Saturday, January 7, 2012

Hepatitis C - Sunday Reading Round Up

Man Reading Book
By Leland Holiday

Today's News
Sunday January 8, 2012


Recall of Excedrin, NoDoz, Bufferin
BASEL, Switzerland — Novartis is recalling some bottles of Excedrin, NoDoz, Bufferin and Gas-X Sunday over concerns that the bottles could contain stray pills from other medicines, or chipped or broken tablets.
The news follows Novartis' recent decision to temporarily suspend production at its Lincoln, Neb., plant for "maintenance and other improvement activities."
The Swiss drug maker said it implemented the recall, which affects U.S. retailers, voluntarily and is working with the Food and Drug Administration during the process.
It became aware of the potential problem during an internal review that identified broken and chipped pills, and inconsistent bottle packaging that could cause pills to be mixed up. The company said it wanted to make sure that customers didn't take any pills that they might be allergic to or that might become dangerous when mixed with their other medications, though it also said that there have been no such reports from consumers.
Novartis said that some of the bottles of headache medicine Excedrin and caffeine caplets NoDoz with expiration dates of Dec. 20, 2014, or earlier will be subject to the recall.
Some of the packages of pain medicine Bufferin and stomach medicine Gas-X with expiration dates of Dec. 20, 2013, or earlier will also be affected.
The company said it will post more information Monday at www.novartisOTC.com. Customers can also call the company at 1-888-477-2403 Monday to Friday, 9 a.m. to 8 p.m. EST.

Pharmaceutical plans

Being a pioneer is not enough any more for Merck, as they strive to also be the best at what they produce.

Among Merck’s well-known first-in-class products are the quadrivalent human papillomavirus vaccine against cervical cancer, sitagliptin for diabetic patients and boceprevir, a protease inhibitor used to treat hepatitis C.
In terms of the bottomline, Dr Rosetti shares that while Merck has had three or four drugs in the top 10 first-in-class mega blockbusters (drugs that earn the most money for their company) over the past decade, they have had none in the best-in-class list. And, he adds, there were more best-in-class mega blockbusters than there were first-in-class ones.
This realisation came about after Merck and fellow American pharmaceutical company Schering-Plough merged to form what is now the second largest healthcare company in the world in November 2009...Continue Reading..


Healthy You

Editors Note: Every day we are launching the January 2012 collection of daily blog entries for the “31 Days of Wellness”, our annual celebration of the New Year, and the opportunity to start anew as we ring in the New Year. Enjoy, visit us daily, and send us your feedback.
Dr. Joe Galati
This is a self explanatory blog entry. Don’t eat any of these foods, or their close relatives, if you are interested in health, wellness, and plan to curb obesity.
Listen here for my podcast Food Not to Eat Part 1 and Food Not to Eat Part 2 as well as browse the images to here the entire story and understand the dangers lurking at the supermarket...Click here to view images.

For Your Reading Pleasure


Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week.
Hosted this week by The blog that ate Manhattan
THIS WEEK’S GRAND ROUNDS EXPERIMENT

Think of this edition more as a little experiment to see if Grand Rounds can make it in the era of the short communiqué (which already this post has far, far exceeded, making me an official blogging dinosaur).
I’ve culled 12 posts well worth your read from submitted links and my wanderings around the internet. Every post is summarized and commented on in 140 characters or less. I’m posting at 7 am and tweeting both the entire set and each post individually throughout the morning, and ask that you re-tweet if you feel about a post the same way I do. If you submitted a post and it wasn’t listed, please don’t be offended – and do submit again next week!
I actually found the curating a shorter list of posts made hosting a much less laborious and more enjoyable process than previously, and while composing tweets is ever challenging, it’s always fun.
Perhaps the echo chamber will not only revive but rejuvenate this old dinosaur, so that it will reverberate throughout and beyond our not so little anymore blogging community. Whether or not that happens, dear reader, is up to you.
So Tweet! Tweet! Tweet!

