mar 3, 2018<br />
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<a href="https://hepatitiscnewdrugs.blogspot.com/2018/03/minireview-daas-and-occurrence-or.html">Minireview - DAAs and the occurrence or recurrence of HCC among patients with HCV related liver disease</a> </div>
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Feb 12, 2018</div>
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<a href="http://www.natap.org/2018/HCV/020918_02.htm">The risk of hepatocellular carcinoma in cirrhotic patients with hepatitis C and sustained viral response: role of the treatment regimen </a><br />
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Recommended Reading</div>
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<b>Hepatocellular carcinoma - Updated and evidence-based review</b> </div>
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Alejandro Forner, MD, MD Alejandro Forner </div>
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Published: 04 January 2018 <br />
DOI: http://dx.doi.org/10.1016/S0140-6736(18)30010-2</div>
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Full Text </div>
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View Article: <a href="https://jumpshare.com/v/La5WS4Mn8Uwpi927nbeU">https://jumpshare.com/v/La5WS4Mn8Uwpi927nbeU</a> </div>
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Hepatocellular carcinoma appears frequently in patients with cirrhosis. Surveillance by biannual ultrasound is recommended for such patients because it allows diagnosis at an early stage, when effective therapies are feasible. The best candidates for resection are patients with a solitary tumour and preserved liver function. Liver transplantation benefits patients who are not good candidates for surgical resection, and the best candidates are those within Milan criteria (solitary tumour ≤5 cm or up to three nodules ≤3 cm). Image-guided ablation is the most frequently used therapeutic strategy, but its efficacy is limited by the size of the tumour and its localisation. Chemoembolisation has survival benefit in asymptomatic patients with multifocal disease without vascular invasion or extrahepatic spread. Finally, sorafenib, lenvatinib, which is non-inferior to sorafenib, and regorafenib increase survival and are the standard treatments in advanced hepatocellular carcinoma. This Seminar summarises the scientific evidence that supports the current recommendations for clinical practice, and discusses the areas in which more research is needed....<br />
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Future perspectives <br />
In the past 10 years, treatment of hepatocellular carcinoma has evolved considerably. Nowadays, patients with hepatocellular carcinoma can benefit from effective options that improve their survival whatever the evolutionary stage of disease at diagnosis. However, improvement can still be made in several areas. Prevention of the acquisition of the risk factors for development of hepatocellular carcinoma is the best strategy for decreasing mortality. The high efficacy of direct acting antivirals in elimination of chronic hepatitis C virus infection is expected to have an impact on the incidence of hepatocellular carcinoma, but further information about disease evolution in the patients after viral cure needs to be collected.......</div>
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Article Downloaded & shared by <a href="https://twitter.com/HenryEChang">@HenryEChang</a><a href="https://twitter.com/HenryEChang"> </a>via Twitter.<br />
View Article: <a href="https://jumpshare.com/v/La5WS4Mn8Uwpi927nbeU">https://jumpshare.com/v/La5WS4Mn8Uwpi927nbeU</a> <b></b></div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />
<b>December 2017</b><br />
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Healio - <span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">December 8, 2017</span><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2017/12/liver-cancer-incidence-after-hcv.html"> Liver cancer incidence after HCV therapy linked to risk factors, not treatment</a><br />
Li DK, et al. Hepatol. 2017;doi:10.1002/hep.29707. </div>
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Direct-acting antiviral treatment for hepatitis C did not correlate with an increased risk for hepatocellular carcinoma in a large cohort study of both treated and untreated patients with or without cirrhosis. Those with incident HCC after DAA treatment had higher risk factors at baseline. “There was no increased risk for HCC as a result of having received DAA therapy whatsoever,” Raymond T. Chung, PhD, director of Hepatology and Liver Center at Massachusetts General Hospital, told Healio Gastroenterology and Liver Disease. “The risk was <a href="https://www.healio.com/hepatology/hepatitis-c/news/online/%7B5aa5a26b-2a6b-4a42-b261-0a2ae5cafa8f%7D/age-comorbidities-greater-impact-on-hcc-rates-than-daa-therapy">related to their preexisting likelihood</a> of developing HCC. The fact that HCC developed post-DAA, we think, is more likely to be an accident of timing than the idea that it's related to receipt of DAA — these persons were at risk for HCC whether they received DAAs or not.”</div>
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<a href="https://www.healio.com/hepatology/hepatitis-c/news/online/%7Be33049e8-2b8e-47f5-ba1e-6ad01e1e88b8%7D/liver-cancer-incidence-after-hcv-therapy-linked-to-risk-factors-not-treatment">Continue reading........ </a></div>
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<a href="https://www.healio.com/hepatology/oncology/news/online/%7B7f92604f-bb4f-4c7e-ba67-85c348194544%7D/hcc-rates-after-interferon-free-hcv-treatment-linked-to-baseline-risk-factors">HCC rates after interferon-free HCV treatment linked to baseline risk factors</a></div>
Innes H, et al. J Hepatol. 2017;doi:10.1016/j.jhep.2017.10.033. <br />
Recently published data suggest that higher hepatocellular carcinoma incidence after sustained virologic response with interferon-free hepatitis C treatment correlates to patient baseline risk factors, such as age, Child-Turcotte Pugh score and prior treatment, rather than IFN-free therapy.<br />
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<a href="https://www.healio.com/hepatology/hepatitis-c/news/print/hcv-next/%7Bdffed0d7-8f2f-4122-a2cd-47b96635ec8e%7D/hcv-clearance-lowers-liver-cancer-risk-by-70-no-matter-drug-of-choice">HCV Clearance Lowers Liver Cancer Risk by 70% no Matter Drug of Choice</a><br />
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Reaching sustained virologic response with direct-acting antivirals reduced the occurrence of hepatocellular carcinoma by 71%, but all treatments that cleared the virus saw a similar reduction in risk, according to a presenter at The Liver Meeting 2017. </div>
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<a href="https://hepatitiscnewdrugs.blogspot.com/2017/12/interferon-free-therapy-of-chronic.html">Interferon-free therapy of chronic hepatitis C with direct-acting antivirals does not change the short-term risk for de novo hepatocellular carcinoma in patients with liver cirrhosis</a> </div>
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<b>November 2017</b><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2017/11/hcv-advocate-direct-acting-antiviral.html">HCV Advocate – Direct-Acting Antiviral Treatment & Decrease a Incidence of Liver Cancer</a> <br />
The studies on this blog looked at treatment with DAAs to find out if curing hepatitis C (HCV) with DAAs improved HCV disease progression and reduced the risk of liver cancer.<br />
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<b>October 2017</b><br />
Oct 23, 2017<br />
<span style="color: black;"><a href="https://hepatitiscnewdrugs.blogspot.com/2017/10/the-liver-meeting-2017-vets-with-hcv.html">The Liver Meeting® 2017 - Vets with HCV Might Settle Cancer Controversy</a></span> <br />
In the largest cohort analyzed to date -- some 62,000 patients in the VA system -- there is no evidence that therapy with newer agents that act directly against the virus (DAAs) increases the risk of hepatocellular carcinoma (HCC), according to George Ioannou, BMBCh, of the Veterans Affairs Puget Sound Health Care System in Seattle.<br />
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Oct 20, 2017<br />
<span style="color: black;"><a href="https://hepatitiscnewdrugs.blogspot.com/2017/10/the-liver-meeting-directacting.html">The Liver Meeting® - Direct‐Acting Antiviral Therapy Cuts Liver Cancer Risk By 71%</a></span> <br />
The study’s findings showed that DAA‐induced sustained virological response is associated with a 71 percent reduction in patients’ liver cancer risk, and showed treatment with DAAs is not associated with increased liver cancer risk compared to treatment with interferon.<br />
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Oct 16, 2017<br />
<span style="color: #145470;"><a href="https://hepatitiscnewdrugs.blogspot.com/2017/10/short-term-risk-of-hepatocellular.html">Short-term risk of hepatocellular carcinoma after hepatitis C virus eradication following direct-acting anti-viral treatment</a></span> <br />
In conclusion, our data showed no evidence of an increased risk of de novo HCC or recurrence by patients treated with interferon-free SOF-based regimens. However, cirrhosis was strongly associated with the short-term development of HCC after HCV eradication. Moreover, our findings underscore the fact that the serum EOT-AFP level is a useful marker for predicting de novo HCC for cirrhotic patients and that close HCC surveillance should be required for patients with a past history of HCC, especially for patients treated with noncurative procedures. Going forward, further studies will be required to elucidate the risk of HCC development over the long-term.....<br />
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Oct 3, 2017<br />
<a href="http://www.mdmag.com/medical-news/hcv-treatment-not-associated-with-liver-cancer-new-evidence-suggests">HCV Treatment Not Associated with Liver Cancer, New Evidence Suggests</a><br />
Kenneth Bender<br />
An assessment of over 62,000 patients treated for hepatitis C (HCV) revealed no evidence to support the suggestion that direct acting antiviral (DAA) agents promote recurrence of hepatocellular carcinoma (HCC), and found instead that successful treatment with or without DAAs is associated with reduced risk of HCC.<br />
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<b>September 2017</b><br />
Sep 18, 2017<br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2017/09/coverage-onclive-2017-international.html">Coverage OncLive - 2017 International Liver Cancer Association Annual Conference</a> <br />
<span style="color: black;">Study Shows DAAs Are Not Associated With Increased HCC Recurrence Risk</span><br />
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Angelica Welch</div>
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Published Online:<b> </b>Monday, Sep 18, 2017</div>
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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.</div>
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Sep 12, 2017</div>
Full Text Article Provided by NATAP<br />
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<a href="http://www.natap.org/2017/HCV/091117_02.htm">New study - (1) DAA SVR Reduced by 71% HCC Risk / (2) DAA Treatment NOT Associated with HCC Increased Risk Compared to Interferon Based Treatment.....[Jules: and cirrhosis increases risk of HCC SO Treat Early </a> </div>
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"Most HCV-infected patients in the United States will undergo DAA-based antiviral treatment in the next few years and the vast majority of them will achieve SVR. Our results suggest that <b>DAA-induced SVR is associated with a 71% reduction in HCC</b> risk (AHR 0.29, 95% CI 0.23-0.37) compared to treatment failure. The reduction in HCC risk associated with SVR was similar irrespective of whether SVR was achieved by DAA-ONLY, DAA+IFN or IFN-ONLY regimens. This suggests that <b>eradication of HCV reduces HCC risk independently of how it is achieved. In contrast to prior reports that suggested an increased HCC risk in patients treated with DAAs[[3], [7]], we found that receipt of DAA-ONLY antiviral treatment was not associated with increased risk of HCC when compared to receipt of IFN-ONLY antiviral treatment.....<i>We found no evidence that treatment with DAAs was associated with increased risk of HCC compared to treatment with IFN</i></b><i>.</i></div>
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<a href="http://www.natap.org/2017/HCV/091117_02.htm">Continue to NATAP to view full article....</a></div>
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Sept 5, 2017</div>
<a href="https://jumpshare.com/v/TGeMAovtBCrZLdy2If0r">Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?</a><br />
Several studies of patients treated with interferon -based therapy nicely documented that the risk for hepatocellular carcinoma (HCC) was markedly lower in patients who achieved SVR compared to those without SVR. 5-7 As a result, it was naturally assumed that with higher cure rates with DAAs, cancer rates would start to decline. It was therefore surprising and unsettling in 2016 to see a series of reports of unexpectedly high rates of ‘early’ HCC recurrence after ‘curative’ therapy as well as higher than expected rates of de novo HCC in patients who achieved SVR with DAAs.<br />
<u><span style="color: #145470;"><a href="https://jumpshare.com/v/TGeMAovtBCrZLdy2If0r">PDF Full Text Article</a> - </span></u>Provided by <a href="https://twitter.com/HenryEChang"><span style="color: #145470;">@HenryEChang</span></a> via Twitter <br />
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<b>August 2017</b><br />
Aug 15, 2017<br />
<span style="color: black;"><a href="https://hepatitiscnewdrugs.blogspot.com/2017/08/how-do-direct-acting-antivirals-for-hcv.html">How Do Direct-Acting Antivirals for HCV Affect HCC Risk?</a></span><span style="color: #2288bb;"> </span><br />
<span class="teaser">The latest data on the controversial hepatitis C-hepatocellular carcinoma treatment link are examined.</span><br />
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<span class="teaser"></span>Aug 10, 2017<br />
<span style="color: black;"><a href="https://hepatitiscnewdrugs.blogspot.com/2017/08/the-risks-of-hepatocellular-carcinoma.html">The risks of hepatocellular carcinoma development after HCV eradication are similar between patients treated with peg-interferon plus ribavirin and direct-acting antiviral therapy</a></span> <br />
The risk of hepatocellular carcinoma (HCC) development is reduced following viral elimination by interferon therapy in chronic hepatitis C patients. However, the risk in patients treated with interferon-free direct-acting antivirals (DAAs) is unknown. We evaluated chronic hepatitis C patients who achieved viral eradication by pegylated-interferon plus ribavirin (PEG-IFN/RBV, n = 244) or daclatasvir plus asunaprevir (DCV/ASV, n = 154) therapy...<br />
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Aug 4, 2017<br />
<a href="https://www.healio.com/hepatology/hepatitis-c/news/online/%7B627be4a1-2017-4e05-998d-27f3409717f1%7D/liver-cancer-mortality-risks-decrease-with-svr-after-direct-acting-antivirals">Liver cancer, mortality risks decrease with SVR after direct-acting antivirals</a><br />
Patients who achieved sustained virologic response after direct-acting antiviral treatment also had significantly lower all-cause mortality and lower incident rates of…<br />
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<b>July 2017</b><br />
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July 26, 2017<br />
Medscape<br />
<a href="http://www.medscape.com/viewarticle/883163">With Hepatitis C Virus on the Run, Meet the New Challenge: Hepatocellular Carcinoma</a><b></b><br />
Significant advances in the clinical practice of hepatology were addressed during this year's Digestive Disease Week. This review focuses on the concerns related to the apparent increase in the incidence of hepatocellular carcinoma (HCC).<br />
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July 16<br />
<a href="https://hepatitiscnewdrugs.blogspot.com/2017/07/hepatitis-c-virus-eradication-with.html">Hepatitis C virus eradication with direct antiviral agents and liver cancer recurrence: Is the best the enemy of the good?</a> Antiviral therapy has long been perceived as an adjuvant treatment modality worth to be offered to patients with chronic hepatitis C virus (HCV) infection after successful removal of a hepatocellular carcinoma (HCC), an approach dating more than two decades since interferon was first employed to treat non-A, non-B hepatitis.<br />
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July 10<br />
<a href="https://www.healio.com/hepatology/hepatitis-c/news/online/%7B43850255-638a-49d1-94ca-d703efec7f9e%7D/daas-do-not-affect-hcc-risk-svr-reduces-risk">DAAs do not affect HCC risk, SVR reduces risk</a><br />
July 10, 2017<br />
Recently published data showed a link between sustained virologic response and a reduced risk for hepatocellular carcinoma among patients treated with direct-acting…</div>
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July 3</div>
<a href="http://www.consultant360.com/story/sustained-response-direct-acting-hcv-antivirals-tied-lower-hcc-risk">Sustained response to direct-acting HCV antivirals tied to lower HCC risk</a><br />
July 3, 2017<br />
by Marilynn Larkin<br />
NEW YORK (Reuters Health) - A sustained virologic response to direct-acting antiviral treatment of hepatitis C (HCV) is associated with a “considerable” reduction in the risk of hepatocellular carcinoma (HCC), researchers say. Dr. Fasiha Kanwal of Baylor College of Medicine in Houston, Texas and colleagues analyzed data on 22,500 HCV patients (mean age 62) from 129 Veterans Health Administration hospitals who filled more than one prescription of sofosbuvir, simeprevir, ledipasvir, a combination of paritaprevir/ritonavir or ombitasvir and dasabuvir, and daclatasvir in 2015.<br />
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<b>June 2017</b><br />
June 26, 2017<br />
<a href="http://freepdfhosting.com/c5e348cfa5.pdf?platform=hootsuite">Challenges in Treatment of Hepatitis C among Patients with Hepatocellular Carcinoma</a> <br />
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June 3, 2017<br />
Medscape Coverage from the <a href="http://www.medscape.com/viewcollection/34043">International Liver Congress (ILC) 2017 </a><br />
<a href="http://www.medscape.com/viewarticle/881041?src=rsshttp://www.medscape.com/viewarticle/881041?src=rss">Navigating the Hep C Treatment and Cancer Risk Minefield</a><b></b><br />
