Friday, September 22, 2017

Statins reduce the risk of liver decompensation and death in chronic viral hepatitis: a propensity score weighted landmark analysis

Statins reduce the risk of liver decompensation and death in chronic viral hepatitis: a propensity score weighted landmark analysis
J. C.-T. Wong, H. L.-Y. Chan, Y.-K. Tse, T. C.-F. Yip, V. W.-S. Wong and G. L.-H. Wong

Version of Record online: 21 SEP 2017 | DOI: 10.1111/apt.14341

Full Text
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Aim
To determine the effects of statin use on the risk of liver decompensation and death among patients with chronic viral hepatitis.

Methods
We conducted a population wide cohort study using a hospital based database from the Hong Kong Hospital Authority. Adults with chronic viral hepatitis without prior liver decompensation were identified from 2000 to 2012 by International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic codes. Statin use was defined as a cumulative defined daily dose of >28. Landmark analysis was used to overcome immortal time bias. Propensity score weighting was further performed to minimise baseline confounders. Primary outcome was a composite of portal hypertension related liver decompensation events, with adjustment for death as a competing risk.

Results
A total of 69 184 patients with chronic viral hepatitis (2053 statin users and 67 131 statin non-users) were identified for the 2-year landmark analysis. After propensity score weighting of 23 baseline covariates, statin use was associated with a significant reduction in composite liver decompensation events (HR: 0.55; 95% CI: 0.36-0.83; P = .005), ascites (HR: 0.57; 95% CI: 0.36-0.92; P = .02), and a dose-dependent decrease in death (HR: 0.87; 95% CI: 0.76-0.99; P = .035) relative to no statin use.

Conclusions
Patients with chronic viral hepatitis who used statins have a reduced risk of liver decompensation and death compared to non-users in this propensity score weighted landmark analysis.

1 INTRODUCTION
2 METHODS
3 RESULTS
4 DISCUSSION
ACKNOWLEDGEMENTS
AUTHORSHIP

In the Battle Against Hepatitis C, the VA Takes the Lead

In the Battle Against Hepatitis C, the VA Takes the Lead

TAG Applauds Malaysian Government's Decision to Make Generic form of Life-Saving Hep C Cure

TAG Applauds Malaysian Government's Decision to Make Generic form of Life-Saving Hep C Cure
September 20, 2017, New York, NY—The Government of Malaysia reaffirmed its commitment to affordable access to hepatitis C treatment by issuing a compulsory license on sofosbuvir (Sovaldi). TAG lauds this landmark decision for enabling the entry of generic competition, which will effectively reduce prices.

Malaysian civil society organizations, including Third World Network, Malaysian AIDS Council, and Positive Malaysian Treatment Access and Advocacy Group, have tirelessly pushed for expanded access to direct-acting antivirals (DAAs) in the public health sector. Last month, Gilead announced Malaysia’s inclusion in a voluntary license (along with Belarus, Thailand, and Ukraine) to permit generic DAA imports from India. Civil society groups urged the government to move ahead with issuing a compulsory license to guarantee high quality generics from an Egyptian manufacturer, which did not fall under the voluntary license.

Compulsory licenses allow a generic company or government institution to manufacture a patented medicine for the “supply of the domestic market” without the consent of the patent holder. However, using these policy flexibilities, enshrined in the global TRIPS Agreement, comes at a risk. Countries, particularly in the global South, may face political pressure or trade repercussions from governments and companies for employing these policy tools. Malaysia’s compulsory license prevents a monopoly control on sofosbuvir, while also paying a royalty to remunerate Gilead. This move helps to reconcile an imbalance between the intellectual property system and protecting public health.

Around half a million people are living with HCV in Malaysia yet DAAs have been priced well out of reach for most patients—a 12-week course of treatment costs up to US$12,000 [MYR 50,000], or nearly half the average annual household income. Healthcare costs and medical bills amount to 35% of Malaysians’ income.

“There’s no justification for Gilead’s exorbitant pricing in a middle-income country like Malaysia: Sofosbuvir can be produced for less than US$100 per average treatment course at volume. Once again, Gilead treats this essential medicine as a luxury good, squeezing maximum revenue from the few who can afford it rather than pricing for universal access,” said Annette Gaudino of Treatment Action Group.

“Patients around the world can no longer be held hostage at Big Pharma’s drug prices. Malaysia has set an example for other countries to fully use policy flexibilities, such as compulsory licenses, when companies like Gilead obstruct expedient delivery of affordable life-saving medicines,” said Bryn Gay of Treatment Action Group. “This decision reinforces people’s fundamental rights to health, the benefits of scientific progress, and access to medicines.”

People living with HCV will now have more treatment options. Sofosbuvir is one of the most widely prescribed DAAs worldwide, and is over 90% effective in curing chronic HCV infection across all genotypes when combined with other antiviral medications. Clinical trials are underway in Malaysia—a collaborative partnership between the Ministry of Health, Drugs for Neglected Diseases initiative, and Pharco Pharmaceuticals—to investigate the potentially new pangenotypic combination, sofosbuvir and ravidasvir.

FDA warns of death, liver injury risks from Intercept's drug Ocaliva used to treat primary biliary cholangitis

FDA warns of death, liver injury risks from Intercept's drug Ocaliva

Last Updated: 2017-09-21
By Reuters Staff

(Reuters) - The U.S. Food and Drug Administration (FDA) warned on Thursday that Intercept Pharmaceuticals Inc's drug Ocaliva (obeticholic acid) is being incorrectly dosed in some patients with a rare liver disease, increasing the risk of liver injury and death.

The U.S. drugmaker's shares fell 10.4 percent to $87.90 in afternoon trading following the news.