GRAND ROUNDS – THE TWITTER EDITION
Dan Muro at Forbes.com
  • Healthcare Stats for 2012. Some will astound, some frighten, some anger you (esp no. 11). http://onforb.es/vRqRDs @GrandRounds
Shara Yurkowitz at Plosblogs -
  • This may hurt a bit” Why some docs fail to live up to their title in a patient’s eyes (and ears). http://bit.ly/vM168E @GrandRounds
Dr Michael Korlwchak at Wired Medical Practice
  • Deep Thoughts from the Meaningful Use Mountaintop. The harsh realities of EMR in practice. http://bit.ly/sKUt5n @GrandRounds
Dr.Bertalan Meskó at Science Roll
  • 12 predictions for HIT, Tech & Innovation in 2012. (He got most of 2011 right.) http://bit.ly/rLB0uh @GrandRounds
Beth L Gainer at Calling the Shots.
  • “Five years ago today, I had to get something off my chest. It was my breasts.” Brutally honest. http://bit.ly/up8V2s @GrandRounds
RL Bates, MD at Suture for a Living
  • @RLBates – Top Eleven of 2011. The years’s best from one of medicine’s best bloggers. http://bit.ly/udij9t @GrandRounds
Jamie Rauscherat Health Jam

Michele R Berman, MD at Celebrity Diagnosis
  • Celebrity Health – 2011. Shamelessly taking advantage of Rich & Famous to teach rest of us about health. @CelebrityDx. http://bit.ly/sLRM93
Dr Elaine Schattnerat Medical Lessons
  • @MedicalLessons – IOM report on environment & breast cancer – great summary of an important report. http://bit.ly/uFjQDP @GrandRounds
Dr Mike Sevilla at Family Medicine Rocks
  • @drmikesevilla – Open Letter to Congress – I Will Stop Taking Medicare. (Cuts delayed – Go Mike!) http://bit.ly/sgo6bm @GrandRounds
Richard Winters, MD at Beyond the Clinical

  • @drwinters. How I lost credibility in 5 mins – Investigating MD Incident Reports.Docs & admins must-read http://bit.ly/uBwcY3 @GrandRounds
William Dale, MD at WilliamDaleMd

  • A Personal Journey Down the Rabbit Hole – Doc tries to get son’s med record. Powerful. @WilliamDale_md http://bit.ly/vWVcQIl @GrandRounds

Off The Cuff

Pot Tops Global Drug Use List
By Kristina Fiore, Staff Writer, MedPage Today
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Each year around the world, more than 200 million people use illegal drugs, and marijuana still appears to be the drug of choice, researchers found.
Although illegality makes accurate estimates a challenge, data from 2009 suggest that 149 to 271 million people around the world used illegal drugs, according to Louisa Degenhardt, PhD, of the University of New South Wales in Sydney, and Wayne Hall, PhD, of the University of Queensland in Australia.
Pot use, with anywhere from 125 to 203 million people lighting up annually is the most widely used, they said.
They reported their estimates in a special issue of The Lancet that focused on addiction.
That proportion is far larger than the 14 to 56 million estimated to use amphetamines, the 14 to 21 million estimated to use cocaine, and the 12 to 21 million estimated to use opioids, they found.
Pot is also the most widely used illegal drug in the U.S., according to the latest data from the Substance Abuse and Mental Health Services Administration (SAMHSA). In 2010, about 22.6 million Americans used illicit drugs, with 17.4 million of them reporting cannabis use.
Yet marijuana is the least likely of all illicit drugs to cause death, the researchers said, cautioning that it's still likely associated with dependence and mental disorders.
Opioids (heroin, fentanyl), on the other hand, are a major cause of death due to overdose and dependence, and have also been tied to HIV and hepatitis B and C infection, especially among injection-drug users.
Preference for drugs varies geographically, with pot and cocaine use highest in North America and Europe, while more than half of opioid users lived in Asia, with the highest levels being along the main drug trafficking routes out of Afghanistan.
"Levels of illicit drug use seem to be highest in high-income countries and in countries near major drug production areas," Degenhardt and Hall wrote. They noted that their study didn't assess use of hallucinogens, inhalants, benzodiazepines, anabolic steroids or ecstasy (3,4-methylenedioxymethamphetamine or MDMA).
Initiation and progression of drug use also varies by region, with most users in high-income countries starting out with alcohol and tobacco, then transitioning to marijuana use, and finally into other drugs.
But that pattern isn't consistent, the researchers said. In Japan, for instance, other illicit drug use is more prevalent than cannabis use, suggesting that abuse depends on social factors and drug availability.
"Social norms have a very powerful impact on drug use patterns," Bruce Goldman, director of substance abuse services at North Shore LIJ in Glen Oaks, N.Y., told MedPage Today in an email. "We need to create norms where substance use and availability, especially for young people, is not acceptable."
Although problematic, the global burden of disease caused by illicit drug use is far less than that of alcohol and tobacco, according to various estimates. One from 2000 found drug use to be associated with 102,000 to 322,000 deaths worldwide -- far lower than the estimated 1.8 million deaths due to alcohol use and 4.8 million deaths with tobacco use.
Similarly, World Health Organization data from 2004 suggested that 250,000 deaths worldwide were attributable to drug use, compared with 2.25 million due to alcohol use and just over five million associated with tobacco, they reported.
Still, Degenhardt and Hall called illicit drug use a "substantial global cause of premature mortality and morbidity."
They added that the 11 to 21 million people around the world estimated to inject drugs are responsible for the largest burden of disease associated with illegal drugs, along with those who are dependent; about 15 to 39 million people are thought to be in this class of "problematic" user, they reported.
They said much of this burden can be reduced or prevented through needle exchange programs, opioid substitution treatment, and antiretroviral therapy.
Many questions about global drug use remain unanswered, they added, concluding that "until we have better answers to these questions, statements about the exact magnitude of the health, social, and financial burden of illicit drug use cannot be made with accuracy."
The editors of The Lancet noted in an accompanying commentary that policymakers in the U.S. need to pay particular attention to abuse of prescription drugs.
"Prevention and treatment of prescription drug dependency offer challenges that differ from those of addiction to illicit drugs, and need innovative solutions," they wrote. "Addiction is a complex disease without a universal policy approach or treatment