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<b>May 2017</b><br />
May 26<br />
<a href="http://hepatitiscnewdrugs.blogspot.com/2017/05/hepatocellular-carcinoma-and-direct.html">Hepatocellular carcinoma and direct- acting antivirals: A never ending story?</a> <br />
Vincenza Calvaruso* andAntonio Craxì Version of Record online: 24 MAY 2017 DOI: 10.1111/liv.13421<br />
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<b>Liver International</b><br />
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<a href="http://onlinelibrary.wiley.com/doi/10.1111/liv.2017.37.issue-6/issuetoc"><span id="volumeNumber"><span style="color: #2288bb;">Volume 37</span></span><span style="color: #2288bb;">, </span><span id="issueNumber"><span style="color: #2288bb;">Issue 6</span></span><span style="color: #2288bb;">, </span></a> <span id="issuePages">pages 812–814</span>, <span id="issueDate">June 2017</span></div>
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<b>Key Points</b> </div>
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• The benefit of SVR is higher in patients without clinically significant portal hypertension </div>
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• HCC occurrence in patients with compensated cirrhosis is comparable to historical controls of patients who achieved SVR after interferon-based therapy. </div>
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• Patients who achieve SVR with DAAs had a lower risk of developing liver cancer than those patients whose HCV infection was not cured. </div>
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• Data available on patients with previous HCC do not show an increased risk of HCC recurrence and report a comparable rate of reappearance of cancer among DAA-treated and untreated patients.</div>
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<b>Full Text</b> </div>
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<a href="http://freepdfhosting.com/4f8116cae5.pdf?platform=hootsuite"><span style="color: #2288bb;">Download PDF</span></a></div>
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<b>Link Provided By</b><br />
<a href="https://twitter.com/HenryEChang"><span style="color: #2288bb;">Henry E. Chang</span></a> via Twitter </div>
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May 26</div>
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<i>Summary Of Available Data:</i><br />
<a href="https://www.medpagetoday.com/reading-room/aga/lower-gi/65573">New Hep C Treatment Not Linked to Liver Cancer</a><br />
Contrary to some earlier research, most recent studies see no association between response to DAAs and HCC<br />
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<a href="https://www.clinicaloptions.com/Hepatitis/Conference%20Coverage/Amsterdam%202017/Clinical%20Thoughts/CT2.aspx">Do HCV DAAs Increase HCC Recurrence Risk or Not?</a><br />
Does the administration of direct-acting antiviral (DAA) therapy increase a patient’s risk of hepatocellular carcinoma (HCC) recurrence?<br />
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<a href="http://www.pharmaceutical-technology.com/comment/commentcan-daa-treatment-increase-the-risk-of-hcc-emerging-data-points-towards-no-5821565/">Can DAA treatment increase the risk of HCC? Emerging data points towards ‘no’</a></div>
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Direct-acting-antivirals (DAA) can cure patients of the life-threating hepatitis C virus (HCV) infection, with cure rates exceeding 95%. However, questions have been raised about the long-term consequences of curing patients with DAAs, including a potential link between DAA treatment and the development of hepatocellular carcinoma (HCC).</div>
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<a href="http://freepdfhosting.com/74fea858bc.pdf?platform=hootsuite">Improved survival of patients with hepatocellular carcinoma and compensated HCV-related cirrhosis who attained SVR</a> <br />
Few studies examined the outcome of patients with HCV-related cirrhosis who developed hepatocellular carcinoma (HCC). The relative weight as determinant of death for cancer versus endstage-liver-disease (ESLD) and the benefit of HCV eradication remain undefined. This multicenter, retrospective analysis evaluates overall survival (OS), rate of decompensation and tumor recurrence in compensated HCC patients treated with IFN according to HCV status since HCC diagnosis. <br />
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Of Interest<br />
<a href="http://www.healio.com/hepatology/oncology/news/online/%7B11cc9822-b6f0-4047-8769-b1dd679b21d4%7D/hcc-in-presence-of-hcv-decreases-cure-rate-in-daa-treatment">HCC in presence of HCV decreases cure rate in DAA treatment</a><br />
Patients with hepatocellular carcinoma and hepatitis C were less likely to achieve sustained virologic response while receiving direct-acting antiviral therapy compared with patients without HCC, according to results of a retrospective study.<br />
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<b>International Liver Congress</b><br />
April 21,2017<br />
<a href="http://www.aidsmap.com/Direct-acting-antivirals-for-hepatitis-C-not-linked-to-higher-liver-cancer-risk-in-most-studies/page/3132818/">Direct-acting antivirals for hepatitis C not linked to higher liver cancer risk in most studies</a><br />
People with hepatitis C who take treatment with direct-acting antivirals (DAAs) do not appear to have a higher risk of developing liver cancer compared to those treated with interferon, and the seemingly higher rates seen in some studies are attributable to risk factors such as older age and more advanced liver disease, according to a set of studies presented on Thursday at the <a href="http://www.aidsmap.com/International-Liver-Congress-2017/page/3124922/">International Liver Congress</a> in Amsterdam. The congress is the annual meeting of the European Association for the Study of the Liver (EASL).<br />
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April 20, 2017<br />
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<a href="http://hepatitiscnewdrugs.blogspot.com/2017/04/ilc-2017-is-direct-acting-antiviral.html">#ILC 2017: Is direct-acting antiviral therapy for Hepatitis C associated with an increased risk of liver cancer? The debate continues</a><br />
Eight studies being presented at The International Liver Congress™ 2017 demonstrate contrasting evidence on the potential link between direct-acting antiviral treatment for Hepatitis C and liver cancer<br />
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<b>Commentary on this study</b><br />
<a href="http://www.targetedonc.com/news/hepatitis-c-patients-at-no-elevated-risk-of-developing-hcc-following-daa-compared-to-interferon">Hepatitis C Patients At No Elevated Risk of Developing HCC Following DAA Compared To Interferon</a><br />
Patients were at no elevated risk of developing hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) following treatment with direct-acting antiviral therapy (DAA) for hepatitis C compared to interferon therapy, according to results of a meta-analysis reported at the 2017 International Liver Congress (ILC).<br />
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<a href="http://www.healio.com/hepatology/hepatitis-c/news/online/%7Bc6843d51-a21c-4e47-a966-877583b53260%7D/timing-of-daa-therapy-and-hcc-response-may-impact-recurrence-rate">Timing of DAA therapy and HCC response may impact recurrence rate</a><br />
April 20, 2017<br />
AMSTERDAM — Unexpectedly high hepatocellular carcinoma recurrence rates were reported among patients who achieved sustained virologic response after receiving direct-acting antiviral therapy, according to data presented at the International Liver Congress.<br />
“This update further supports our findings about an unexpected high recurrence rate associated in time with DAA, but also exposes a more aggressive pattern of recurrence and faster tumor evolution,” <strong>Maria</strong><strong> </strong><strong>Reig</strong><strong>, MD,</strong> of the Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clinic Barcelona, at the University of Barcelona, said in her presentation.<br />
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<b>Liver International</b><br />
April 20, 2017<br />
<a href="http://freepdfhosting.com/cb19c2acc8.pdf?platform=hootsuite">Download PDF</a> - Full Text <br />
<a href="http://freepdfhosting.com/cb19c2acc8.pdf?platform=hootsuite">Direct-acting antiviral therapy decreases hepatocellular carcinoma recurrence rate in cirrhotic patients with chronic hepatitis C</a><br />
Arrival of direct-acting antiviral (DAA) agents against hepatitis C virus (HCV) with high-sustained virological response (SVR) rates and very few side effects has drastically changed the management of HCV infection. The impact of DAA exposure on hepatocellular carcinoma (HCC) recurrence after a first remission in patients with advanced fibrosis remains to be clarified<br />
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<b>Editorial - Healio</b><br />
April 20, 2017<br />
<a href="http://www.healio.com/hepatology/oncology/news/print/hcv-next/%7Be4dcf746-1ebf-49b6-9f3c-5088873dc0cb%7D/hcc-after-daas-requires-more-study-but-no-cause-for-withheld-treatment">HCC After DAAs Requires More Study, but no Cause for Withheld Treatment</a><br />
HCV Next, April 2017<br />
As we continue to see the success of direct-acting antiviral therapy in treating hepatitis C virus, we must be aware of any potential complications from the underlying liver disease after successful treatment, especially hepatocellular carcinoma.<br />
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March 15, 2017<br />
Full Text - <a href="http://download.springer.com/static/pdf/60/art%253A10.1186%252Fs12916-017-0815-7.pdf?originUrl=http%3A%2F%2Fbmcmedicine.biomedcentral.com%2Farticle%2F10.1186%2Fs12916-017-0815-7&token2=exp=1489582191~acl=%2Fstatic%2Fpdf%2F60%2Fart%25253A10.1186%25252Fs12916-017-0815-7.pdf*~hmac=d35602720e744282b96693b84ef6506b86763ff444e9c3f756d6b7a495e4653d">Download PDF</a></div>
<a href="http://hepatitiscnewdrugs.blogspot.com/2017/03/hepatitis-c-related-hepatocellular.html">Hepatitis C-related hepatocellular carcinoma in the era of new generation antivirals</a> <br />
Abstract <br />
Hepatitis C virus infection is a major cause of hepatocellular carcinoma worldwide. Interferon has been the major antiviral treatment, yielding viral clearance in approximately half of patients. New direct-acting antivirals substantially improved the cure rate to above 90%. However, access to therapies remains limited due to the high costs and under-diagnosis of infection in specific subpopulations, e.g., baby boomers, inmates, and injection drug users, and therefore, hepatocellular carcinoma incidence is predicted to increase in the next decades even in high-resource countries. Moreover, cancer risk persists even after 10 years of viral cure, and thus a clinical strategy for its monitoring is urgently needed. Several risk-predictive host factors, e.g., advanced liver fibrosis, older age, accompanying metabolic diseases such as diabetes, persisting hepatic inflammation, and elevated alpha-fetoprotein, as well as viral factors, e.g., core protein variants and genotype 3, have been reported. Indeed, a molecular signature in the liver has been associated with cancer risk even after viral cure. Direct-acting antivirals may affect cancer development and recurrence, which needs to be determined in further investigation.<br />
<a href="http://download.springer.com/static/pdf/60/art%253A10.1186%252Fs12916-017-0815-7.pdf?originUrl=http%3A%2F%2Fbmcmedicine.biomedcentral.com%2Farticle%2F10.1186%2Fs12916-017-0815-7&token2=exp=1489582191~acl=%2Fstatic%2Fpdf%2F60%2Fart%25253A10.1186%25252Fs12916-017-0815-7.pdf*~hmac=d35602720e744282b96693b84ef6506b86763ff444e9c3f756d6b7a495e4653d">Download PDF</a><br />
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Feb 27, 2017<br />
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<a href="http://www.aidsmap.com/page/3120999/">Are people with HIV and HCV co-infection who are cured of hepatitis C with DAAs at increased risk for liver cancer?</a></div>
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People with HIV and hepatitis C virus (HCV) co-infection who are successfully treated for hepatitis C using interferon-free direct-acting antiviral (DAA) therapy do not appear to have an increased likelihood of developing hepatocellular carcinoma (HCC), according to a study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) this month in Seattle. </div>
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Accepted Manuscript</div>
Gastroenterology Accepted Date: 23 January 2017<br />
Genome-wide Association Study Identifies TLL1 <a href="http://www.gastrojournal.org/article/S0016-5085(17)30130-0/pdf">Variant Associated With Development of Hepatocellular Carcinoma After Eradication of Hepatitis C Virus Infection</a> <br />
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<i>Media Coverage of this Article</i><br />
Feb 22, 2017<br />
<a href="http://hepatitiscnewdrugs.blogspot.com/2017/02/genetic-variant-linked-to-risk-of-liver.html">Genetic variant linked to risk of liver cancer after hep C eradication</a> <br />
NEW YORK (Reuters Health) – A single nucleotide polymorphism (SNP) in the tolloid-like 1 (TLL1) gene is associated with the development of hepatocellular carcinoma (HCC) after eradication of hepatitis C virus (HCV) infection, researchers from Japan report.<br />
<!--break-->“When we constructed different models for predicting HCC in patients with mild as opposed to advanced hepatic fibrosis by combining this TLL1 variant with other distinct risk factors, these proposed models including TLL1 variant could be useful for predicting the occurrence of HCC after achieving sustained virological response (SVR) in the clinical practice,” Dr. Yasuhito Tanaka from Nagoya City University Graduate School of Medical Sciences told Reuters Health by email.<br />
<a href="http://www.journalofclinicalpathways.com/news/genetic-variant-linked-risk-liver-cancer-after-hep-c-eradication">Continue reading...</a><b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />
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<b>Feb 8, 2017</b><br />
<a href="http://www.medscape.com/viewarticle/875494">High Rates of Hepatocellular Carcinoma After Hepatitis C Treatment</a><br />
NEW YORK (Reuters Health) - Patients treated with direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV)-related cirrhosis appear to have high rates of hepatocellular carcinoma (HCC).<br />
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"If these findings are confirmed from other centers, studies are suggested to examine mechanisms of these findings," Dr. Ashwani Singal from University of Alabama at Birmingham told Reuters Health by email.<br />
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Some studies have shown unexpectedly high HCC recurrence rates after DAA therapy, whereas others have shown no such association.<br />
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Dr. Singal and colleagues examined the occurrence of de novo HCC in their retrospective study of 66 patients with HCV-related cirrhosis who received DAA between 2015 and 2016.<br />
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Typically, patients with HCV cirrhosis have an HCC incidence of 3%-5% per year, the researchers say.</div>
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But six of these patients (9.1%) developed HCC during or within six months after treatment, and two additional patients (3%) developed indeterminate liver lesions, according to their letter online February 1st in Gastroenterology.</div>
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They note that another study showed a reduced risk of HCC occurrence among DAA-treated patients who achieved sustained viral responses (SVR) versus those not achieving SVR, so they suggest prospective multicenter studies to confirm these findings.</div>
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"Be aware of this potential issue and consider more intensive HCC surveillance of HCV cirrhotics during and after HCV therapy," Dr. Singal concluded.</div>
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Dr. Gaetano Serviddio from University of Foggia, Italy, who has reported on the outcomes of DAA therapy, told Reuters Health by email, "DAAs have completely changed the prognosis of chronic hepatitis C patients who have a unique possibility to be cured definitively. To discover that such drugs have some tumor risks is particularly terrible. In any case, the number of events is small, and the data are not enough to support the hypothesis that the risk is directly related to the drugs."<br />
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"DAAs are safe and powerful drugs; millions of lives will be saved with such drugs," he said. "Studies should be supported to completely define patients at risk of HCC recurrence."<br />
SOURCE: <a href="http://bit.ly/2lmDbXa">http://bit.ly/2lmDbXa</a><br />
Gastroenterol 2017. <br />
<br />
<b>January 2017</b> <br />
In Press, Corrected Proof<br />
<a class="cLink" href="http://www.sciencedirect.com/science/journal/15908658" querystr="?zone=centerPane" title="Go to Digestive and Liver Disease on ScienceDirect">Digestive and Liver Disease</a><br />
<div class="volIssue">
Available online 21 January 2017</div>
<a href="http://www.sciencedirect.com/science/article/pii/S1590865817301639" target="_blank">HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma: A “true-or-false game”</a><br />
<div class="svArticle section clear" id="par0085">
Three years ago, the new direct antiviral therapies (DAAs) were approved for HCV treatment and the scenario completely changed. The share of patients in whom eradication is obtained raised to over 90% <span id="bbib0035"><a class="intra_ref" href="http://www.sciencedirect.com/science/article/pii/S1590865817301639#bib0035" id="ancbbib0035">[7]</a></span>, the limits in the stage of the disease that can be treated disappeared, but solid data on the long-term outcome of cirrhotics treated with these new drugs are lacking. </div>
<!--VALIDHTML--><br />
<div class="svArticle section clear" id="par0090">
A totally unexpected, intriguing and somehow hard-to-believe report of an increased incidence of HCC with rapid recurrence after HCV eradication with DAAs was first presented at the 2016 EASL meeting and then published in the <em>Journal of Hepatology.....</em> <span id="bbib0040"><a class="intra_ref" href="http://www.sciencedirect.com/science/article/pii/S1590865817301639#bib0040" id="ancbbib0040"></a></span></div>
