Monday, July 23, 2012

So You Think You’re A Hepatitis C Expert? 35 questions answered by 9 hepatology experts

Hello folks,
A few days ago Clinical Care Options released an online quiz containing 35 questions on treating hepatitis C, answered by nine world-renowned hepatology experts.

Check out these two questions offered in the quiz, with expert analysis by Stefan Zeuzem, MD.

Patient Case: Management of Rash

A 45-year-old female patient chronically infected with genotype 1b HCV relapsed following previous therapy with peginterferon/ribavirin. During previous therapy, treatment was well tolerated and she responded to peginterferon/ribavirin rapidly and had undetectable HCV RNA by Week 8. She is interested in retreatment with triple therapy and favors telaprevir-based therapy because of the 12-week period of triple therapy and hopes that this will minimize potential for adverse events. She is a TV moderator and is, therefore, particularly worried about a potential telaprevir-associated rash and specifically asks whether the rash is likely to occur in the face. How should this patient be counseled?

Analysis by Stefan Zeuzem, MD:
The typical telaprevir-associated rash can be described as an eczematous dermatitis, associated with pruritus and xerosis.[21,22] High-volume treaters have seen that telaprevir-associated rash is typically located on the trunk, arms, and legs, and only rarely affects the face. Grade 1 and 2 rash can be treated using emollients, moisturizers, and topical steroids.[21] Grade 3, or severe, rash requires immediate discontinuation of telaprevir.[21] Systemic steroids are not recommended during concomitant telaprevir administration and should be given only for severe rash after discontinuation of telaprevir.[1

Patient Case: Management of Rash

A 58-year-old male Hispanic patient with chronic genotype 1a HCV infection was started on triple therapy with peginterferon/ribavirin and telaprevir. After 4 weeks of therapy, HCV RNA was no longer detectable in serum. During Week 6 of triple therapy, he develops skin itching and a maculopapular rash on his trunk sparing the face, arms, and legs. He has a strong hair growth both on the front and the back of his trunk, which makes the rash difficult to visualize. Should telaprevir be discontinued?

Analysis by Stefan Zeuzem, MD:
The management strategy for telaprevir rash depends on its severity, with treatment discontinuation indicated only for grade 3 or “severe” rashes that cover > 50% of the body surface area. According to the “rule of nines,” each arm and leg comprises 9% and 18% of body surface area, respectively (in total 54%).[24] Rash affecting the complete trunk but sparing arms and legs is calculated to comprise approximately 36% of the body surface area (18% for the chest and abdomen, 18% for the back), that is, < 50% of total body surface area. Therefore, this patient’s rash would be classified as grade 2,[21] and treatment with telaprevir can be continued. Pruritus should be treated with cetirizine or other antihistamines without relevant drug–drug interactions with telaprevir.[21] Despite strong hair growth on the patient’s trunk, emollients/moisturizers and topical steroids should also be used in the treatment of the rash. Coadministration of systemic steroids and telaprevir is not recommended.

Are you ready to take the quiz?

Provided below is a look at the 35 questions. If you haven't registered with CCO, click here to register, and here to take the quiz. Thanks CCO !

Part 1 - ClinicalQuiz: So You Think You’re A Hepatitis C Expert?
By: Nezam H. Afdhal, MD, FRCPI, Donald M. Jensen, MD, Paul Y. Kwo, MD, Andrew J. Muir, MD, MHS, David R. Nelson, MD, Paul J. Pockros, MD, Fred Poordad, MD, Mark S. Sulkowski, MD, Stefan Zeuzem, MD

Hepatitis C is a rapidly evolving field with 2 newly available medications, recently updated treatment guidelines, and several investigational therapies in late stages of development. New therapies available for the treatment of patients infected with genotype 1 hepatitis C virus (HCV) have unique features that have changed the way clinicians treat the disease.

At the same time, management of non–genotype 1 HCV has evolved as new data have highlighted strategies for optimizing treatment in these patients. To help clinicians better apply current treatment guidelines and best management practices for hepatitis C, Raymond T. Chung, MD, and Jordan J. Feld, MD, together with 9 world-renowned hepatology experts, developed the educational program, “ClinicalQuiz: So You Think You’re a, Hepatitis C Expert,” an online and mobile game application designed to test knowledge and competence in treating hepatitis C.

This CME-certified educational activity includes important recommendations and clinical pearls from the first 35 questions of the HCV ClinicalQuiz.

Applying Response-Guided Paradigms for Treatment With Protease Inhibitor–Based Therapy
1-Patient Case: Telaprevir Regimen in Cirrhotic
2-Patient Case: Telaprevir Regimen in Previous Relapser
3-Patient Case: Telaprevir Regimen in Treatment-Experienced
4-Patient Patient Case: Use of Lead-in With Telaprevir
5-Patient Case: Qualifying for Shortened Therapy With Telaprevir
6-Patient Case: Boceprevir Regimen in Treatment-Experienced
7-Patient Patient Case: Telaprevir Futility Rules
8-Patient Case: Management of Missed Virologic Time Point
9-Patient Case: Assessing Response to Lead-in With Boceprevir Therapy
10-Patient Case: Response-Guided Therapy With Boceprevir in Treatment-Naive
11-Patient Patient Case: Qualifying for Shortened Therapy With Boceprevir
12-Patient Case: Futility Rules With Boceprevir
13-Patient Case: Interpretation of HCV RNA Assay Results

Adverse Event Management
14-Patient Case: Management of Anemia
15-Patient Case: Counseling Regarding Anemia
16-Patient Case: Counseling Regarding Neutropenia
17-Patient Case: Management of Thrombocytopenia
18-Patient Case: Management of Depression
19-Patient Case: Management of Rash
20-Patient Case: Management of Rash
21-Patient Case: Management of Dysgeusia

Strategies for Management of Special Populations With HCV Infection
22-Patient Case: Protease Inhibitor Therapy in Women of Childbearing Age
23-Patient Case: Management of Acute HCV Infection
24-Patient Case: Selection of Therapy in Patient With Renal Impairment
25-Patient Case: Management of HCV Posttransplant

Applying Best Practices to the Management of Genotype 2/3 Patients
26-Patient Case: Selection of Therapy in Genotype 3
27-Patient Patient Case: Pretreatment Counseling in Genotype 3 Patient
28-Patient Case: Treatment Duration in Genotype 2 Patient Cases and Strategies for Additional Management Considerations

Cases and Strategies for Additional Management Considerations
29-Patient Case: Food Requirements With Telaprevir
30-Patient Case: Posttreatment Monitoring of Patients
31-Patient Case: Interpretation of Assay Results
32-Patient Case: Treatment Options in Treatment-Experienced Genotype 1
33-Patient Patient Case: Treatment Options in Treatment-Experienced Genotype 2 Patient
34-Patient Case: Food Requirements With Boceprevir Therapy
35-Patient Case: Managing a Missed Dose of Boceprevir

Coming Soon!
Answer Case-Based Questions Online Or On Your Mobile Device

CME-Certified Modules:
ClinicalQuiz: So You Think You’re a Hepatitis C Expert, Educational Material, Part 2
ClinicalQuiz: So You Think You’re a Hepatitis C Expert, Educational Material, Part 3

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