Treatment approaches- Treat HCV now or wait and management of adverse events

Hi Folks,
When a new HCV learning activity is released online this blog provides background information, and links to the new video, article or CME.

In July and August two learning activities were published over at Medscape, both presented in an interview format.

*Like any site offering continuing medical education (CME), it requires a free quick registration to participate.

In the most recent CME, Paul Y. Kwo, MD, professor of medicine at Indiana University School of Medicine describes a case scenario of a 59-year-old man with hepatitis C who has cirrhosis thus motivated to begin treatment now instead of waiting for future therapies.

As noted by Dr. Kwo in the CME;

With new agents on the horizon, it is important to identify those patients who cannot afford to wait for new treatments. There are also patients whose clinical characteristics allow for treatment delay but who are highly motivated and wish to initiate treatment right away.

In regard to side effects Dr. Kwo remarked:

There are some other issues to be aware of with both of these HCV protease inhibitors.^[7,13] Gastrointestinal side effects occur with both telaprevir and boceprevir. Boceprevir causes dysgeusia, which usually does not lead to treatment discontinuation. Clinicians should also know that boceprevir is associated with slightly higher levels of neutropenia as well as anemia. There are some perianal symptoms with telaprevir that sometimes require management.^[7,13] We use topical hydrocortisone cream. Mesalamine suppositories and topical lidocaine can also be used to address this issue during the 12 weeks of telaprevir therapy. To address the gastrointestinal issues associated with the protease inhibitors as well as with PEG-IFN and RBV, we may use loperamide or fiber supplements.

Click here to begin.

In the second CME Andrew J Muir, MD., Director of GI/Hepatology Research at Duke Clinical Research Institute discusses eligibility and adherence in standard therapy for genotype 1 patients comprising of HCV protease inhibitor-based triple therapy -Telaprevir or Boceprevir.

Dr. Muir discusses the standard of care for HCV genotype 1 patients

The current standard of care for treatment of chronic HCV genotype 1 infection in the United States is the combination of PEG-IFN-alfa, RBV, and one of the HCV NS3/4A protease inhibitors boceprevir or telaprevir.^[1] In clinical studies, the addition of boceprevir or telaprevir to the previous standard of care for these patients (ie, PEG-IFN plus RBV) was associated with a significantly increased rate of sustained virologic response (SVR) in both treatment-naïve and previously treated patients

Dr. Muir comments on the promise of new agents to treat hepatitis C;

The guidelines recommend that treatment should be considered in all patients who qualify; we take that approach on a case-by-case basis to determine whether treatment is appropriate for an individual patient at this time. A number of the new HCV agents are expected to become available in the next few years, and we expect that there will be an IFN-free regimen available for HCV genotype 2 and 3 by late 2013, and hopefully for genotype 1 by 2015 or so. The question, then, is this: Should you treat the patient now, or wait until these new therapies are available?

Click here to begin.
                         
Medscape Education Gastroenterology

CME Released: 08/14/2013
Timely and Appropriate Care for Chronic HCV Infection: Therapy Selection and Adverse Event Management
On June 17, 2013, Medscape spoke to Paul Y. Kwo, MD, professor of medicine at Indiana University School of Medicine and medical director of liver transplantation at Indiana University Health, Indianapolis, to discuss the current HCV treatment approaches and provide a case-based illustration of the decision of whether a patient is a candidate for treatment with the current standard of care, and to detail management of adverse events associated with HCV therapy.

CME Released: 07/31/2013
Providing Timely and Appropriate Care for Chronic HCV Infection: Patient Readiness and Likelihood of Response
This represented a new paradigm in the management of HCV. On May 29, 2013, Medscape spoke to Andrew J Muir, MD, Associate Professor of Medicine and Director of GI/Hepatology Research at Duke Clinical Research Institute in Durham, North Carolina, to discuss the current HCV treatment approaches and provide a case-based illustration of the decision whether a patient is a candidate for treatment with the current standard of care.