<a href="http://www.sciencedirect.com/science/article/pii/S1590865817301639" target="_blank">Continue to full text article...</a></div>
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<b><br /></b>
<b>2016</b><br />
AASLD 2016 and International Liver Congress 2016</div>
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Two studies presented at The Liver Meeting® 2016, and research presented in April at the International Liver Congress 2016. </div>
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<b>Patients With HCV Who Treated With I</b><b>nterferon-based Therapy </b><b> </b></div>
We begin with a study presented at AASLD 2016; <i>The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort,</i> that suggested patients achieving SVR were still at risk for hepatocellular carcinoma, more specifically older patients and those with cirrhosis, commentary on the study is available over at Healio; <a href="http://www.healio.com/hepatology/hepatitis-c/news/online/%7B69cd1e88-bf4f-4dcf-a87d-9ce327c43e01%7D/svr-postinterferon-based-therapy-reduces-not-eliminates-risk-for-hcc"><i>SVR post–interferon-based therapy reduces, not eliminates risk for HCC</i></a>, below is a summary of the study followed by slides @ <a href="http://www.natap.org/2016/AASLD/AASLD.htm" target="_blank">NATAP </a><br />
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<b>Liver cancer risk reduced in patients cured of HCV</b><br />
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A large study found that the risk of hepatocellular carcinoma was reduced by 80% in people cured of HCV compared to those who were not cured.<br />
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This was a study of the entire population of people treated for HCV in British Columbia province, Canada, between 1990 and 2013. The study identified 8147 people treated with interferon-based regimens, 57% of whom were cured. Treated individuals were followed for a median of 5.6 years.<br />
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The liver cancer incidence was highest among those with cirrhosis who did not achieve a SVR (21 cases per 1000 patient-years of follow-up). In comparison, the liver cancer incidence was 6.4 per 1000 patient-years in those with cirrhosis who achieved SVR, 7.2 in those without cirrhosis who did not achieve SVR12 and 1.1 per 1000 patient-years in those without cirrhosis who achieved SVR12.<br />
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In a multivariable analysis liver cancer was associated with cirrhosis, age over 50 years, genotype three infection versus genotype one, alcohol consumption and being male in those who were not cured. In those who were cured of hepatitis C, only cirrhosis, age over 50 and being male were associated with an increased risk of liver cancer.<br />
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The researchers concluded that although curing HCV greatly reduces the risk of developing liver cancer, it does not eliminate the risk entirely. Older people and those with cirrhosis are at higher risk than others, underlining the importance of early diagnosis and treatment.<br />
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Reference</div>
<div>
<a href="http://onlinelibrary.wiley.com/doi/10.1002/hep.28796/full">The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort</a>. Janjua NZ et al. The 67th Meeting of the American Association for the Study of Liver Diseases, Boston 2016. Abstract 175</div>
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Summary Source - <a href="https://www.basl.org.uk/">https://www.basl.org.uk/</a><b></b></div>
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<b><br /></b></div>
<div>
<b>Review Slides</b> </div>
<div class="newsItemLarge collapse in" id="newsContent415">
<a href="http://www.natap.org/2016/AASLD/AASLD.htm" target="_blank">NATAP </a>- Reported by Jules Levin<br />
<a href="http://www.natap.org/2016/AASLD/AASLD_63.htm">The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: The BC Hepatitis Testers Cohort </a><br />
<br />
<a href="http://www.natap.org/2016/AASLD/AASLD_42.htm">Impact of treatment induced vs. spontaneous HCV clearance on the long term risk of hepatocellular carcinoma: BC Hepatitis Testers Cohort </a> </div>
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<b>Patients With HCV Who Treated With Oral DAAs</b><br />
In a prospective study presented at the 2016 AASLD; <em>Incidence and pattern of "de novo" hepatocellular carcinoma in HCV patients treated with oral DAAs, </em>reported that treatment with direct-acting antiviral therapy did not increase the risk of developing hepatocellular carcinoma in patients with HCV, but patients with advanced liver disease should continue to be monitored for liver cancer after treatment, here is the AASLD press release, followed by slides @ <a href="http://www.natap.org/2016/AASLD/AASLD_59.htm" target="_blank">NATAP</a>.<br />
<br />
AASLD Press Release;<br />
<b>AASLD 2016 - Is There an Increased Risk of Cancer After Taking Direct-Acting Antiviral Medication?</b> <br />
BOSTON, Nov. 11, 2016 <br />
A new study presented this week at <a href="http://www.thelivermeeting.org/">The Liver Meeting®</a> — held by the <a href="http://www.aasld.org/">American Association for the Study of Liver Diseases</a> — found patients with hepatitis C who take direct-acting antiviral medication are at no higher risk for developing liver cancer than those who do not take the medication. However, they might be at an increased for more aggressive, infiltrative patterns of cancer, should they develop it.<br />
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"Data on clinical outcomes in cirrhotic patients with hepatitis C treated with direct-acting antiviral agents (DAAs) are still scanty and somehow controversial, and this is particularly true for development of a liver cancer, one of the most frequent and deadly complications of the disease," says Alfredo Alberti; professor of gastroenterology at University of Padova in Padova, Italy, and lead investigator in the study.<br />
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Recent studies have suggested the possibility of increased risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after DAA treatment in patients with hepatitis C (HCV). Dr. Alberti's team recently looked at the incidence of new cases of liver cancer among 3,075 HCV patients with advanced liver disease who were treated with DAAs. Almost 70 percent of the patients studied were men, and nearly 86 percent had cirrhosis (scarring of the liver). HCV genotypes one through four were all represented in the study, and patients with a past history of liver cancer were excluded. <br />
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All participants were treated with oral DAA therapy and monitored monthly. At the time of Dr. Alberti's team's analysis, patients had an average follow up of nearly 305 days from the time they started DAA therapy. During this period, the researchers found 41 patients had developed liver cancer, and the overall incidence (per 100 patient years) was 1.64.<br />
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Dr. Alberti's team further noted an incidence rate of 0.23 in patients without cirrhosis and of 1.93 in those with cirrhosis (1.93 for men and 1.94 for women). Incidence rates varied among HCV genotypes as well, with HCV-1 at the low end (1.70) and HCV-3 at the high end (2.44). Finally, cirrhotic patients with a Child-Pugh score of 'A' had an incidence rate of 1.64 and those with more advanced disease and a score of 'B' had a rate of 2.92.<br />
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"These rate incidences were not significantly different from those observed in historical control cohorts of similar patients from the same geographic area, not receiving antiviral therapy, indicating that the risk of developing HCC is not increased by oral DAAs, being closely dependent on stage of disease as in untreated cases," says Dr. Alberti.<br />
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Liver cancer was diagnosed four weeks after starting DAA therapy in three patients, at week eight in three patients, week 12 in six patients, between week 12 and 24 in thirteen patients, and after treatment ended in sixteen patients. Fifty percent of patients who developed liver cancer developed a single nodular cancer with a typical vascular pattern, while 50 percent had a more aggressive pattern. Finally, 28 out of the 41 patients who developed cancer were successfully cured of HCV (reaching a sustained virological response at 12 weeks), while the remaining 13 relapsed.<br />
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In different analyses of the data, Dr. Alberti's team found elevated liver enzymes and low platelet count to be associated with liver cancer risk, while gender, age, HCV genotype and DAA regimen were not. The best baseline predictor of liver cancer risk was APRI scores (which calculate scarring in the liver). The researchers find the risk of developing liver cancer increased linearly by 10 percent at each one-point increase in APRI value. <br />
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"The results of this study, while confirming that DAAs treatment doesn't increase the overall risk of HCC, indicate that there is no pharmacological prevention of HCC even with successful antiviral therapy, at least during the first six to 12 months after initiation of treatment when microscopic and therefore initially invisible HCC foci might even be boosted in their growth as consequence of the profound immunological and molecular changes in the liver microenvironment following abrupt cessation of HCV replication," explains Dr. Alberti. "Therefore, it is mandatory that patients treated with DAAs with advanced liver disease should continue to be monitored for HCC." <br />
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This release contains updated data. Dr. Alberti will present these findings at AASLD's press conference in Room 313 at John B. Hynes Veterans Memorial Convention Center in Boston on Saturday, November 12 at 4pm. The study entitled "Incidence and pattern of "de novo" hepatocellular carcinoma in HCV patients treated with oral DAAs" will be presented by Antonietta Romano, MD in Ballroom A on Sunday, November 13 at 10am. The corresponding abstract (number 19) can be found in the journal, Hepatology – <a href="http://aasldpubs.onlinelibrary.wiley.com/hub/issue/10.1002/hep.v64.S1">Special Issue: The 67th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2016</a>.<br />
<br />
View the slides @ <a href="http://www.natap.org/2016/AASLD/AASLD_59.htm" target="_blank">NATAP</a> Reported by Jules Levin<br />
<div>
<div class="reference">
<a href="http://www.natap.org/2016/AASLD/AASLD_59.htm">"Incidence and pattern of "de novo" hepatocellular carcinoma in HCV patients treated with oral DAAs" </a><br />
Another look at both studies; <i> Incidence and pattern of `de novo` hepatocellular carcinoma in HCV patients treated with oral DAAs and</i> <i>The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort.</i> <br />
<br />
<a href="http://www.aidsmap.com/page/3099046/" target="_blank">Liver cancer risk reduced after hepatitis C treatment, but vigilance needed for aggressive cancers in months after treatment</a></div>
<div class="reference">
<div class="reference">
Keith Alcorn <br />
People who are cured of hepatitis C after a course of direct-acting antiviral treatment do not have a higher risk of developing liver cancer (hepatocellular carcinoma), and probably have a reduced risk, studies from Italy and Canada presented at The Liver Meeting this week in Boston have shown. However, Italian researchers also found that those people who did develop liver cancer during or shortly after antiviral treatment were more likely to develop an aggressive form of liver cancer, perhaps because of changes in immune surveillance in the liver as a result of treatment.</div>
<div class="reference">
<a href="http://www.aidsmap.com/page/3099046/">Continue reading...</a></div>
</div>
<div class="reference">
<br /></div>
</div>
<b>Patients With HCV And History Of Liver Cancer Who Treated With New Antivirals</b> <br />
As a reference point two studies presented in April at the International Liver Congress 2016 found; patients with a history of hepatocellular carcinoma have the highest risk of developing a tumor after direct-acting antiviral therapy, but new diagnoses were also reported. Read the report; <em>Liver Cancer Found in Hepatitis C Patients on New Antivirals </em>provided below, or over at <a href="http://www.medscape.com/viewarticle/862041" target="_blank"><em>Medscape.</em></a> <br />
<br />
<b>Liver Cancer Found in Hepatitis C Patients on New Antivirals</b><br />
Kate Johnson<br />
April 15, 2016<br />
BARCELONA, Spain — In a surprising number of patients with hepatitis C and cirrhosis, hepatocellular carcinoma develops within weeks of starting treatment with direct-acting antivirals, new research suggests.<br />
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"I do not think that direct-acting antivirals are directly responsible," said lead investigator Stefano Brillanti, MD, from the University of Bologna, Italy.<br />
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"The hypothesis is that immune surveillance may be reduced too rapidly," he told <em>Medscape Medical News</em>. "You have an immediate drop in viremia, but also attenuation of inflammation. I think inflammation is a bad thing in terms of hepatitis progression, but it may be a good thing in terms of controlling cancer."<br />
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The study by Dr Brillanti's team, presented here at the International Liver Congress 2016, suggests that patients with hepatitis C should be closely monitored after treatment with direct-acting antivirals. Two days earlier, a study conducted by a team from the University of Barcelona in Spain suggested the same thing (<em>J Hepatol</em>. <a href="http://www.journal-of-hepatology.eu/article/S0168-8278(16)30113-1/abstract">Published online April 12, 2016</a>).<br />
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Both studies indicate that patients with a history of hepatocellular carcinoma have the highest risk of developing a tumor after direct-acting antiviral therapy, but new diagnoses were also reported.<br />
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The EMA has <a href="http://www.medscape.com/viewarticle/862023">extended the scope</a> of its review of the six direct-acting antivirals approved for use in the European Union for the treatment of chronic hepatitis C infection to include the risk for early liver cancer recurrence, the agency reported.<br />
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<strong>Tumor Risk</strong><br />
"Patients with previous hepatocellular carcinoma are, of course, at risk of recurrence anyway," Dr Brillanti said. "A 30% rate over 3 years from initial surgery or ablation is normal. What was surprising to us was that we were observing 4 cm lesions after 12 weeks."<br />
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The retrospective cohort study involved 344 consecutive patients with hepatitis C and cirrhosis who were treated with one or two direct-acting antivirals and followed for 24 weeks after therapy. Median age was 63 years.<br />
In this cohort, 237 patients were infected with hepatitis C genotype 1, 191 had received previous antiviral treatment, and 59 had been successfully treated for hepatocellular carcinoma.<br />
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Contrast-enhanced ultrasonography and CT scans or MRIs were performed at baseline to exclude active hepatocellular carcinoma, and then again 12 and 24 weeks after treatment.<br />
During the follow-up period, 26 of the 344 patients (7.6%) were diagnosed with hepatocellular carcinoma. This included 17 of the 59 patients previously treated for hepatocellular carcinoma, and nine of the 285 patients (3.2%) with no history of carcinoma.<br />
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There was no association between recurrence and hepatitis C genotype, direct-acting antiviral regimen, or treatment response for patients who did not develop hepatocellular carcinoma or for those who did. The sustained viral response rate at 12 weeks was 89% in the two groups.<br />
For patients with a history of hepatocellular carcinoma, those who developed a recurrence were significantly younger than those who did not (56 vs 73 years), were more frequently treatment-experienced (88.2% vs 61.9%), and had more advanced liver fibrosis at baseline.<br />
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More patients who developed hepatocellular carcinoma during the follow-up period, regardless of history, had advanced cirrhosis than those who did not, indicated by a Child-Pugh class B score (26.9% vs 10.1%; <em>P</em> =.02). They also had more liver stiffness, indicated by a measure above 21.3 Kpa (61.5% vs 31.8%; <em>P</em> = .005), and fewer platelets at baseline (102.3 vs 124.4 × 1000/mm³; <em>P</em> = .02).<br />
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<strong>Second Study</strong><br />
In the Spanish study, all 58 hepatitis C patients had a history of hepatocellular carcinoma (with complete radiologic response), and all but three were cirrhotic at the start of direct-acting antiviral therapy. After a median follow-up of 5.7 months, the rate of tumor recurrence was 27.6%, with a median time to recurrence of 3.5 months. The sustained viral response rate at 12 weeks was 97.5%.<br />
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In their publication, the Spanish authors note that these findings "raise a concern about the benefits" of direct-acting antiviral therapy in the subgroup of hepatitis C patients with a history of hepatocellular carcinoma. Although the therapies "offer a major hope for current and future patients, we may face a drawback that may change these predictions in specific groups of patients," they point out.<br />
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Dr Brillanti said he is less concerned. "Clones of the hepatocellular carcinoma were present before the therapy," he pointed out, suggesting that direct-acting antivirals simply accelerated their inevitable progression. Either way, he said, an increased risk for hepatocellular carcinoma should not deter clinicians or patients from pursuing treatment with direct-acting antivirals when it is needed.<br />