Drug Companies Reduce Payments to Doctors as Scrutiny Mounts
This is part of our year-end series, looking at where things stand in each of our major investigations.

Some of the nation's top medical schools cracked down on professors who give paid promotional talks for drugmakers last year, and the firms themselves cut back on such spending in the wake of mounting scrutiny.
Last year began with the University of Colorado Denver and its affiliated teaching hospitals launching an overhaul of conflict-of-interest policies [1] after ProPublica found that more than a dozen of its faculty members had given paid promotional talks.
"We're going to just have to say we're not going to be involved with these speakers bureaus because they're primarily marketing," Dr. Richard Krugman, vice chancellor for health affairs, said in an interview in January 2011.
A few months later, Stanford University took disciplinary action against five faculty members [2] identified by ProPublica who had taken money to deliver drug company speeches, a violation of university policy..Continue reading...

The most popular posts for the first week in January

Bristol-Myers Squibb to Acquire Inhibitex
“Bristol-Myers Squibb’s expertise in antiviral drug development, and its existing complementary portfolio, will assure that the potential of INX-189 is realized as part of future oral combination therapies for millions of patients in need around the world.”

India's Drug Trials-Thousands have died since rules were eased
Thousands have died since rules were eased
"Since India eased guidelines for conducting drug trials in 2005, the number of Indians participating has shot up to 150,000 from close to zero, as international drug companies take advantage of lower costs here. But questions about the consent process have fueled fears that many Indians are entering the trials without knowing the risks...In the wake of the recent controversies, the Indian Council for Medical Research invited public feedback on draft guidelines about compensation for injuries that occur during clinical research…Across India, 1,700 people who participated in clinical drug trials died between 2007 and 2010, the government’s drug regulatory agency said, although no autopsies were carried out to determine the causes of the deaths. In 2010, 22 families of the dead were compensated by U.S. and European drug companies, ranging from $2,000 to $20,000.

Hepatitis C Research-Jan 2012
January Pubmed Literature Review

Fatigue in Cirrhosis Linked to Psychosocial Factors
Cirrhosis patients have significantly more fatigue than do matched controls from the general population, and this fatigue often persists 1 year after liver transplantation, reported Dr. Evangelos Kalaitzakis and colleagues in the February issue of Clinical Gastroenterology and Hepatology.

