Sunday, May 20, 2012

DDW Lecture on Sunday-Hepatitis C patients may benefit from delaying treatment until new therapies debut

Source - DDW Daily News

Categories @ DDW Daily News

Hepatitis C patients may benefit from delaying treatment until new therapies debut

Hepatitis C patients who don’t need treatment immediately may be able to hold out for a less complicated and more effective antiviral treatment currently in the development pipeline.

During an AASLD State-of-the-Art Lecture on Sunday, Maribel Rodriguez-Torres, MD, will discuss which patients need therapy now and which patients might be good candidates for watchful waiting. Dr. Rodriguez-Torres is a gastroenterologist at Ashford Presbyterian Hospital in San Juan, Puerto Rico, and a hepatitis C researcher. Her lecture is titled HCV Therapy: Who Can Wait and Who Can’t?
AASLD President Guadalupe Garcia-Tsao, MD, professor of medicine at Yale University School of Medicine, New Haven, CT, and chief of digestive diseases at VA-CT Healthcare System, said the session’s topic is important for physicians who treat hepatitis C because the potential therapies may be much simpler to use and more effective.

The current standard of care for patients infected with HCV genotype 1 is weekly injections of interferon combined with ribavirin pills taken twice a day and either boceprevir or telaprevir pills taken every eight hours.

“Triple therapy has good results,” Dr. Garcia-Tsao said. “It’s not 100 percent — you will get a cure rate of up to 78 percent depending on factors such as fibrosis stage and response to previous therapy. But we think in the future we’ll have therapies that are interferon-free, with a smaller number of pills, able to be taken just once or twice a day, and you’ll get up to a 90 percent cure rate in genotype 1 HCV and up to 100 percent in genotypes 2 and 3. These therapies are currently being tested in phase III randomized trials and we don’t know for sure whether they will become available, so we have to choose very carefully the patients who require therapy right now.”

The third element in combination therapy, the protease inhibitors boceprevir and telaprevir, just became available in 2011 and dramatically increased the number of genotype 1 patients who achieved a sustained virologic response (SVR). However, in addition to requiring commitment from the patient and a lot of effort from the provider, current therapies often result in severe side effects, including anemia, rashes, headache, fatigue, diarrhea and nausea.

“At this point we’re in a therapeutic window where we have new therapies but they’re very intense and we’re waiting for newer therapies that may be less so,” Dr. Garcia-Tsao said. “If right now a patient is at an early fibrosis stage — say 0, 1 or 2 — he or she might have time to wait for the new therapies, and so why undergo intense therapies when there’s hope on the horizon?”

Patients who can delay treatment are often best advised to do so because it will give them the best chance at achieving SVR (cure). The new therapies may also apply to a wider range of patients.
Dr. Rodriguez-Torres will help audience members identify those patients who are the best candidates for delaying treatment and those who probably need treatment sooner.

“Those who have advanced stages of fibrosis, particularly cirrhosis, may not have time, as cirrhosis may decompensate. Once cirrhosis decompensates, the patient is no longer a candidate for therapy,” Dr. Garcia-Tsao said.

More information can be found at

No comments:

Post a Comment