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"This is a different cancer than elsewhere in oncology — it is a cancer within an advanced chronic disease — so the prognosis, the life expectancy, is related not only to the liver cancer but also to the liver disease and liver function," he explained. "If you don't treat these patients and ameliorate their liver function, and if hepatocellular carcinoma occurs, you have no chance of curing them. But if you ameliorate liver function and they develop hepatocellular carcinoma, you can cure it better because their improved liver function will allow an ablation."<br />
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This finding is "quite striking and unexpected, but we have to be cautious," said Laurent Castera, MD, PhD, from Hôpital Beaujon in Clichy, France, who is vice-secretary of the European Association for the Study of the Liver, and was not involved with the research.<br />
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"It is potentially worrying, but these are retrospective studies, with possible referral bias, and no long-term follow-up," he told <em>Medscape Medical News</em>.<br />
<br />
<em>Dr Brillanti reports receiving research grants from Gilead Sciences and being on the advisory board for Janssen and Gilead Sciences. Dr Castera reports serving on the speaker's bureau for Echosens.</em><br />
International Liver Congress (ILC) 2016: Abstract LBP506. Presented April 14, 2016.<br />
Source - <a href="http://www.medscape.com/viewarticle/862041">Medscape </a><br />
<br />
<b>Feb 2017</b><br />
Of Interest - In The News<br />
<a href="http://hepatitiscnewdrugs.blogspot.com/2017/02/risk-of-liver-cancer-low-in-patients.html">Risk of liver cancer low in patients with cirrhosis, study finds</a> <br />
01 Feb 2017<br />
The results of a study by researchers at The University of Nottingham suggest that the risk of liver cancer in patients with cirrhosis may be much lower than previously thought.<br />
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Liver cancer – or hepatocellular carcinoma (HCC) – is one of the most serious complications of cirrhosis, or scarring of the liver, caused by long-term liver damage.<br />
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However, an analysis of health records, published in the academic journal <a href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2036">Alimentary Pharmacology and Therapeutics</a>, found that the 10-year incidence of HCC in UK patients with cirrhosis is actually only four per cent, or lower.<br />
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<a href="https://www.nottingham.ac.uk/medicine/people/joe.west">Joe West</a>, Professor of Epidemiology in the University’s <a href="https://www.nottingham.ac.uk/medicine/">School of Medicine</a>, led the study and believes that the results could better inform doctors on how best to focus resources for the benefit of patients with liver damage.<br />
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He said: “This very low incidence of HCC occurrence in people with cirrhosis caused by alcohol or of unknown origin suggests that surveillance for HCC among these groups is likely to benefit patients little.<br />
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“As surveillance incurs substantial cost, it is therefore unlikely to represent value for money for the NHS. There may well be other ways of spending this money that would benefit patients far more.”<br />
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Cirrhosis is caused by long-term damage to the liver, which leads to a build-up of scar tissue which replaces healthy tissue and eventually can result in liver failure.<br />
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The researchers identified more than 3,000 patients with cirrhosis of the liver using the UK’s General Practice Research Database between 1987 and 2006 and then cross-referenced this information with diagnoses of HCC on linked national cancer registries.<br />
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The study found that only 1.2 per cent of patients with alcoholic cirrhosis and 1.1 per cent of patients with cirrhosis of unknown cause will develop HCC within a decade. The highest 10-year incidence of HCC was among those with cirrhosis due to chronic viral hepatitis (four per cent).<br />
<a href="http://www.nottingham.ac.uk/news/pressreleases/2017/january/risk-of-liver-cancer-low-in-patients-with-cirrhosis-study-finds.aspx">http://www.nottingham.ac.uk/news/pressreleases/2017/january/risk-of-liver-cancer-low-in-patients-with-cirrhosis-study-finds.aspx</a><br />
<br />
<b>March 2017</b><br />
<a href="http://www.mdedge.com/idpractitioner/article/133709/hepatitis/antiviral-medication-successful-treating-hcv-hepatocellular">Antiviral medication successful for treating HCV in hepatocellular carcinoma</a><br />
<div class="byline">
Direct-acting antiviral (DAA) medication was successful in treating hepatitis C in 74.5% of patients with hepatocellular carcinoma, and 93.4% of patients with HCC who underwent liver transplants, according to a study funded by Veterans Affairs.</div>
<br />
<a href="http://hepatitiscnewdrugs.blogspot.com/2017/03/hepatocellular-carcinoma-decreases.html">Hepatocellular Carcinoma Decreases the Chance of Successful Hepatitis C Virus Therapy with Direct-Acting Antivirals</a><br />
The new medications for hepatitis C have excellent cure rates. However, our study shows that in patients with both liver cancer and hepatitis C, they do not achieve these cure rates. Patients with liver cancer are almost 6 times more likely to fail hepatitis C treatment than patients without liver cancer<br />
<br />
<b>AGA Institute Clinical Practice Update: Care of Patients Who Have Achieved a Sustained Virologic Response (SVR) Following Antiviral Therapy for Chronic Hepatitis C Infection</b> <br />
Ira M. Jacobson M.D., Joseph K. Lim, M.D., and Michael W. Fried, M.D.<br />
ACCEPTED MANUSCRIPT<br />
DOI: <a href="http://dx.doi.org/10.1053/j.gastro.2017.03.018">http://dx.doi.org/10.1053/j.gastro.2017.03.018</a><br />
<b><u><span style="color: #2288bb;"><br /></span></u></b> <b>View Full Text</b><br />
<a href="http://freepdfhosting.com/f727239201.pdf?platform=hootsuite">PDF Download</a><br />
<u><span style="color: #2288bb;"><br /></span></u><b>Abstract</b><br />
<div class="content">
Chronic hepatitis C virus (HCV) infection is well-recognized as a common blood borne infection with global public health impact, affecting 3 to 5 million persons in the U.S. and over 170 million persons worldwide. Chronic HCV infection is associated with significant morbidity and mortality due to complications of liver cirrhosis and hepatocellular carcinoma (HCC). Current therapies with all-oral directly acting antiviral agents (DAAs) are associated with high rates of sustained virologic response (SVR), generally exceeding 90%. SVR is associated with a reduced risk of liver cirrhosis, hepatic decompensation, need for liver transplantation, and both liver-related and all-cause mortality. However, a subset of patients who achieve SVR will remain at long-term risk for progression to cirrhosis, liver failure, HCC, and liver-related mortality. Limited evidence is available to guide clinicians on which post-SVR patients should be monitored versus discharged, how to monitor and with which tests, how frequently should monitoring occur, and for how long. In this clinical practice update, available evidence and expert opinion are used to generate best practice recommendations on the care of patients with chronic HCV who have achieved SVR.</div>
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<b>Index</b><br />
<b>Assessment of HCV RNA after SVR12 has been attained</b> <br />
<i>With the initiation of trials of DAA regimens, initially in combination with interferon and later without it, the attainment of SVR 12 weeks after completion of treatment replaced SVR24 as the primary endpoint, defined as undetectable HCV RNA on a highly sensitive PCR assay (lower limit of detection <12 IU/mL). This transition was based upon the rarity of relapse after follow up week 12, and it helped move the field ahead by shortening the intervals between successive trials in development programs (22). It has become apparent that late relapse beyond this time point is no more common, and perhaps less so, than it was after interferon-based therapy</i><br />
Ongoing surveillance for hepatocellular carcinoma after SVR Is HCC risk after SVR exclusive to patients with advanced fibrosis and cirrhosis? <br />
Can HCC surveillance ever be discontinued? <br />
How should screening for, and management of, varices be affected by SVR? <br />
Should patients be routinely monitored for regression of advanced fibrosis or <br />
cirrhosis? <br />
Recurrent HCC After SVR <br />
Reinfection <br />
Lifestyle Measures <br />
Conclusions <br />
<a href="http://freepdfhosting.com/f727239201.pdf?platform=hootsuite">Continue reading...</a> <br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-64122394797222998282019-12-31T12:43:00.000-05:002019-12-31T13:08:27.884-05:00Long-term follow-up after cure from chronic hepatitis C virus infection shows occult hepatitis and a risk of hepatocellular carcinoma in noncirrhotic patients<div>
<b>Long-term follow-up after cure from chronic hepatitis C virus infection shows occult hepatitis and a risk of hepatocellular carcinoma in noncirrhotic patients</b></div>
<div>
Lybeck, Charlottea; Brenndörfer, Erwin D.c; Sällberg, Mattic; Montgomery, Scott M.b,d,g; Aleman, Sooe,f; Duberg, Ann-Sofia<br />
<i>SVR is associated with clinical cure and regression of liver fibrosis in most patients after 10 years of FU. However, occult HCV infection can be detected in some patients many years after achievement of SVR; this may have a negative effect on the regression of liver fibrosis, but more studies are needed. Future studies are planned to determine whether the viable virus can be recovered from PBMC. If so, this raises the question of whether those repetitively positive for HCV in PBMC should be retreated. Further, the risk of HCC is not eliminated in all noncirrhotic patients with SVR. Studies of the long-term outcome more than 10 years after IFN therapy and eventually after DAA therapy are needed.</i></div>
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Full-text <a href="https://journals.lww.com/eurojgh/Fulltext/2019/04000/Long_term_follow_up_after_cure_from_chronic.14.aspx">available online...</a><br />
<b><br /></b>
<b>On This Blog</b></div>
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<a href="https://hepatitiscnewdrugs.blogspot.com/search/label/liver%20cancer">Read All Posts With The Label Liver Cancer</a><br />
Review a collection of current research articles extracted from peer-reviewed journals, liver meetings/conferences, and learning activities investigating the natural history of liver cancer, approved therapies, risk factors associated with chronic viral hepatitis, cancer-prevention, including diet, nutrition and physical activity, and trends associated with the rising rate of hepatocellular carcinoma in the U.S.</div>
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Begin, <a href="https://hepatitiscnewdrugs.blogspot.com/search/label/liver%20cancer">here.....</a></div>
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<a href="https://hepatitiscnewdrugs.blogspot.com/2016/11/november-updates-liver-cancer-after.html">Liver Cancer After Treatment For Hepatitis C</a></div>
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Research demonstrates that while SVR markedly reduced liver-related complications and liver cancer, some long-term risk for liver cancer remained in those who were cured of Hepatitis C. But after direct-acting antiviral therapy does the risk of developing liver cancer increase? Research is saying no, <a href="https://hepatitiscnewdrugs.blogspot.com/2016/11/november-updates-liver-cancer-after.html">check out an index of articles here..... </a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-72146882285819831212019-03-06T08:14:00.000-05:002019-03-06T08:14:22.963-05:00Trio Health and Express Scripts’ Accredo Specialty Pharmacy Form Collaboration<b>Trio Health and Express Scripts’ Accredo Specialty Pharmacy Form Collaboration to Provide Real World Evidence on Prescription Medicines across Specialty and Rare Diseases </b><br /><div>
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<i>“Our collaboration with Accredo enables us to expand on our experience analyzing real world evidence in evaluating treatments for hepatitis C, oncology, RA, hemophilia and HIV, and review medications covering a broad range of diseases and conditions that are prescribed to millions of patients and cost billions of dollars.” </i></div>
<br />Trio Health announced today that Accredo Specialty Pharmacy will collaborate with Trio Health on their proprietary technology and analytics platform to provide real world evidence of outcomes on a wide range of medicines. The collaboration is expected to bring unprecedented value-based transparency to a medication’s journey. <br /><br />“Our healthcare system is comprised of patients, pharmaceutical companies, payers, physicians, pharmacy benefits managers and pharmacies, all with differing interests in terms of innovation, pricing and access to care. The ability to evaluate a complete data set encompassing patient experience and outcomes enables unparalleled insight into medication selection and value, insight that has been missing from our healthcare system,” said Brent Clough, CEO of Trio Health. “We believe once these factors become clearer, patients and biopharma innovators will benefit, as payers adopt a true performance-based model for drug reimbursement.” <br /><br /> Continued Mr. Clough, “Our collaboration with Accredo enables us to expand on our experience analyzing real world evidence in evaluating treatments for hepatitis C, oncology, RA, hemophilia and HIV, and review medications covering a broad range of diseases and conditions that are prescribed to millions of patients and cost billions of dollars.” <br /><br /><div>
Trio Health has the ability to analyze pharmacy, physician, and clinical information within its proprietary database. The resultant patient de-identified data is harmonized to bring a new understanding of the delivery, use and outcomes of prescription medications while optimizing care of real world patients. </div>
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<a href="https://www.businesswire.com/news/home/20190306005053/en"></a><br /></div>
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<a href="https://www.businesswire.com/news/home/20190306005053/en">https://www.businesswire.com/news/home/20190306005053/en</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-18071798822722708012019-03-05T16:00:00.000-05:002019-03-06T08:20:31.939-05:00Has a second person with HIV been cured? <b>Has a second person with HIV been cured? </b><br />
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By <a href="https://www.sciencemag.org/author/jon-cohen">Jon Cohen</a></div>
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Mar. 4, 2019 , 6:05 PM</div>
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Timothy Ray Brown, aka the “Berlin patient,” the only person to be cured of HIV, may finally have company. A decade after Brown became famous thanks to a stem cell transplant that eliminated his HIV infection, a similar transplant from a donor who has HIV-resistant cells appears to have cured another man, dubbed the “London patient.”<br />
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“This is a big deal,” says Sharon Lewin, who heads the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia. “It tells us that Timothy Brown wasn’t a one-off.” Although the interventions that the two patients received could only be used on a tiny fraction of the 37 million HIV-infected people worldwide, their stories point to cure strategies that could be more widely applicable.</div>
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Read more: <a href="https://www.sciencemag.org/news/2019/03/has-second-person-hiv-been-cured">https://www.sciencemag.org/news/2019/03/has-second-person-hiv-been-cured</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-74229418148997762352019-03-04T12:30:00.000-05:002019-03-04T12:30:25.860-05:00Hepatitis B and C among diabetes mellitus type 2 individuals<b>Prevalence of hepatitis B and hepatitis C among diabetes mellitus type 2 individuals </b><br />
Livia Melo Villar ,
Bruno Geloneze ,
Ana Carolina Junqueira Vasques ,
Maria Lucia Elias Pires ,
Juliana Custódio Miguel ,
Elisangela Ferreira da Silva ,
Vanessa Alves Marques ,
Leticia de Paula Scalioni ,
Elisabeth Lampe<br />
<br />
Published: February 28, 2019 <br />
<a href="https://doi.org/10.1371/journal.pone.0211193">https://doi.org/10.1371/journal.pone.0211193</a><br />
<br />
<b>Abstract</b><br />
Diabetes mellitus type 2 (DM2) patients have higher risk to be infected with parenterally transmitted viruses, like hepatitis B or C virus. This study aims to determine HBV and HCV infection prevalence in DM2 patients from Northeast and Southeast Brazil. A total of 537 DM2 patients were included, 194 (36.12%) males and 343 (63.87%) females, with mean age of 57.13±11.49 years. HBV and HCV markers were determined using serological and molecular analysis, and risk factors were evaluated in a subgroup from Southeast (n = 84). Two HBV acute (HBsAg+/anti-HBc -) and one HBV chronic case (HBsAg+/anti-HBc+) were found. Six individuals (1.1%) were isolated anti-HBc, 37 (6.9%) had HBV infection resolved (anti-HBc+/anti-HBs+), 40 (7.4%) were considered HBV vaccinated (anti-HBc-/anti-HBs+). Thirteen patients (2.42%) had anti-HCV and 7 of them were HCV RNA+. In the subgroup, anti-HBc positivity was associated to age and anti-HCV positivity was associated to age, time of diabetes diagnosis, total bilirubin, indirect bilirubin, alkaline phosphatase at bivariate analysis, but none of them was statistically significant at multivariate analysis. <br />
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As conclusion, low prevalence of HBV and high prevalence HCV was found in DM2 patients.<br />
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Full-text available online: <br />
<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211193">https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211193</a>HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-90768693974672758232019-03-04T12:25:00.000-05:002019-03-04T12:32:21.676-05:00No need to discontinue hepatitis C therapy at the time of liver transplantation <b>No need to discontinue hepatitis C virus therapy at the time of liver transplantation </b><br />
Catarina Skoglund, Martin Lagging, Maria Castedal<br />
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Published: February 22, 2019<br />
<a href="https://doi.org/10.1371/journal.pone.0211437">https://doi.org/10.1371/journal.pone.0211437</a> <br />