Radical Liver Surgery, West Coast First
A team led by Alan Hemming, MD, transplant surgeon at UC San Diego Health System, has successfully performed the west coast’s first ex-vivo liver resection, a radical procedure to completely remove and reconstruct a diseased liver and re-implant it without any tumors

Stanford discusses link between low vitamin D levels and an increased risk for cardiovascular disease, autoimmune disease and some cancers
Video- research on the link between low vitamin D levels and an increased risk for cardiovascular disease, autoimmune disease and some cancers.

Future treatment of patients with HCV cirrhosis
Understanding of the structures of HCV protease and HCV polymerase has allowed structure-based drug design to develop inhibitors of these enzymes. Two first generation protease inhibitors (boceprevir and telaprevir) were marketed in 2011. The aim of this article is to review the treatment of HCV cirrhosis in the era of new direct-acting antiviral (DAAs), according to the recent literature.

What's new in HCV genotype 2 treatment
The triple combination treatment, including direct-acting antivirals (DAA) that will be commercialized in the coming months might increase SVR rates in this particular subgroup of patients. According to existing results, telaprevir might be beneficial in HCV-2 but not in HCV-3 patients. A nucleotide analogue polymerase inhibitor, PSI-7977 by Pharmasett has been shown to be active against both.

Treatment of patients with genotype 3 chronic hepatitis C- current and future therapies
In a retrospective study of 353 patients, Nkontchou et al. [9] showed that hepatitis C genotype 3 was associated with a higher incidence of hepatocellular carcinoma (HCC) in patients with ongoing cirrhosis. The risk factors for an increased risk of HCC were male gender, older age, higher body mass index, low platelet count and genotype 3. Probably because of the rapid progression to fibrosis, genotype 3 could predispose to HCC along with other defined risk factors. The HCV genotype 3 core protein causes steatosis [10, 11, 12] that can lead to oxidative stress and reactive oxygen species predisposing to carcinogenesis [13, 14]. Thus, better treatment must be found for this dreadful yet curable infection.

The future for the treatment of genotype 4 chronic hepatitis C
The approval of new direct inhibitors of HCV replication should significantly improve the management of HCV. Many compounds are currently in phase II and III trials, mainly inhibitors of the HCV NS3/4A protease and NS5B polymerase [25, 26]. The first two HCV protease inhibitors (telaprevir and boceprevir) were recently approved for genotype-1 HCV, in some countries. Most of these new antiviral drugs have only been developed and investigated for genotype-1 HCV. The SVR rates with telaprevir in naïve patients and previously unresponsive patients have improved by 70% and up to 40% respectively [27, 28]. The results of the concept study show that telaprevir is active against HCV-4 after 15 days of monotherapy or in combination with PEG-IFN and RBV compared with PEG-IFN, RBV and placebo [28]. Boceprevir the other drug with direct action, is also effective in HCV-1 patients [29], however, preliminary data suggest that boceprevir might not be effective in HCV-4 with the present regimen [30].

New targets for antiviral therapy of chronic hepatitis C
Attributable to its poorly characterized role in HCV RNA replication and the lack of enzymatic activity, NS5A has long been neglected as a primary drug target. However, by using replicon-based screens and subsequent intensive chemical refinements of primary hits, a highly active compound (BMS-790052) characterized by its symmetric structure was identified [34]. This compound has an amazingly high potency with antiviral efficacy in the picomolar range. In fact, it has been calculated that one inhibitor molecule can block 10–100 NS5A molecules, arguing that BMS-790052 might exert a ‘dominant negative’ phenotype. This high potency was well recapitulated in a phase I clinical trial with chronic hepatitis C patients; a single application of 100 mg BMS-790052 reduced viral load around 1000-fold within 24 h after application [34].

Triple therapy for HCV geno1: telaprevir or boceprevir?
Boceprevir and telaprevir are the first two protease inhibitors available for the treatment of patients infected with hepatitis C virus (HCV) genotype 1. A sustained virological response (SVR) of 70–80% is observed when either of these protease inhibitors is utilized with pegylated interferon (PEG-IFN) and ribavirin (RBV) in treatment naïve patients. Both agents are also highly effective in patients who failed to achieve a SVR during previous treatment

Chronic Liver Disease Hospitalizations Greater for Diabetics
For each hospitalization, the investigators checked for the presence of diagnostic codes for hepatitis B; hepatitis C; chronic hepatitis and cirrhosis; malignancy of the liver or bile ducts; and alcoholic liver disease. They used National Health and Nutrition Examination Survey data to obtain population denominators for adults with and without diabetes.

