Weekend Reading: Expert Commentary On Two Regimens To Treat Cirrhotic HCV GT1 Patients

Expert Commentary On Two Regimens To Treat Cirrhotic HCV GT1 Patients

Good day folks, welcome back to another edition of weekend reading.

It sure is a lovely afternoon here in Michigan, a perfect day to spend time outside with friends or family.  

My plans? A nice long jog around the park, on second thought maybe I shall drive.

Truth?  I never really go jogging these days, I just so enjoy typing it. 

In any case, if you find yourself stuck inside this weekend, Clinical Care Options published expert commentary from Paul Y. Kwo, MD and Ira M. Jacobson, MD., on the subject of treating HCV genotype 1 patients with cirrhosis.

In order to read both articles you need to register with CCO, it's free, quick and almost painless.

Here is an excerpt from both articles to get you started.

3/23/2015
Ira M. Jacobson, MD. - Using Ledipasvir/Sofosbuvir in Cirrhotic, Treatment-Experienced GT1 Patients: 12 Weeks With Ribavirin or 24 Weeks Without?
Although new data suggest comparable efficacy of ledipasvir/sofosbuvir with ribavirin for 12 weeks vs 24 weeks without ribavirin in genotype 1 cirrhotic, treatment-experienced patients, I am not convinced that shortening treatment is the best approach.

When I Would Choose Ledipasvir/Sofosbuvir Plus Ribavirin for 12 Weeks
Are there any instances in which I would choose the 12-week course of ledipasvir/sofosbuvir plus ribavirin over the 24-week course of ledipasvir/sofosbuvir alone? Yes—in patients for whom there are anticipated adherence challenges or economic barriers. In these cases, I have a dialogue with my patients to ensure they understand that we are making a decision with potential medical implications, particularly regarding tolerability, on the basis of economic concerns. They should be counseled as to the potential adverse effects, such as anemia and teratogenicity.

4/8/2015 Paul Y. Kwo, MD - Using Ombitasvir/Paritaprevir/Ritonavir Plus Dasabuvir in Cirrhotic, Treatment-Experienced GT1 Patients: 12 or 24 Weeks, With or Without Ribavirin?
Until more data are available on the use of the 3-DAA regimen in genotype 1 cirrhotic, treatment-experienced patients, I prefer to err on the side of caution to maximize opportunity for achieving SVR.

My Preferred Approach for Genotype 1b Cirrhotic Treatment-Experienced Patients
Until more data are available to inform this management decision, my own practice will be to include ribavirin when using the 3-DAA regimen for treatment-experienced cirrhotic patients with genotype 1b HCV infection. In my opinion, clinicians should be very cautious about moving forward with a ribavirin-free regimen in these patients. However, if you are treating such a patient with this regimen and they develop significant anemia or are having difficulty tolerating ribavirin, the data thus far suggest that the likelihood of achieving SVR without ribavirin is still very high and reducing the ribavirin dose or discontinuing the ribavirin is unlikely to have a significant deleterious effect on the likelihood of SVR in a genotype 1b cirrhotic patient.

Check out both articles, here.

April Updates @ CCO

4/7/2015
HCV Treatment in Liver Transplantation Recipients: My Take on the Latest HCV Guidance
Nezam H. Afdhal, MD, FRCPI 
In starting HCV treatment after liver transplant, how soon is soon enough?

I hope today the sun is shinning in your part of the world. 

Always Tina