<br />
<b>Abstract</b><br />
Objectives<br />
Direct antiviral agents (DAA) has dramatically improved the therapy outcome of hepatitis C-virus (HCV) infection, both on the waiting-list and post liver transplantation (LT). DAA are generally well-tolerated in patients with mild to moderate liver and kidney failure, but some DAAs are contraindicated in patients with severe dysfunction of these organs. Today there are few studies of peri-LT DAA use and treatment is commonly discontinued at the time of LT. We report here our experience of DAA therapy given continuously in the perioperative LT period in a real-life setting in Sweden. <br />
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Material<br />
In total 10 patients with HCV-cirrhosis, with or without hepatocellular carcinoma, and a median age of 60.5 years (range, 52–65) wsere treated with DAAs on the waiting list for LT, and continued in the early postoperative period without any interruption, on the basis of not having reached a full treatment course at the time of LT. Sofosbuvir and a NS5A inhibitor with or without ribavirin, or sofosbuvir and ribavirin only, were given. The distribution of genotypes was genotype 1 and 3, in 4 and 6 patients, respectively. Six of the 10 patients had previously been treated with IFN-based therapy. <br />
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Results<br />
There were no adverse events leading to premature DAA discontinuation. All recipients achieved a sustained viral response 12 weeks after end-of-treatment (SVR12). At the time of LT the median MELD-score was 16.5 (range 7–21), CTP-score 9.0 (range 5–10), creatinine 82.5 μmol/L (range 56–135, reference 60–105), bilirubin 33 μmol/L (range 16–79, reference 5–25) and PK-INR 1.5 (range 1.1–1.8). The median duration of DAA therapy was 60 days (range 18–132) pre-LT, 54 days post-LT (range 8–111 days) and in total 15.5 weeks (range 12–30 weeks). <br />
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Conclusion<br />
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Interferon-free DAA therapy of HCV-infection given in the immediate pre- and post-operative LT period is safe, well-tolerated and yields high SVR rates.</div>
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<b>Full-text available online:</b></div>
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<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211437">https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211437</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-72081557808417444122019-03-04T12:21:00.000-05:002019-03-04T12:21:30.932-05:00Hepatitis C among intravenous drug users in upper middle-income countries. <b>Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis</b> <br />
Víctor Granados-García , Yvonne N. Flores, Lizbeth I. Díaz-Trejo, Lucia Méndez-Sánchez, Stephanie Liu, Guillermo Salinas-Escudero, Filiberto Toledano-Toledano, Jorge Salmerón <br />
<br />Published: February 26, 2019 <br /><div>
<a href="https://doi.org/10.1371/journal.pone.0212558">https://doi.org/10.1371/journal.pone.0212558</a> </div>
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<b>Abstract</b></div>
Aim<br />
This systematic review and meta-analysis characterizes the prevalence of hepatitis C virus (HCV) infection among intravenous drug users (IDUs) in upper middle-income countries. <br />
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Methods<br />
Five databases were searched from 1990–2016 for studies that took place in countries with a GDP per capita of $7,000 to $13,000 USD. The data extraction was performed based on information regarding prevalence, sample size, age of participants, duration of intravenous drug use (IDU), recruitment location, dates of data collection, study design, sampling scheme, type of tests used in identifying antibody reactivity to HCV, and the use of confirmatory tests. The synthesis was performed with a random effects model. The Cochrane statistical Q-test was used to evaluate the statistical heterogeneity of the results. <br />
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Results<br />
The 33 studies included in the analysis correspond to a sample of seven countries and 23,342 observations. The point prevalence value estimates and confidence intervals of the random effects model were 0.729 and 0.644–0.800, respectively for all seven countries, and were greatest for China (0.633; 0.522–0.732) as compared to Brazil (0.396; 0.249–0.564). Prevalence for Montenegro (0.416; 0.237–0.621) and Malaysia (0.475; 0.177–0.792) appear to be intermediate. Mexico (0.960) and Mauritania (0.973) had only one study with the largest prevalence. A clear association was not observed between age or duration of IDU and prevalence of HCV, but the data from some groups may indicate a possible relationship. The measures of heterogeneity (Q and I2) suggest a high level of heterogeneity in studies conducted at the country level and by groups of countries. <br />
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Conclusions<br />
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In this systematic review and meta-analysis, we found that the pooled prevalence of HCV was high (0.729) among a group of seven upper middle income countries. However, there was significant variation in the prevalence of HCV observed in China (0.633) and Brazil (0.396). </div>
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<b>Full-text available online:</b></div>
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<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212558">https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212558</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-74276279169112982072019-03-04T12:00:00.001-05:002019-03-04T12:06:15.714-05:00NIH study of brain energy patterns provides new insights into alcohol effects<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4VIXp8JjpgkCzAl4gbgmPlCLSJXS4CE20W-J7Nkeligi1EwXxtkHvn0H0jqDuJrLB4B84uElpJulAY7F2sTMAz4L3zkpzlYgG9wJYys_r4e9sB3n0hCGpkiHzyU5kR7SczrZVjl-50tw/s1600/20190304-brain-niaaa.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="816" data-original-width="1157" height="140" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4VIXp8JjpgkCzAl4gbgmPlCLSJXS4CE20W-J7Nkeligi1EwXxtkHvn0H0jqDuJrLB4B84uElpJulAY7F2sTMAz4L3zkpzlYgG9wJYys_r4e9sB3n0hCGpkiHzyU5kR7SczrZVjl-50tw/s200/20190304-brain-niaaa.jpg" width="200" /></a></div>
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<i>NIH scientists present a new method for combining measures of brain activity (left) and glucose consumption (right) to study regional specialization and to better understand the effects of alcohol on the human brain.</i></div>
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<i>Dr. Ehsan Shokri Kojori, NIAAA</i></div>
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<b>NIH study of brain energy patterns provides new insights into alcohol effects</b></div>
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Assessing the patterns of energy use and neuronal activity simultaneously in the human brain improves our understanding of how alcohol affects the brain, according to new research by scientists at the National Institutes of Health. The new approach for characterizing brain energetic patterns could also be useful for studying other neuropsychiatric diseases. A report of the findings is now online in Nature Communications.</div>
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“The brain uses a lot of energy compared to other body organs, and the association between brain activity and energy utilization is an important marker of brain health,” said George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of NIH, which funded the study. “This study introduces a new way of characterizing how brain activity is related to its consumption of glucose, which could be very useful in understanding how the brain uses energy in health and disease.”<br />
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The research was led by Dr. Ehsan Shokri-Kojori and Dr. Nora D. Volkow of the NIAAA Laboratory of Neuroimaging. Dr. Volkow is also the director of the National Institute on Drug Abuse at NIH. In previous studies they and their colleagues have shown that alcohol significantly affects brain glucose metabolism, a measure of energy use, as well as regional brain activity, which is assessed through changes in blood oxygenation.<br />
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“The findings from this study highlight the relevance of energetics for ensuring normal brain function and reveal how it is disrupted by excessive alcohol consumption,” says Dr. Volkow.<br />
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In their new study, the researchers combined human brain imaging techniques for measuring glucose metabolism and neuronal activity to derive new measures, which they termed power and cost.<br />
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“We measured power by observing to what extent brain regions are active and use energy,” explained Dr. Shokri-Kojori. “We measured cost of brain regions by observing to what extent their energy use exceeds their underlying activity.”<br />
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In a group of healthy volunteers, the researchers showed that different brain regions that serve distinct functions have notably different power and different cost. They then investigated the effects of alcohol on these new measures by assessing a group of people that included light drinkers and heavy drinkers and found that both acute and chronic exposure to alcohol affected power and cost of brain regions.<br />
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“In heavy drinkers, we saw less regional power for example in the thalamus, the sensory gateway, and frontal cortex of the brain, which is important for decision making,” said Dr. Shokri-Kojori. “These decreases in power were interpreted to reflect toxic effects of long-term exposure to alcohol on the brain cells.”<br />
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The researchers also found a decrease in power during acute alcohol exposure in the visual regions, which was related to disruption of visual processing. At the same time, visual regions had the most significant decreases in cost of activity during alcohol intoxication, which is consistent with the reliance of these regions on alternative energy sources such as acetate, a byproduct of alcohol metabolism.<br />
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They conclude that despite widespread decreases in glucose metabolism in heavy drinkers compared to light drinkers, heavy drinking shifts the brain toward less efficient energetic states. Future studies are needed to investigate the mechanisms contributing to this relative inefficiency.<br />
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“Studying energetic signatures of brain regions in different neuropsychiatric diseases is an important future direction, as the measures of power and cost may provide new multimodal biomarkers for such disorders,” says Dr. Shokri-Kojori.<br />
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The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at: <a href="https://www.niaaa.nih.gov/">https://www.niaaa.nih.gov</a>.<br />
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About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit <a href="https://www.nih.gov/">www.nih.gov</a>.<br />
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Reference<br />
Shokri-Kojori E, Tomasi D, Alipanahi B, Wiers CE, Wang GJ, Volkow ND (2019). Correspondence between cerebral glucose metabolism and BOLD reveals relative power and cost in human brain. Nat Commun. 10(1):690.HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-21684385992638248372019-03-03T17:50:00.002-05:002019-03-03T18:04:25.050-05:00HCV reinfection as a positive indication of high‐risk population treatment accessRecommended Reading<br />
<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jvh.13035">High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme</a><br />
We show that it is feasible to recruit people who inject drugs(PWID) from a community-basedneedle and syringe programme (NSP) onto HCV treatment, and achieve over 80% SVR-12 andimpressive treatment adherence.<br />
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Commentary<br />
<b>HCV reinfection as a positive indication of high‐risk population treatment access</b><br />
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Gregory J Dore</div>
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First published: 25 February 2019 <br />
<a href="https://doi.org/10.1111/jvh.13092">https://doi.org/10.1111/jvh.13092</a><br />
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Strategies to address HCV reinfection and limit its overall impact on HCV elimination are required, but the most important of these is ongoing engagement with high- risk individuals to enable detection of HCV reinfection and its retreatment without stigma and discrimination. <br />
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Download full-text article:<br />
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<a href="https://jumpshare.com/v/e6nm2pXcbAWHvAV3jKSr">https://jumpshare.com/v/e6nm2pXcbAWHvAV3jKSr </a></div>
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Article shared via Twitter by <a href="https://twitter.com/HenryEChang">Henry E. Chang</a>.</div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-28283811346037459362019-03-03T12:42:00.000-05:002019-03-04T12:43:21.491-05:00First patient dosed in phase 2/3 trial of advanced HCC therapy<a href="https://www.healio.com/hepatology/oncology/news/online/%7Bb968f9fe-3d78-4500-b505-5b2a81d7aefb%7D/first-patient-dosed-in-phase-23-trial-of-advanced-hcc-therapy">First patient dosed in phase 2/3 trial of advanced HCC therapy</a><br />March 3, 2019<br /><br />Innovent Biologics announced first patient dosing in a phase 2/3 trial of Tyvyt with IBI305 for patients with advanced hepatocellular carcinoma taking place in China, according to a press release.<br /><br />"HCC is the fourth most common cancer and the second leading cause of cancer related death in China,” Fan Jia, president of Zhongshan Hospital, said in the release. “The five-year survival rate is about 10%, and only 20-30% of patients have the opportunity for curative surgery. Current targeted therapies have only shown limited responses in HCC. Immune checkpoint inhibitors have brought new hope to patients with this life-threatening disease.”<br />
<br />
<a href="https://www.healio.com/hepatology/oncology/news/online/%7Bb968f9fe-3d78-4500-b505-5b2a81d7aefb%7D/first-patient-dosed-in-phase-23-trial-of-advanced-hcc-therapy">Continue reading article...</a>HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-14597429425549739702019-03-02T18:33:00.002-05:002019-03-02T18:36:38.739-05:00Discovery may lead to a blood test to detect early stages of NAFLD<b>Towards a blood test for early-stage liver disease</b><br />
<i>Researchers uncover a set of proteins that are enriched in pre-symptomatic non-alcoholic fatty liver disease</i><br />
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Heidelberg, 1 March 2019 – One in four people in Western and Asian societies develop a build-up of fat in the liver as a result of an unhealthy diet. This disease – referred to as non-alcoholic fatty liver disease (NAFLD) – causes no symptoms initially but can develop into end-stage liver cirrhosis with limited treatment options. A discovery, published today in <a href="http://msb.embopress.org/">Molecular Systems Biology</a>, paves the way for a simple blood test to detect early stages of NAFLD, opening up the possibility of preventing the development of liver cirrhosis through lifestyle changes or pharmaceutical intervention.<br />
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The liver is an important organ, filtering toxic substances from the body and producing proteins required for digestion, blood clotting, and other important physiological functions.<br />
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“The liver is very resilient and capable of regenerating itself, which may be the reason why liver damages due to excessive fat deposition can go undetected for a long time,” says <a href="https://www.biochem.mpg.de/en/rd/mann">EMBO Member Matthias Mann</a> of the University of Copenhagen, Denmark, and the Max Planck Institute of Biochemistry in Martinsried, Germany, who led the study. However, when damage accumulates liver function eventually starts to fail.<br />
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To date, the standard procedure for diagnosing NAFLD is liver biopsy – a cumbersome and costly procedure that can lead to complications. Non-invasive methods that reliably detect early stage NAFLD are therefore urgently required.<br />
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Mann and his colleagues investigated the plasma proteome – the entire set of proteins present in the blood plasma – of NAFLD patients. Using sophisticated mass spectrometry technologies, they uncovered a set of proteins that accumulate in the plasma of patients with non-symptomatic NAFLD.<br />
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In a first set of experiments, they determined that the blood proteome of patients in a late stage of the disease differed considerably from that of healthy controls. Many proteins that were altered in the patients’ blood proved to be associated with known aspects of the disease, such as thrombosis, vitamin A and D deficiency, or defects in glucose metabolism. These observations show the validity of the procedure to find new disease-related proteins.<br />
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In the next step, comparing the proteome of patients in early stage NAFLD with that of healthy individuals, the researchers found only minor differences. They did, however, succeed in identifying six proteins that were significantly associated with early stage NAFLD.<br />
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“One of the proteins we uncovered, termed PIGR, is of special interest,” says Mann. “Individuals with NAFLD who do not show any symptoms have increased levels of PIGR in their blood. And the concentration of the protein increases the further the disease progresses, making PIGR an interesting biomarker candidate for the inclusion in liver damage tests.”<br />
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While current blood tests only detect liver damage at a late stage in disease development, the present study is an important step towards developing new diagnostic tools to identify patients with NAFLD in a much earlier, pre-symptomatic phase.<br />