Why Have Cases of Liver Cancer Tripled?
  • The overall incidence of HCC is higher than what the National Cancer Institute (NCI) estimates - 6.9 cases are found in 100,000 individuals vs. NCI's estimate of 5.1 per 100,000.
  • Two decades ago, liver cancer typically resulted from tissue scarring caused by alcohol consumption or cirrhosis.
  • HCC is now developing after an individual is infected with the hepatitis C virus.
Hepatitis C vaccine: Oxford researchers' trial 'promising'
They attempted to target the inner workings of the virus, rather than the variable surface markings.
While we are hopeful, it could be a long road to any vaccine that protects people against hepatitis C”

ACH-1625 Protease Inhibitor Receives Fast Track For The Treatment Of HCV
Fast Track designation was granted to ACH-1625 for its potential to provide:
- Improved safety and tolerability as compared to the current standard of care;
- Convenient once-daily dosing;
- Broader genotypic coverage of HCV;
- An improved drug-drug interaction profile with greater potential to treat HCV patients with comorbidities, co-infected with HIV, or pre- or post-liver transplantation; and
- Development in a once-daily interferon-free oral combination.
"We are very pleased with the granting of a Fast Track designation for ACH-1625, which we believe highlights this protease inhibitor's attributes which include broad genotypic coverage of HCV, once-daily administration and an improved safety, efficacy and tolerability profile over currently approved therapies for HCV," commented Michael Kishbauch, President and Chief Executive Officer of Achillion. "As we work toward achieving our near-term milestones, we remain eager to initiate an interferon-free, all-oral combination clinical study evaluating our protease inhibitor plus NS5A inhibitor for the treatment of HCV during the second half of this year."


Results:CF102 in the treatment of hepatocellular carcinoma (HCC).
Can-Fite BioPharma Ltd (TASE:CFBI), a biotechnology company developing small molecule drugs for the treatment of inflammatory, and liver diseases, traded on the Tel Aviv Stock Exchange announced today the successful results of the Phase 1/2 study of its drug candidate CF102 in the treatment of hepatocellular carcinoma (HCC).

Mayo study links hepatitis C to liver cancer
St. Paul, Minn. — The Mayo Clinic released a study today that identifies hepatitis C as a cause of rising liver cancer rates. Researchers say with that information, more people can be screened for hepatitis C and prevent cancer.

The finding may have a particular impact on the Somali community. That's because a second study published by Mayo today says hepatitis C rates among Somalis are much higher than previously suspected.

HCV News Ticker: American scientist arrested in stem-cell clinic sting
News Updates

Hepatitis C (DAA) drugs - The invaders and the barrier
A number of direct acting antiviral (DAA) drugs are in development for the treatment of chronic hepatitis C virus (HCV) infection. Two NS3/4A protease inhibitors, telaprevir and boceprevir, have been recently approved in combination with pegylated interferon (IFN)-α and ribavirin for the treatment of genotype 1 chronic hepatitis C [2], [3], [4], [5]. Other DAAs are at various stages of preclinical to late clinical development. They can be schematically classified into two groups, according to their barrier to resistance. Drugs with a low barrier to resistance include first-generation NS3/4A protease inhibitors (e.g. telaprevir and boceprevir and numerous other molecules in development), NS5A inhibitors, and non-nucleoside inhibitors (NNI) of HCV RNA-dependent RNA polymerase (RdRp) [6].

Hepatitis C - Looking Ahead to 2012
As we close out 2011 and usher in 2012, the treatment for hepatitis C remains promising with two new drugs FDA approved, and interferon free regimens in the future, a cure is now finding its way into the world of the difficult to treat patient. Today on the blog we have a few links on these promising therapies, starting with a few recent articles from the scientific journal, Nature.

Hepatitis C and Liver health: Getting It Right In 2012

Yep, its 2012, a time for shaping up, eating right and addressing all those unhealthy habits from 2011. Enter - liver disease, hepatitis C, and a few healthy ways to improve liver health.

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