<b><br />Plasma proteome profiling discovers novel proteins associated with non-alcoholic fatty liver disease</b><br />
Molecular Systems Biology<br />
Lili Niu, Philipp E. Geyer, Nicolai J. Wewer Albrechtsen, Lise L. Gluud, Alberto Santos, Sophia Doll, Peter V. Treit, Jens J. Holst, Filip K. Knop, Tina Vilsbøll, Anders Junker, Stephan Sachs, Kerstin Stemmer, Timo D. Müller, Matthias H. Tschöp, Susanna M. Hofmann, Matthias Mann<br />
<br />
DOI: <a href="http://msb.embopress.org/cgi/doi/10.15252/msb.20188793">10.15252/msb.20188793</a><br />
Read the paper: <a href="http://msb.embopress.org/cgi/doi/10.15252/msb.20188793">http://msb.embopress.org/cgi/doi/10.15252/msb.20188793</a>HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-37810378211623158982019-03-02T18:21:00.000-05:002019-03-02T18:21:27.691-05:00Current and future pharmacological therapies for managing cirrhosis and its complicationsWorld J Gastroenterol. Feb 28, 2019; 25(8): 888-908<br /> Published online Feb 28, 2019. doi: <a href="http://dx.doi.org/10.3748/wjg.v25.i8.888">10.3748/wjg.v25.i8.888</a> <div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br /></div>
<div>
<b>Current and future pharmacological therapies for managing cirrhosis and its complications</b></div>
<div>
David Kockerling, Rooshi Nathwani, Roberta Forlano, Pinelopi Manousou, Benjamin H Mullish, Ameet Dhar </div>
<div>
<br /></div>
<div>
Core tip: <i>Pharmacological therapy is central to the management of cirrhosis and its complications. Whilst there has been recent debate about the safety of beta-blockade in patients with ascites, conversely there is growing interest in potential benefits relating to a reduction in gut bacterial translocation and hepatocellular carcinoma risk. In addition to its well-established role in treating hepatic encephalopathy, rifaximin may also have a key role in preventing secondary infections. In this review, we summarise these and other uncertainties, controversies and novel developments related to pharmacotherapy in the clinical management of chronic liver disease</i>.</div>
<div>
<br /></div>
<div>
View full-text article online: </div>
<div>
<a href="https://www.wjgnet.com/1007-9327/full/v25/i8/888.htm">https://www.wjgnet.com/1007-9327/full/v25/i8/888.htm</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-53751545028332419892019-03-01T17:20:00.002-05:002019-03-01T17:22:29.798-05:00Companies, states interested in Louisiana Netflix-style hepatitis C plan <div>
<b>Companies, states interested in Louisiana hepatitis C plan</b></div>
<div>
By MELINDA DESLATTE Associated Press</div>
<div>
<br /></div>
<div>
BATON ROUGE, La.</div>
<div>
<blockquote class="tr_bq">
Three drug companies are interested in Louisiana's plan to use a Netflix-style subscription model to buy access to hepatitis C drugs for Medicaid patients and prisoners, a treatment concept being watched by other states, the state health department announced Friday. <br />
<br />
Health Secretary Rebekah Gee wants Louisiana to pay a fee to a drug manufacturer for unlimited access to its hepatitis C medication. The state will treat as many people as it can during the access period, rather than pay a per-patient treatment price</blockquote>
Continue reading:<br />
<a href="https://www.ledger-enquirer.com/news/article226991064.html">https://www.ledger-enquirer.com/news/article226991064.html </a><br />
<div class="content-body" style="box-sizing: border-box;">
<div style="box-sizing: border-box; color: black; font-family: sans-serif; font-size-adjust: none; font-size: 13.33px; font-stretch: 100%; font-style: normal; font-variant: normal; font-weight: 400; height: 1px; line-height: normal; overflow: hidden; text-align: left; text-transform: none; width: 1px;">
<a href="https://www.ledger-enquirer.com/news/article226991064.html">https://www.ledger-enquirer.com/news/article226991064.html</a><br />
Read more here: https://www.ledger-enquirer.com/news/article226991064.html#storylink=cpy</div>
</div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-20488086461791789652019-02-26T08:28:00.002-05:002019-02-26T08:33:31.323-05:00Identification of 19 Novel Hepatitis C Virus Subtypes-Further Expanding HCV Classification <div>
Open Forum Infectious Diseases</div>
<div>
<a href="https://doi.org/10.1093/ofid/ofz076">https://doi.org/10.1093/ofid/ofz076</a> </div>
<div>
Published: 22 February 2019 </div>
<div>
<span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-variant: normal; letter-spacing: normal; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><br /></span></span></div>
<div>
<span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-variant: normal; letter-spacing: normal; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"><span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Accepted Manuscript</span></span></div>
<div>
<b>Identification of 19 Novel Hepatitis C Virus Subtypes-Further Expanding HCV Classification </b></div>
<div>
Charlotte Hedskog1, Bandita Parhy1, Silvia Chang1, Stefan Zeuzem2, Christophe Moreno3, Stephen D.Shafran4, Sergio M. Borgia5, Tarik Asselah6, Laurent Alric7, Armand Abergel8, Jyh-Jou Chen9, Jane Collier10,Dharmesh Kapoor11, Robert H. Hyland1, Peter Simmonds12, Hongmei Mo1, Evguenia S. Svarovskaia</div>
<br />
<div>
<span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Full-text only available as a PDF: </span><a href="https://watermark.silverchair.com/ofz076.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAlUwggJRBgkqhkiG9w0BBwagggJCMIICPgIBADCCAjcGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMddFOQBpDpIfdOZb-AgEQgIICCJtHLQrZuMyqSS1DENxwwy3r4WHsO9HhaF-TnQjfI6EBw85DbXfHT3ZjnP7JoaA6J9btSR1s9eor9HHRiT4-AiUnxltCwbcpB2hIk1BeqWC3H7e0tl7RBscGX0NWxCe9CApXvDdiMeJapvSn6-SCiFDL1y-AidjdgZmROvagnmNw3I_WjL_hIzFdQVOnIy0D_gc1kXDLdMzsB_wBIWAHLPwNyjJCCuPbdcx4ZoPjD4fpfFDG5TfanE7gXd9QAcaMIBm1lpVNfVdC-hloZhix9P940i2LR3dKEm0D2SU25gpXYqplTD5gaa1XdudmNd7NgqtsftiiVHnbE_B85I-EFfhNw3BLHaGcOPX_Glykur2TRjnHc5ZG02rAZjXT9cW9o-H3iAA_DjzOGNhItrT9HP3pJEgz7ekBflTomxDUaV7ksTfR83QnvDg82xTiN7I6PQylyDn2GBg_i47osSrLVl4VXCw2F2V4ecWEtztGaNMZNKLVdXzqmpTKAubgYDrWTPzOHwSIsieMqPp2YPCLFAVEoqiM6ZNMrJo5OOnH3iL4yCnVhqFmmwcWuSIj7-rcmfhybJRCOAcrnb7eISLnVjRNLo2ban-Hjx6edMcjvSFyuYhqvDi8V4bD2acXAdeDIZrqa_fsJdEfL_wP0WHFxRA9Xsu4_5OdULozashkU7v870P86egiFOo" style="-webkit-text-stroke-width: 0px; background-color: transparent; color: #0066cc; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: underline; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Download </a></div>
<div>
<br /></div>
<div>
Abstract</div>
Background<br />
<div>
The hepatitis C virus (HCV) is currently classified into 8 genotypes and 86 subtypes. The objective of this study was to characterize novel HCV subtypes and to investigate the impact of subtypes on treatment outcome. </div>
<div>
<br /></div>
<div>
Methods</div>
<div>
Full genome sequencing was performed on HCV plasma samples with <85% sequence homology of NS3, NS5A and/or NS5B to HCV genotype (GT) 1 to 8 reference strains.</div>
<div>
<br /></div>
<div>
Results</div>
<div>
14,653 patients with GT1 to 6 HCV infection were enrolled in clinical studies of sofosbuvir-based regimens. For the majority of the patients, a specific subtype could be assigned based on a close genetic relationship to previously described subtypes. However for 19 patients, novel subtypes were identified with <85% homology compared to previously described subtypes. These novel subtypes had the following genotypes; 9 in GT2, 5 in GT4, 2 in GT6 and one each in GT1, GT3 and GT5. Despite presence of polymorphisms at resistance-associated substitutions (RAS) positions, 18 of the 19 patients treated with sofosbuvir-containing therapy achieved SVR12. </div>
<div>
<br /></div>
<div>
Conclusions</div>
<div>
Nineteen novel HCV subtypes were identified, suggesting an even greater genetic diversity of HCV subtypes than previously recognized. </div>
<div>
<br /></div>
<div>
Full-text only available as a PDF: <a href="https://watermark.silverchair.com/ofz076.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAlUwggJRBgkqhkiG9w0BBwagggJCMIICPgIBADCCAjcGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMddFOQBpDpIfdOZb-AgEQgIICCJtHLQrZuMyqSS1DENxwwy3r4WHsO9HhaF-TnQjfI6EBw85DbXfHT3ZjnP7JoaA6J9btSR1s9eor9HHRiT4-AiUnxltCwbcpB2hIk1BeqWC3H7e0tl7RBscGX0NWxCe9CApXvDdiMeJapvSn6-SCiFDL1y-AidjdgZmROvagnmNw3I_WjL_hIzFdQVOnIy0D_gc1kXDLdMzsB_wBIWAHLPwNyjJCCuPbdcx4ZoPjD4fpfFDG5TfanE7gXd9QAcaMIBm1lpVNfVdC-hloZhix9P940i2LR3dKEm0D2SU25gpXYqplTD5gaa1XdudmNd7NgqtsftiiVHnbE_B85I-EFfhNw3BLHaGcOPX_Glykur2TRjnHc5ZG02rAZjXT9cW9o-H3iAA_DjzOGNhItrT9HP3pJEgz7ekBflTomxDUaV7ksTfR83QnvDg82xTiN7I6PQylyDn2GBg_i47osSrLVl4VXCw2F2V4ecWEtztGaNMZNKLVdXzqmpTKAubgYDrWTPzOHwSIsieMqPp2YPCLFAVEoqiM6ZNMrJo5OOnH3iL4yCnVhqFmmwcWuSIj7-rcmfhybJRCOAcrnb7eISLnVjRNLo2ban-Hjx6edMcjvSFyuYhqvDi8V4bD2acXAdeDIZrqa_fsJdEfL_wP0WHFxRA9Xsu4_5OdULozashkU7v870P86egiFOo">Download </a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-3563306057114233402019-02-23T14:30:00.000-05:002019-02-23T14:44:43.386-05:00Treatment for Advanced Liver Cancer: Current Standard and the Future <div>
<b>Clinical Liver Disease (CLD) </b></div>
<div>
Clinical Liver Disease is an official digital educational learning resource from the <a href="http://www.aasld.org/">American Association for the Study of Liver Diseases</a>. Visitors are able to view videos, access full text articles, and download files in either HTML or PDF formats.</div>
<div>
<b><br /></b></div>
<div>
<b>Special Issue on HCC </b><br />
<a href="https://aasldpubs.onlinelibrary.wiley.com/journal/20462484">Volume13, Issue1</a></div>
<div>
<span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">January 2019</span><br />
<span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Pages 13-19</span><b></b><i></i><u></u><sub></sub><sup></sup><strike></strike></div>
<b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />Treatment for Advanced Hepatocellular Carcinoma: Current Standard and the Future </b><br />
Alisa Likhitsup M.D. Nataliya Razumilava M.D. Neehar D. Parikh M.D.<br />
First published: 21 February 2019<br />
https://doi.org/10.1002/cld.782<br />
<br />
<div>
<a href="http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/13-1-reading-likhitsup">Watch</a> a video presentation of this article</div>
<a href="https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/cld.782">Download PDF</a><br />
<br />
Hepatocellular carcinoma (HCC) is the third leading cause of death worldwide with increasing incidence and mortality in the United States.<a href="https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.782#cld782-bib-0001">1</a>, <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.782#cld782-bib-0002">2</a> High HCC‐associated mortality is in part due to the high proportion of patients diagnosed with advanced stage HCC and historical lack of effective systemic therapies for HCC. <br />
<br />
<div>
HCC staging is unique because liver function and functional status, in addition to tumor burden, are integral determinants of stage and prognosis. Although staging systems vary, parameters that define advanced stage HCC eligible for therapy include presence of portal vein tumor invasion and/or extrahepatic metastases, with relatively preserved liver function and functional status. Generally, systemic therapy trials excluded patients with Child Pugh class B and C cirrhosis, largely because of the competing risk for mortality with cirrhosis. Thus, for many therapies, there are little data on efficacy and tolerability in patients with more advanced liver disease. Systemic therapies may also be appropriate in those patients with unresectable HCC who are not eligible for or are unlikely to benefit from locoregional therapies, although the decision on timing of when to initiate systemic therapy in a patient with intermediate HCC who is eligible for recurrent locoregional therapy remains an open question. In this review, we discuss contemporary approaches and ongoing studies for the treatment of patients with advanced HCC.<br />
Continue to full-text article : <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.782">https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.782</a></div>
<div>
or <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/cld.782">Download PDF</a><br />
<br />
Review all articles in this special issue online:<br />
<span style="color: #000120;"></span><u></u><a href="https://aasldpubs.onlinelibrary.wiley.com/journal/20462484">https://aasldpubs.onlinelibrary.wiley.com/journal/20462484</a><br />
<b></b><br />
<b>On This Blog</b><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/search/label/liver%20cancer">Read All Posts With The Label Liver Cancer</a><br />
Review a collection of current research articles extracted from peer-reviewed journals, liver meetings/conferences, and learning activities investigating the natural history of liver cancer, approved therapies, risk factors associated with chronic viral hepatitis, cancer-prevention, including diet, nutrition and physical activity, and trends associated with the rising rate of hepatocellular carcinoma in the U.S.</div>
<div>
Begin, <a href="https://hepatitiscnewdrugs.blogspot.com/search/label/liver%20cancer">here.....</a></div>
<div>
<u><span style="color: #000120;"></span></u><br /></div>
<div>
<a href="https://hepatitiscnewdrugs.blogspot.com/2016/11/november-updates-liver-cancer-after.html">Liver Cancer After Treatment For Hepatitis C</a>: </div>
<div>
Research demonstrates that while SVR markedly reduced liver-related complications and liver cancer, some long-term risk for liver cancer remained in those who were cured of Hepatitis C. But after direct-acting antiviral therapy does the risk of developing liver cancer increase? Research is saying no, <a href="https://hepatitiscnewdrugs.blogspot.com/2016/11/november-updates-liver-cancer-after.html">check out an index of articles here..... </a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-40321989434874954202019-02-23T13:43:00.002-05:002019-02-23T13:49:31.611-05:00No need to discontinue hepatitis C virus therapy at the time of liver transplantation PLoS One. 2019<br />
<strong>No need to discontinue hepatitis C virus therapy at the time of liver transplantation</strong><br />
Catarina Skoglund,
Martin Lagging,
Maria Castedal <br />
<br />
Published: February 22, 2019
<a href="https://doi.org/10.1371/journal.pone.0211437">https://doi.org/10.1371/journal.pone.0211437</a> <br />
<br />
Full-text<br />
<a href="https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0211437&type=printable">Download PDF</a><br />
<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211437">View Online</a><br />
<br />
Abstract<br />
Objectives <br />
Direct antiviral agents (DAA) has dramatically improved the therapy outcome of hepatitis C-virus (HCV) infection, both on the waiting-list and post liver transplantation (LT). DAA are generally well-tolerated in patients with mild to moderate liver and kidney failure, but some DAAs are contraindicated in patients with severe dysfunction of these organs. Today there are few studies of peri-LT DAA use and treatment is commonly discontinued at the time of LT. We report here our experience of DAA therapy given continuously in the perioperative LT period in a real-life setting in Sweden.<br />
<br />
Material <br />
In total 10 patients with HCV-cirrhosis, with or without hepatocellular carcinoma, and a median age of 60.5 years (range, 52–65) were treated with DAAs on the waiting list for LT, and continued in the early postoperative period without any interruption, on the basis of not having reached a full treatment course at the time of LT. Sofosbuvir and a NS5A inhibitor with or without ribavirin, or sofosbuvir and ribavirin only, were given. The distribution of genotypes was genotype 1 and 3, in 4 and 6 patients, respectively. Six of the 10 patients had previously been treated with IFN-based therapy.<br />
<br />
Results <br />
There were no adverse events leading to premature DAA discontinuation. All recipients achieved a sustained viral response 12 weeks after end-of-treatment (SVR12). At the time of LT the median MELD-score was 16.5 (range 7–21), CTP-score 9.0 (range 5–10), creatinine 82.5 μmol/L (range 56–135, reference 60–105), bilirubin 33 μmol/L (range 16–79, reference 5–25) and PK-INR 1.5 (range 1.1–1.8). The median duration of DAA therapy was 60 days (range 18–132) pre-LT, 54 days post-LT (range 8–111 days) and in total 15.5 weeks (range 12–30 weeks).<br />
<br />
Conclusion <br />
Interferon-free DAA therapy of HCV-infection given in the immediate pre- and post-operative LT period is safe, well-tolerated and yields high SVR rates.<br />
<br />
Full-text: <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211437">https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211437</a>HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-57542430949962402922019-02-23T13:00:00.000-05:002019-02-23T14:09:48.798-05:00Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases—meta‐analytic assessmentCancer Med. 2019 Feb 21. doi: 10.1002/cam4.1998. [Epub ahead of print]
<br />
<strong>Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases-meta-analytic assessment.</strong>
<br />
Tarao K1, Nozaki A2, Ikeda T3, Sato A4, Komatsu H5, Komatsu T6, Taguri M7, Tanaka K8.
<br />
<br />
<strong>Abstract
BACKGROUND:</strong> <br />
It is well known that the incidence of developing hepatocelluler carcinoma (HCC) is increased in liver cirrhosis of different etiologies. However, comparison of HCC incidence in various liver diseases has not yet been estimated. We surveyed this comparison.
<br />
<br />
METHODS:
The PubMed database was examined (1989-2017) for studies published in English language regarding the prospective follow-up results for the development of HCC in various liver diseases. A meta-analysis was performed for each liver disease.
<br />
<br />
RESULTS:
The annual incidence (%) of HCC in the non-cirrhotic stage and cirrhotic stage, and the ratio of HCC incidence in the cirrhotic stage/non-cirrhotic stage were as follows. (a) hepatitis B virus liver disease: 0.37%→3.23% (8.73-fold), (b) hepatitis C virus liver diseases: 0.68%→4.81% (7.07-fold), (c) primary biliary cholangitis (0.26%→1.79%, 6.88-fold), (d) autoimmune hepatitis (0.19%→0.53%, 2.79-fold), and (e) NASH (0.03%→1.35%, 45.00-fold). Regarding primary hemochromatosis and alcoholic liver diseases, only follow-up studies in the cirrhotic stage were presented, 1.20% and 2.06%, respectively.
<br />
<br />
CONCLUSIONS:
When the liver diseases advance to cirrhosis, the incidence of HCC is markedly increased. The development of HCC must be closely monitored by ultrasonography, magnetic resonance imaging, and computed tomography, irrespective of the different kinds of liver diseases.
<br />
<br />
<strong>DISCUSSION</strong><br />
--<a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998">Download Full-text</a>--<br />
It is known that cirrhosis is present in 80~90% of HCC patients with any underlying liver disease,<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0119">119</a> and it is the most important risk factor for HCC. However, comparison of the incidence of HCC in various liver diseases was not accurately and precisely evaluated in previous studies. In this study, we found that the incidence of HCC is highest in HCV LC (4.81%/year) and second highest in HBV LC (3.23%), followed by alcoholic LC (2.06%), PBC LC (1.79%), NASH LC (1.35%), primary hemochromatosis (1.20%), and AIH (0.53%). <br />
<br />
The incidence of HCC has been wildly studied in patients with HBV LC and HCV LC, and was reported to be 3% and 5%,<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0029">29</a>, <a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0120">120</a> which was almost the same as that in our study.<br />
<br />
In this study, we also demonstrated that the incidence of HCC is markedly increased (2.79‐ to 45.00‐fold) in the cirrhotic state compared with non‐cirrhotic state, irrespective of the etiology of liver disease. Why this increase in HCC development occurs in the cirrhotic state must be considered.<br />
<br />
First, chronic inflammation may be a key mechanism for HCC development in the cirrhotic state. In this respect, we made clinical observation in the HCV LC patients (Child A) in the past. The LC patients were divided into three groups: Group A: 28 patients whose annual average serum alanine aminotransferase (ALT) level was persistently high (≧80 IU; high‐ALT group); Group B: 28 patients whose annual average serum ALT levels was persistently low (<80 IU; low‐ALT group), and Group C: 13 unclassified patients. The patients had been followed up prospectively. The 5‐year incidence rate of HCC in the high‐ALT group was as high as 53.6% compared with only 7.1% in the low‐ALT group (<i>P</i> < 0.001).<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0120">120</a> Thus, this clinical observation demonstrated the importance of chronic inflammation in the development of HCC in HCV LC. <br />
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The same tendency was demonstrated in HBV LC. Chen et al<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0121">121</a> reported that high serum levels of HBV DNA and ALT were independent risk factors for HCC development in HBV infection. Ishikawa et al<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0020">20</a> also reported that serum aminotransferase are one of predictive factor for the development of HCC. One important mechanism for high incidence of HCC in HCV LC and HBV LC as compared with the incidence of HCC in LC caused by other etiologies may be the sustained high‐grade inflammation. <br />
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Furthermore, in autoimmune hepatitis, persistent elevation of serum aminotransaminase was reported to lead to the development of HCC.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0078">78</a> This suggests a role for inflammation in the development of HCC, but this hypothesis has not been confirmed solidly.<br />
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Second, increases in DNA synthesis in the hepatocytes of cirrhotic patients is suspected as a possible mechanism of HCC development. In our previous study, we demonstrated that in the high DNA synthetic group [BrdU (thymidine analog) labeling index ≧1.5%] 64.3% of patients developed HCC in 5 years, in contrast to 14.3% in the low DNA synthesis (Brd U LI <1.5%) group in HCV LC patients (<i>P</i> < 0.05).<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0122">122</a> We further demonstrated that in HCV‐associated cirrhosis patients who showed nodular formation on ultrasound, the cell cycle of hepatocytes was markedly accelerated, as estimated by the bromodeoxyuridine (thymidine analog) uptake into hepatocytes in vitro, and the incidence of HCC was greatly increased.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0123">123</a><br />
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Third, accumulated genomic change was also important factor for HCC development. In this respect, Hiatt et al<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0124">124</a> reported that C282Y mutation itself may increase the risk of HCC development in hereditary hemochromatosis. In addition, in alcoholic LC, the genetic effect of long‐term alcoholic intake may influence the development of HCC.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0125">125</a><br />
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Fourth, obesity, and diabetes are suspected to increase the incidence of developing HCC. In a large epidemiologic study, patients with BMI >35 had an increased risk of cancer, especially HCC, with hazard ratio (HR) of 4.52.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0126">126</a> In addition, diabetes is associated with HCC occurrence, with a HR of 2.39 in a US cohort.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0127">127</a> It is generally accepted that NASH is associated with obesity and diabetes in high percentages.<br />
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Notably, in 2014, Flemming et al<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0128">128</a> predicted the risk of HCC in patients with cirrhosis, using the ADRESS‐HCC risk model. They examined the l‐year probability of HCC in various liver diseases in 34 932 patients in the national transplantation waitlist database. HCC developed in 1960 patients (5.6%) during a median follow‐up of 1.3 years. Six baseline clinical variables including age, diabetes, race, etiology of cirrhosis, sex, and severity (ADRESS) of liver dysfunction were independently associated with HCC. They settled ADRESS‐HCC risk model from these data and the risk model well‐coincided with the clinical observation. They concluded that the risk model was clinically useful tool for predicting the risk of HCC in patients with diverse etiologies.<br />
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In addition, the aging of the patients must be taken into the consideration, as the cirrhotic patients were considered to be older than the non‐cirrhotic patients in almost all liver diseases. In this regard, Asahina et al<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0129">129</a> investigated the difference of HCC incidence in aging in HCV‐associated liver disease, and found that the incidence of HCC was higher in the older patients (>65 years old) than the younger patients (<65 years old). The same tendency was observed by Taura et al<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0130">130</a> However, the difference in incidence was approximately twofold. So, it is difficult to explain the marked difference in HCC incidence between the cirrhotic state and non‐cirrhotic state found in this meta‐analysis. Regarding other liver diseases, there were very few reports which demonstrated a difference between patients in the non‐cirrhotic and cirrhotic states concerning age.<br />
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The next consideration is the prevention of patients not to become cirrhosis state. We demonstrated that the incidence of HCC in the cirrhotic state and that in the non‐cirrhotic state were markedly different in many liver diseases; therefore, efforts to prevent patients with liver diseases from progressing to the cirrhotic state by all means is very important.<br />
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In HBV infection, the effort to diminish HBV‐DNA by pegylated interferon (Peg IFN)<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0019">19</a> or oral antiviral agents, such as entecavir (ETV), tenofovir, and tenofovir anafenamide, is important. Indeed, ETV and tenofovir were reported to prevent the occurrence of HCC.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0131">131</a>, <a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0132">132</a>In HCV infection, Peg IFN plus ribavirin or direct‐acting antivirals (DAAs) are effective to eliminate HCV, and may be prevent the progression of the disease, resulting in prevention of HCC development.<br />
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In primary biliary cholangitis, administration of ursodeoxycholic acid is important. Indeed, the risk of HCC in UDCA‐treated PBC patients was reported to be relatively low.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0059">59</a>, <a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0063">63</a><br />
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In autoimmune hepatitis, well‐designed corticosteroid therapy is important to prevent HCC development, and persistent elevation of serum aminotransaminase is reported to lead the development of HCC.<a class="bibLink tab-link" data-tab="pane-pcw-references" href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998#cam41998-bib-0078">78</a> It seems that alleviation of serum ALT levels might prevent HCC development, but this hypothesis is not confirmed solidly. <br />
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In NASH patients, improvement in metabolic syndrome, especially improvement in diabetes mellitus and obesity, is important.<br />
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Next, we mentioned whether the treatment of underlying liver diseases substantially modulates the HCC risk or not. We restricted the survey chiefly to the cirrhotic patients because they are at high risk of HCC development.<br />
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Continue to full-text article: <br />
<a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998">https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1998</a><br />
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© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.<br />
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KEYWORDS:
hepatocellular carcinoma; liver cirrhosis; liver diseases; meta-analysis; risk of HCCHCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-9305138311976108112019-02-21T15:33:00.000-05:002019-02-21T15:33:41.122-05:00MAVIRET - AbbVie reaches an agreement with the pan-Canadian For HCV Drug<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMr-jJe4j0vcOkqojMAaqubcUhQjnGO_jlKOxZ0ySCZvjEYWXdGgIcLTiIM6h-dPytPoKBBz_Pg2NzN-80IzVBXoX3lWJ6M9winW69uSS4LAbgqKB0igBNw7khoafBE6WDR9lS4l-nr7U/s1600/1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="286" data-original-width="400" height="142" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMr-jJe4j0vcOkqojMAaqubcUhQjnGO_jlKOxZ0ySCZvjEYWXdGgIcLTiIM6h-dPytPoKBBz_Pg2NzN-80IzVBXoX3lWJ6M9winW69uSS4LAbgqKB0igBNw7khoafBE6WDR9lS4l-nr7U/s200/1.jpg" width="200" /></a></div>
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<b>AbbVie reaches an agreement with the pan-Canadian Pharmaceutical Alliance (pCPA) for its hepatitis C treatment MAVIRET™</b></div>
Feb. 21, 2019, 12:09 PM <b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br /><div>
Ontario will be the first province to reimburse MAVIRET as of February 28, 2019</div>
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MAVIRET is the first and only 8-week, pan-genotypic treatment for chronic hepatitis C patients without cirrhosis and who are new to treatment*1</div>
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MAVIRET previously received positive reimbursement recommendations from the CADTH Canadian Drug Expert Committee (CDEC)2 in January 2018 and the Institut national d'excellence en santé et services sociaux (INESSS) in February 2018</div>
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MAVIRET is the only pan-genotypic treatment approved for use in patients across all stages of chronic kidney disease<br /><br /><div>
MONTREAL, Feb. 21, 2019 /CNW/ - AbbVie (NYSE: ABBV), a global, research and development-based biopharmaceutical company, announced an agreement was reached with the pan-Canadian Pharmaceutical Alliance (pCPA) regarding MAVIRET™ (glecaprevir/pibrentasvir tablets), a once-daily, ribavirin-free treatment for adults with chronic hepatitis C virus (HCV) infection across all major genotypes (GT1-6)2. MAVIRET is the only 8-week, pan-genotypic treatment for patients without cirrhosis and who are new to treatment,* who make up a large portion of HCV patients in Canada. </div>
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Following the positive conclusion with the pCPA, Ontario will be the first province to reimburse MAVIRET on its public formulary as of February 28, 2019. As listed on the Ontario Drug Benefit (ODB)3 Formulary as a Limited Use product, MAVIRET will be covered for treatment-naïve and treatment-experienced adult patients with chronic hepatitis C infection (regardless of fibrosis stage)3:<i style="box-sizing: border-box;"><br /></i></div>
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<br />Laboratory confirmed hepatitis C genotype 1,2,3,4,5,6<br />HCV RNA value within the last six months <br /><br />***Prescription by a hepatologist, gastroenterologist or an infectious disease specialist (or other physician experienced in treating hepatitis C). <br /><br />"After more than 20 years of treating hepatitis C, I am hopeful that soon we will successfully eliminate this virus. But in order to reach this goal in Canada and across the world, we need to work together to test, diagnose and bring these high curative treatments to every individual, regardless of their genotype, fibrosis stage and background," explains Dr. Magdy Elkhashab, Gastroenterologist/Hepatologist, Director of the Toronto Liver Centre. "As a hepatologist, MAVIRET offers me the opportunity to put my patients on an effective, short duration therapy that has a proven track record." <br /><br />Approximately 300,000 Canadians are infected with hepatitis C.4 Over time chronic hepatitis C can lead to chronic liver diseases, with a risk of developing cirrhosis of up to 30 per cent within 20 years5 of infection. Additionally, HCV is common among people with severe chronic kidney disease (CKD), and some of these patients previously did not have a direct-acting antiviral (DAA)-based treatment option.6<br /><br />"The Canadian Liver Foundation is committed to seeing Canada meet the target set by the World Health Organization's Global Strategy on Viral Hepatitis. And that target is to eliminate hepatitis C by 2030. It is within our reach, but all our elimination efforts require support, plans and concrete actions at the local level to combat the increasing burden of HCV infection and the associated stigma," says Dr. Morris Sherman, Chairman of the Canadian Liver Foundation and Toronto-based hepatologist. "To be successful, we need a comprehensive screening strategy based on risk factors, plus a one-time test for all Canadians born 1945 – 19757, as well as adapted linkage to care to allow access to all available treatment options for all Canadians."<br /><br />The efficacy and safety of MAVIRET was evaluated in nine Phase 2-3 clinical trials, in over 2,300 patients with genotype 1, 2, 3, 4, 5 or 6 HCV infection and with compensated liver disease (with or without cirrhosis).<br /><br />"AbbVie is committed to the World Health Organization's targets and looks forward to working with governments, health care professionals and patient associations in their concerted efforts to achieve HCV elimination in Canada," explains Stéphane Lassignardie, General Manager, AbbVie Canada. "MAVIRET brings value in order to achieve elimination and all Canadians should have access to innovative and curative therapies."</div>
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<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>https://markets.businessinsider.com/news/stocks/abbvie-reaches-an-agreement-with-the-pan-canadian-pharmaceutical-alliance-pcpa-for-its-hepatitis-c-treatment-maviret-1027973100</div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-72136477407692284812019-02-21T14:26:00.000-05:002019-02-23T14:32:53.912-05:00Targeted and immune therapies for hepatocellular carcinoma: Predictions for 2019 and beyond <a href="https://www.wjgnet.com/1007-9327/current.htm">World J Gastroenterol</a>. Feb 21, 2019; 25(7): 789-807<br />
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Published online Feb 21, 2019. doi: <a href="http://dx.doi.org/10.3748/wjg.v25.i7.789">10.3748/wjg.v25.i7.789</a> </div>
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Full-text: <a href="https://www.wjgnet.com/1007-9327/full/v25/i7/789.htm">View Online</a></div>
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<b> Targeted and immune therapies for hepatocellular carcinoma: Predictions for 2019 and beyond </b><br />
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Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan. Author contributions: Kudo M designed the research and wrote the paper.</div>
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<b>Core tip:</b> Systemic therapy for hepatocellular carcinoma (HCC) has markedly advanced since sorafenib was approved in 2007. Since then, there was no active drug for 10 years that prolong overall survival, however, in 2017 and 2018, clinical trials of 4 more molecular targeted agents including lenvatinib as first line agent, regorafenib, cabozantinib and ramucirumab as second line agent have shown their survival benefit. In addition, immune check point inhibitors, nivolumab and pembrolizumab, were approved by Food and Drug Administration. Combination cancer immunotherapy, that combines immune checkpoint inhibitors and molecular targeted agents show great promise in the treatment of HCC.<br />
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<b>Abstract</b><br />
Systemic therapy for hepatocellular carcinoma (HCC) has markedly advanced since the survival benefit of a molecular targeted agent, sorafenib, were demonstrated in the SHARP and Asia Pacific trials in 2007. Treatment options for patients with advanced HCC increased by sorafenib, and long-term survival for patients with advanced stage HCC has become possible to some extent. However, development of a more potent first-line novel molecular targeted agent replacing sorafenib and a potent second-line agent after disease progression on or intolerant to sorafenib has been warranted because sorafenib lacks tumor shrinking/necrotizing effects and induces relatively severe adverse events such as hand foot skin reaction. Many agents in the 1st line and 2nd line setting were attempted to develop between 2007 and 2016, but all of these clinical trials failed. On the other hand, clinical trials of 4 agents (regorafenib, lenvatinib, cabozantinib, and ramucirumab) succeeded in succession in 2017 and 2018, and their use in clinical practice is possible (regorafenib and lenvatinib) or underway (cabozantinib and ramucirumab). Furthermore, all of 5 clinical trials of combination therapy with transcatheter chemoembolization (TACE) plus a molecular targeted agent failed to date, however, the combination of TACE and sorafenib (TACTICS trials) was reported to be successful and presented at ASCO in 2018. Phase 3 clinical trials of immune checkpoint inhibitors and a combination therapy of immune checkpoint inhibitors and molecular targeted agents are also ongoing, which suggests treatment paradigm of HCC in all stages from early, intermediate and advanced stage, is expected to be changed drastically in the very near future.</div>
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<b>On This Blog</b><br />
<a href="https://hepatitiscnewdrugs.blogspot.com/search/label/liver%20cancer">Read All Posts With The Label Liver Cancer</a><br />
Review a collection of current research articles extracted from peer-reviewed journals, liver meetings/conferences, and learning activities investigating the natural history of liver cancer, approved therapies, risk factors associated with chronic viral hepatitis, cancer-prevention, including diet, nutrition and physical activity, and trends associated with the rising rate of hepatocellular carcinoma in the U.S.<span style="background-color: transparent; color: #222222; display: inline; float: none; font-family: "arial" , "tahoma" , "helvetica" , "freesans" , sans-serif; font-size: 13.2px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; line-height: 18.48px; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">
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Begin, <a href="https://hepatitiscnewdrugs.blogspot.com/search/label/liver%20cancer">here.....</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-49323778394019508782019-02-21T14:22:00.001-05:002019-02-21T14:22:57.107-05:00Is high intake of whole grains associated with lower risk of developing liver cancer?Media<br /><b>Whole grains might help ward off liver cancer</b><br />Linda Carroll<br /><div>
(Reuters Health) - Yet another benefit of eating a diet containing high amounts of whole grains may be a reduced risk of liver cancer, a new U.S. study suggests. </div>
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“Consumption of whole grains and dietary fiber, especially cereal fiber, have been associated with lower risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease, which are known predisposing factors for (liver cancer),” Zhang said. “Besides improving insulin sensitivity, metabolic regulation, and decreasing systemic inflammation, intake of whole grains and dietary fiber may improve gut integrity, and alter gut microbiota composition, thereby leading to increased production of microbiota-related metabolites including short-chain fatty acids, particularly butyrate.” </div>
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Read more: <a href="https://in.reuters.com/article/us-health-grains-liver-cancer/whole-grains-might-help-ward-off-liver-cancer-idINKCN1QA2BE">https://in.reuters.com/article/us-health-grains-liver-cancer/whole-grains-might-help-ward-off-liver-cancer-idINKCN1QA2BE</a></div>
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JAMA Network OpenFebruary 21, 2019<br />
<b>Association of Intake of Whole Grains and Dietary Fiber With Risk of Hepatocellular Carcinoma in US Adults </b><br />
Wanshui Yang, PhD1,2; Yanan Ma, PhD2,3; Yue Liu, MD2,4; et al
Stephanie A. Smith-Warner, PhD5,6; Tracey G. Simon, MD7,8,9; Dawn Q. Chong, MD10; Qibin Qi, PhD11; Jeffrey A. Meyerhardt, MD, MPH12; Edward L. Giovannucci, MD, ScD2,5,6; Andrew T. Chan, MD, MPH2,8,9; Xuehong Zhang, MD, ScD2
Author Affiliations
JAMA Oncol.<br />
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Published online February 21, 2019.<br />
doi:10.1001/jamaoncol.2018.7159<br />
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<b>Key Points</b><br />
Question Is high intake of whole grains and dietary fiber associated with lower risk of developing hepatocellular carcinoma (HCC)?<br />
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Findings In this cohort study of 125 455 participants in the United States, including 141 patients with HCC, with an average follow-up of 24.2 years, increased intake of whole grains was associated with a reduced risk of HCC. A nonsignificant inverse HCC association was observed for total bran but not for germ; increased intake of cereal fiber but not fruit or vegetable fiber was associated with a nonsignificant lower risk of HCC.<br />
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Meaning Increased intake of whole grains and possibly cereal fiber and bran could be associated with reduced risk of HCC among US adults.<br />
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Abstract<br />
Importance Increased intake of whole grain and dietary fiber has been associated with lower risk of insulin resistance, hyperinsulinemia, and inflammation, which are known predisposing factors for hepatocellular carcinoma (HCC). Therefore, we hypothesized that long-term intake of whole grains and dietary fiber may be associated with lower risk of HCC.<br />
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Objective To assess the associations of whole grain and dietary fiber intake with the risk of HCC.<br />
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Design, Setting, and Participants Cohort study of the intake of whole grains, their subcomponents (bran and germ), and dietary fiber (cereal, fruit, and vegetable) in 125 455 participants from 2 cohorts from the Nurses’ Health Study and the Health Professionals Follow-up Study.<br />
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Exposures Intake of whole grains, their subcomponents (bran and germ), and dietary fiber (cereal, fruit, and vegetable) were collected and updated almost every 4 years using validated food frequency questionnaires.<br />
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Main Outcomes and Measures Multivariable hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression model after adjusting for most known HCC risk factors.<br />
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Results After an average follow-up of 24.2 years, we identified 141 patients with HCC among 125 455 participants (77 241 women and 48 214 men (mean [SD] age, 63.4 [10.7] years). Increased whole grain intake was significantly associated with lower risk of HCC (the highest vs lowest tertile intake: HR, 0.63; 95% CI, 0.41-0.96; P = .04 for trend). A nonsignificant inverse HCC association was observed for total bran (HR, 0.70; 95% CI, 0.46-1.07; P = .11 for trend), but not for germ. Increased intake of cereal fiber (HR, 0.68; 95% CI, 0.45-1.03; P = .07 for trend), but not fruit or vegetable fiber, was associated with a nonsignificant reduced risk of HCC.<br />
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Conclusions and Relevance Increased intake of whole grains and possibly cereal fiber and bran could be associated with reduced risk of HCC among adults in the United States. Future studies that carefully consider hepatitis B and C virus infections are needed to replicate our findings, to examine these associations in other racial/ethnic or high-risk populations, and to elucidate the underlying mechanisms.<br />
<a href="https://jamanetwork.com/journals/jamanetworkopen">https://jamanetwork.com/journals/jamanetworkopen</a>HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-22305937093254038892019-02-21T13:29:00.000-05:002019-02-21T13:31:14.997-05:00Nine-year distribution pattern of hepatitis C virus (HCV) genotypes in Southern Italy<b>Nine-year distribution pattern of hepatitis C virus (HCV) genotypes in Southern Italy</b><br />
Arnolfo Petruzziello ,
Rocco Sabatino,
Giovanna Loquercio,
Annunziata Guzzo,
Lucia Di Capua,
Francesco Labonia,
Anna Cozzolino,
Rosa Azzaro,
Gerardo Botti<br />
Published: February 20, 2019<br />
https://doi.org/10.1371/journal.pone.0212033 <br />
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<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212033">Full-text available online</a></div>
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<a href="https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0212033&type=printable">Download PDF </a></div>
<i><br />In conclusion, the epidemiological framework of Hepatitis C infection in Southern Italy, particularly interesting for the high prevalence of this virus in the general population, seems to highlight the "returning" role of the iatrogenic transmission as risk factor for the diffusion of HCV infection. Furthermore, the small increase of genotype 3a among young people should be more investigated, with a support of a phylogenetic analysis. </i><i>At support of our hypothesis, some studies report small HCV outbreaks in Europe due to breaches in standards of health and safety practices among health-care workers [<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212033#pone.0212033.ref056">56</a>]. Indeed, an interesting case–control study highlighted some unconventional routes of diffusion of Hepatitis C infection such as digestive endoscopy, beauty treatments and professional pedicure/manicure [<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212033#pone.0212033.ref057">57</a>]. This suggest not only a necessary evaluation of the safety practices in surgery, but the fundamental importance of not lowering the safety levels, especially among all health-care professionals.</i><br />
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Abstract<br />
Introduction<br />
It has been greatly described that different hepatitis C virus (HCV) genotypes are strictly correlated to various evolution, prognosis and response to therapy during the chronic liver disease. Aim of this study was to outline the changes in the epidemiology of Hepatitis C genotypes in Southern Italy regions from 2006 to 2014. <br />
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Material/Methods<br />
Prevalence of HCV genotypes was analyzed in 535 HCV-RNA positive patients with chronic Hepatitis C infection, selected during the period 2012–2014, and compared with our previous data, referred to periods 2006–2008 and 2009–2011. <br />
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Results<br />
In all the three periods analyzed, genotype 1b is predominant (51.8% in 2006–08, 48.3% in 2009–11 and 54.4% in 2012–14) while genotype 2 showed an increase in prevalence (27.9% in 2006–08, 31.7% in 2009–11 and 35.2% in 2012–14) and genotypes 3a and 1a a decrease during the same period (6.8% in 2006–08, 4.7% in 2009–11 and 3.2% in 2012–14 and 7.9% in 2006–08, 4.7% in 2009–11 and 2.6% in 2012–14, respectively). Subtype 1b seems to be equally distributed between males and females (52.7% vs 56.6%) and the prevalence in the age range 31–40 years is significantly higher in the 2012–14 period than in both previous periods (53.8% vs. 16.6% in 2009–11, p< 0.001 and 13.4% in 2006–08, p < 0.001). <br />
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Conclusions<br />
Genotype 1b is still the most prevalent, even if shows a significantly increase in the under 40 years old population. Instead, genotype 3a seems to have a moderate increase among young people. Overall, the alarming finding is the “returning” role of the iatrogenic transmission as risk factor for the diffusion of Hepatitis C infection.HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-81501709722583756212019-02-20T08:26:00.002-05:002019-02-20T09:52:10.608-05:00Intercept - Phase 3 REGENERATE Study of Obeticholic Acid in Patients with Liver Fibrosis Due to NASH<div style="-webkit-text-stroke-width: 0px; background-color: transparent; color: black; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">
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The beginning of 2019 has already seen several significant advancements for the field of nonalcoholic steatohepatitis, from the inaugural NASH-TAG meeting to the recently announced positive results from the phase 3 study of Ocaliva.</div>
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<b>Intercept Announces Positive Topline Results from Pivotal Phase 3 REGENERATE Study of Obeticholic Acid in Patients with Liver Fibrosis Due to NASH</b></div>
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First and largest successful pivotal Phase 3 study in patients with liver fibrosis due to NASH </div>
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OCA achieves primary endpoint demonstrating statistically significant improvement in liver fibrosis without worsening of NASH at 18 months (p=0.0002) </div>
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Intercept intends to file for regulatory approval in the U.S. and Europe in the second half of 2019 </div>
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<i>Results to be presented at European Association for the Study of the Liver 2019 International Liver Congress</i><br />
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<b>The International Liver CongressTM</b><br />
Every year in April, scientific and medical experts from a broad range of fields including hepatology, gastroenterology, internal medicine, cell biology, transplant surgery, infectious diseases, microbiology and virology, pharmacology, pathology and radiology and imaging come together from around the world to learn about the latest in liver research. Specialists share recent data, present studies and findings, and discuss the hottest topics on liver disease. The annual Congress attracts around 10,000 delegates and 250 media representatives from all over the world making this a truly international networking opportunity!<br />
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The International Liver CongressTM 2019 <a href="https://mobile.twitter.com/hashtag/ILC2019?src=hashtag_click">#ILC2019</a> will take place 10-14 April 2019 at the <a href="https://ilc-congress.eu/venuefloorplans/">Reed Messe Wien Exhibition & Congress Center, Vienna, Austria</a>.<br />
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<i><span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Intercept </span>Press Release</i><br />
NEW YORK, Feb. 19, 2019 (GLOBE NEWSWIRE) -- Intercept Pharmaceuticals, Inc. (Nasdaq:ICPT), a biopharmaceutical company focused on the development and commercialization of novel therapeutics to treat progressive non-viral liver diseases, today announced positive results from its pivotal Phase 3 REGENERATE study of obeticholic acid (OCA) in patients with liver fibrosis due to nonalcoholic steatohepatitis (NASH). In the primary efficacy analysis, once-daily OCA 25 mg met the primary endpoint of fibrosis improvement (≥1 stage) with no worsening of NASH at the planned 18-month interim analysis (p=0.0002 vs. placebo). In the primary efficacy analysis, a numerically greater proportion of patients in both OCA treatment arms compared to placebo achieved the primary endpoint of NASH resolution with no worsening of liver fibrosis, but this did not reach statistical significance. As agreed with the U.S. Food and Drug Administration (FDA), in order for the primary objective to be met, the study was required to achieve one of the two primary endpoints. </div>
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“We are thrilled to report the first positive registrational Phase 3 study results in patients with NASH, a devastating disease that is on track to become a leading cause of liver transplant in coming years,” said Mark Pruzanski, M.D., President and Chief Executive Officer of Intercept. “The topline REGENERATE data we are reporting today support our belief that OCA will become the first approved medicine for those living with liver fibrosis due to NASH. We are deeply grateful to the patients, investigators and study staff whose ongoing participation in REGENERATE has brought us one step closer to delivering a much-needed therapeutic option to address the enormous unmet medical need in this population.” </div>
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Based on these results, Intercept intends to file for approval in the U.S. and Europe in the second half of 2019. OCA remains the only investigational drug to have received Breakthrough Therapy designation from the FDA for NASH with fibrosis. REGENERATE results will be presented at the European Association for the Study of the Liver (EASL): The International Liver CongressTM 2019. </div>
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“Patients with significant fibrosis due to NASH are at the greatest risk of progression to severe liver-related complications, such as liver failure and death, and fibrosis is considered the strongest predictor of liver-related mortality in this population,” said Zobair M. Younossi, M.D., Professor and Chairman of the Department of Medicine at Inova Fairfax Medical Campus, Professor of Medicine at Virginia Commonwealth University, Inova Campus and the Chair of the REGENERATE Steering Committee. “I am very encouraged by these results that demonstrate OCA’s ability to significantly improve fibrosis in patients with advanced disease. As the first successful pivotal trial in NASH, REGENERATE is an important advancement for the liver community.” </div>
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Efficacy Results<br />
The primary efficacy analysis (Intent-to-Treat or ITT) assessed efficacy at 18 months in 931 patients with stage 2 or 3 liver fibrosis due to NASH. Overall study discontinuations in the primary efficacy analysis population were balanced across treatment arms: 16% in placebo, 17% in OCA 10 mg and 15% in OCA 25 mg. </div>
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An additional pre-specified full efficacy analysis at 18 months added an exploratory cohort of 287 NASH patients with stage 1 liver fibrosis and additional risk factors who were at increased risk of progression to cirrhosis (N=1,218). </div>
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Patients with biopsy proven NASH with fibrosis were randomized 1:1:1 to receive placebo, OCA 10 mg or OCA 25 mg once daily. A repeat biopsy was conducted after 18 months for histologic endpoint assessment. Patients without a repeat biopsy due to study discontinuation or other reason were treated as non-responders in the primary and full efficacy analyses. </div>
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<i>Fibrosis Improvement at Month 18</i><br />
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<i>NASH Resolution at Month 18</i><br />
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Safety and Tolerability<br />
The safety population in this planned 18-month analysis of REGENERATE included 1,968 randomized patients who received at least one dose of investigational product (OCA or placebo). <br />
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Adverse events were generally mild to moderate in severity and the most common were consistent with the known profile of OCA. The frequency of serious adverse events was similar across treatment arms (11% in placebo, 11% in OCA 10 mg and 14% in OCA 25 mg) and no serious adverse event occurred in >1% of patients in any treatment arm. There were 3 deaths in the study (2 in placebo: bone cancer and cardiac arrest, 1 in OCA 25 mg: glioblastoma) and none were considered related to treatment.<br />
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The most common adverse event reported was dose-related pruritus (19% in placebo, 28% in OCA 10 mg and 51% in OCA 25 mg). The large majority of pruritus events were mild to moderate, with severe pruritus occurring in a small number of patients (<1% in placebo, <1% in OCA 10 mg and 5% in OCA 25 mg). A higher incidence of pruritus associated treatment discontinuation was observed for OCA 25 mg (<1% in placebo, <1% in OCA 10 mg and 9% in OCA 25 mg). According to the clinical study protocol, investigator assessed severe pruritus mandated treatment discontinuation.<br />
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Consistent with observations from previous NASH studies, OCA treatment was associated with an increase in LDL cholesterol, with a peak increase of 22.6 mg/dL at 4 weeks and subsequently reversing and approaching baseline at month 18 (4.0 mg/dL increase from baseline). Triglycerides rapidly and continually decreased in the OCA treatment arms through month 18. There were few and varied serious cardiovascular events and incidence was balanced across the three treatment arms (2% in placebo, 1% in OCA 10 mg and 2% in OCA 25 mg).<br />
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With respect to hepatobiliary events, more patients (3%) on OCA 25 mg experienced gallstones or cholecystitis compared to <1% on placebo and 1% on OCA 10 mg. While numerically higher in the OCA 25 mg treatment arm, serious hepatic adverse events were uncommon with <1% incidence in each of the<br />
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Source - <a href="http://ir.interceptpharma.com/node/12371/pdf">Download PDF</a></div>
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MarketWatch </div>
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<a href="https://www.marketwatch.com/story/intercept-pharmaceuticals-is-one-step-closer-to-getting-fda-approval-for-the-first-ever-nash-drug-2019-02-19">Intercept Pharmaceuticals is one step closer to getting FDA approval for the first-ever NASH drug</a></div>
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There are no approved treatments for NASH, or nonalcoholic steatohepatitis, a serious liver disease caused by fat accumulation in the liver that can result in chronic inflammation and scarring, or fibrosis. Eventually, the disease can lead to liver failure, cancer and death. </div>
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Intercept’s treatment, obeticholic acid (OCA), is meant to treat patients with liver fibrosis due to NASH. The Phase 3 trial enrolled 931 patients with liver fibrosis who were randomly assigned to be treated with a placebo drug or one of two doses of OCA. </div>
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<a href="https://www.marketwatch.com/story/intercept-pharmaceuticals-is-one-step-closer-to-getting-fda-approval-for-the-first-ever-nash-drug-2019-02-19">Continue reading....</a></div>
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HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0tag:blogger.com,1999:blog-8358569997429791810.post-10950867404475690712019-02-19T12:00:00.000-05:002019-02-20T12:01:08.832-05:00Merck's Keytruda fails late-stage study in liver cancer patients<span style="-webkit-text-stroke-width: 0px; background-color: transparent; color: black; display: inline !important; float: none; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Reuters</span><br /><b>Merck's Keytruda fails late-stage study in liver cancer patients</b><br />(Reuters) - Merck & Co Inc’s cancer drug Keytruda failed a late-stage trial’s main goals of slowing disease progression and extending the life of patients with a common type of liver cancer, the company said on Tuesday. <br /><br /><div>
The results could hamper prospects for the drug, which had received an accelerated approval from the U.S. Food and Drug Administration in November as a treatment for patients with advanced liver cancer who had been previously treated with Bayer AG’s Nexavar. </div>
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<a href="https://in.reuters.com/article/merck-co-study/mercks-keytruda-fails-late-stage-study-in-liver-cancer-patients-idINKCN1Q82PK">Continue reading...</a></div>
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Press Release</div>
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<a href="https://www.mrknewsroom.com/news-release/oncology/merck-provides-update-keynote-240-phase-3-study-keytruda-pembrolizumab-previou">Merck Provides Update on KEYNOTE-240, a Phase 3 Study of KEYTRUDA® (pembrolizumab) in Previously Treated Patients with Advanced Hepatocellular Carcinoma</a> </div>
KENILWORTH, N.J.--(<a href="http://www.businesswire.com/">BUSINESS WIRE</a>)--Merck (NYSE: MRK), known as MSD outside the United States and Canada, today announced that the pivotal Phase 3 KEYNOTE-240 trial evaluating KEYTRUDA, Merck’s anti-PD-1 therapy, plus best supportive care, for the treatment of patients with advanced hepatocellular carcinoma (HCC) who were previously treated with systemic therapy, did not meet its co-primary endpoints of overall survival (OS) and progression-free survival (PFS) compared with placebo plus best supportive care. In the final analysis of the study, there was an improvement in OS for patients treated with KEYTRUDA compared to placebo, however these OS results did not meet statistical significance per the pre-specified statistical plan (HR=0.78 [95% CI, 0.611-0.998]; p=0.0238). Results for PFS were also directionally favorable in the KEYTRUDA arm compared with placebo but did not reach statistical significance (HR=0.78 [95% CI, 0.61-0.99]; p=0.0209). The key secondary endpoint of objective response rate (ORR) was not formally tested, since superiority was not reached for OS or PFS. The safety profile of KEYTRUDA in this trial was consistent with that observed in previously reported studies. Results will be presented at an upcoming medical meeting and have been shared with the U.S. Food and Drug Administration for discussion. <br /><br /> “While we are disappointed KEYNOTE-240 did not meet its co-primary endpoints, the results for overall survival, progression-free survival and objective response rate are generally consistent with findings from the Phase 2 study, KEYNOTE-224, which led to the accelerated approval of KEYTRUDA for the treatment of patients with hepatocellular carcinoma who have been previously treated with sorafenib,” said Dr. Roy Baynes, senior vice president and head of global clinical development, chief medical officer, Merck Research Laboratories. “We sincerely thank the patients and investigators for their participation in this study and are committed to helping patients diagnosed with this common and difficult-to-treat type of liver cancer.” <br /><br /> KEYTRUDA is being studied across multiple settings and lines of therapy for HCC through our broad clinical program that includes 10 clinical trials sponsored by Merck or in collaborations. As monotherapy in second-line HCC, in addition to KEYNOTE-240 and KEYNOTE-224, KEYTRUDA is being investigated in the ongoing Phase 3, KEYNOTE-394 trial, a randomized, double-blind trial evaluating KEYTRUDA in combination with best supportive care, compared to placebo in combination with best supportive care, in Asian patients with advanced HCC who were previously treated with systemic therapy. In addition, there are several ongoing trials investigating KEYTRUDA in combination with other treatments, including therapies through our collaborations. <br /><br /> About KEYNOTE-240<br /><div>
KEYNOTE-240 is a Phase 3, randomized, double-blind trial (ClinicalTrials.gov, <a href="https://cts.businesswire.com/ct/CT?id=smartlink&url=https%3A%2F%2Fclinicaltrials.gov%2Fct2%2Fshow%2FNCT02702401%3Fterm%3DNCT02702401%26rank%3D1&esheet=51942701&newsitemid=20190219005993&lan=en-US&anchor=NCT02702401&index=1&md5=2a8179d3166f133680a24f1370028666">NCT02702401</a>) evaluating KEYTRUDA plus best supportive care compared to placebo plus best supportive care in patients with advanced HCC who were previously treated with systemic therapy. The primary endpoints are OS and PFS. The secondary endpoints include ORR, duration of response, disease control rate and time to progression. The study enrolled 413 patients who were randomized to receive either KEYTRUDA (200 mg fixed dose every three weeks for up to 35 cycles of treatment [up to approximately two years]) plus best supportive care (including pain management and management of other potential complications including ascites per local standards of care) or placebo plus best supportive care. </div>
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<a href="https://www.mrknewsroom.com/news-release/oncology/merck-provides-update-keynote-240-phase-3-study-keytruda-pembrolizumab-previou">Continue reading....</a></div>
HCV New Drugshttp://www.blogger.com/profile/16049941177490552710noreply@blogger.com0