The FDA warning comes two weeks after Intercept gave healthcare providers prescribing information for Ocaliva and flagged reports of liver failure and deaths. (http://bit.ly/2xudehJ)

Ocaliva, approved last May, is used to treat primary biliary cholangitis (PBC), a rare, chronic liver disease that causes bile ducts in the liver to become inflamed, damaged and destroyed.

Nineteen deaths and 11 cases of serious liver injury were associated with the use of Ocaliva, the FDA said. Some patients were receiving higher doses of the drug, particularly due to a higher frequency of dosing than recommended in the label, the agency added. (http://bit.ly/2hiUvil)

"FDA's narrative about the high number of deaths and worsening of PBC cases strikes us as particularly concerning, and could tilt the FDA more toward a black box warning," Leerink analyst Joseph Schwartz said in a report to clients.

A black box warning is the strictest warning by the FDA that appears on a prescription drug's label, calling attention to serious or life-threatening risks of a drug.

However, RBC Capital Markets analysts said the risks flagged by the FDA were already known and included on the drug's label. The affected patients represent under 5 percent of the overall PBC population, limiting likely commercial impact to Intercept, they said.

In the quarter ended June 30, Intercept generated $30.4 million in worldwide sales from Ocaliva.

The New York-based company was reviewing the FDA's warning, Intercept said via email.

Rapid HCV testing may help better screen young adults

Rapid hepatitis C testing may help better screen young adults

Study finds improved life expectancy when patients get immediate results

Boston Medical Center
BOSTON-- Routine and rapid hepatitis C virus (HCV) testing among young adults who use injection drugs improves life expectancy and may provide a good use of limited resources, according to new research out of Boston Medical Center, in partnership with the Boston Public Health Commission. The findings are published online ahead of print in the journal Clinical Infectious Diseases.

HCV is a viral infection that affects the liver. An estimated 3.2 million people in the United States are infected with HCV, and most do not feel ill or know that they are infected, according to the Centers for Disease Control and Prevention (CDC). Since 2010, acute cases of HCV have more than doubled, with new cases predominantly among young, white individuals with a history of injection drug use.

Currently, the CDC recommends doctors screen patients at high-risk for contracting HCV, which include but are not limited to people born between 1945 and 1965, those diagnosed with HIV, children born to HCV-positive women and individuals who engage in injection drug use, among other select populations at high risk. This strategy is called "targeted" screening. "Routine" screening, as defined in the study, tests all individuals in a community with a high prevalence of HCV.

There are two ways to perform these screenings. Rapid testing is when results are given on the same day that the sample is drawn. Standard testing requires patients to return for a second appointment to get the results.

Using simulation modeling, researchers evaluated the clinical benefits and cost-effectiveness of testing strategies among 15 to 30-year-olds at urban community health centers. They found that routine, rapid testing was cost effective and increased the quality of life among this patient population. Additionally, when dedicated counselors initiated the tests, they identified more cases of hepatitis C and reduced the proportion of deaths compared to targeted, standard testing by a physician.

"When standard testing was applied, patients were less likely to come back for that second appointment to get their results, which in turn meant more people weren't getting the treatment they so desperately needed," said Sabrina Assoumou, MD, MPH, infectious disease physician at Boston Medical Center and assistant professor of medicine at Boston University School of Medicine who led the study. "Our results indicate that we must initiate rapid [testing] strategies so that more people will know their status and get treatment more quickly."

HCV Guidance Updates - Recommendations Reflecting Vosevi and Mavyret


HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV.

The guidelines have a complex algorithm for practitioners around the country to follow and see what's the right treatment, for the right patients, for the right about of time. The document is beneficial for patients as well living with or treating HCV. When new HCV drugs are approved, and new real world data is established, the guidelines are updated.

What’s New, Updates, and Changes to the Guidance
Thursday, September 21, 2017
This version of the guidance has been updated to reflect several important developments, including the recent approvals of glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilaprevir. Updated recommendations reflecting these approvals are provided throughout the guidance.

Updated references have been provided throughout the guidance.

In addition to updates to all the sections, the following new sections have been added to the guidance:
The following pages include guidance for management of treatment-naive patients.
The following pages include guidance for management of treatment-experienced patients.
Stay current with all guideline updates, "click here."

Thursday, September 21, 2017

An Updated Conclusion - Henry E. Chang Tweets About Cochrane Review of HCV Direct-acting antivirals

An Updated Conclusion - Henry E. Chang Tweets About Cochrane Review of DAAs

Welcome, Autumn is just a day away, as the season changes so did one systematic review, one that was highly debated by researchers, clinicians, and HCV advocates this summer.  This past June a Cochrane Review concluded that achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits. Soon a Guardian article was in widespread circulation across social networks, with this glaring headline; Hepatitis ‘wonder drug’ may be clinically ineffective, say experts. Patients were confused, experts disappointed, and the HCV community was blindsided.

Follow Henry E. Chang
on Twitter
The Controversy Is Archived On Twitter
While advocates and clinicians were in the process of writing a rebuttal, Henry E. Chang put together a nice collection of tweets during the controversy: "Reactions from Hepatitis C Community on a Recent Cochrane Review of DAAs." Thank you for continuing to make the conversation easy to follow, especially for patients.

New On Twitter - Cochrane Update
Yesterday on Twitter we were updated, again thanks to Henry E. Chang.
Recently, authors of Cochrane DAA review "changed" their conclusions but remain amazingly tone-deaf to what HCV community & experts are saying.
View the tweet here, and changed conclusions with links below.

Full Text
A message from Mr. Chang with the full-text Cochrane review articles http://jmp.sh/qF4tI1Y (pub 2) and http://jmp.sh/mma5f2c (pub 3).

Changed Conclusions - September 18, 2017
Version 3
Direct-acting antivirals for chronic hepatitis C
Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kiran Kumar Katakam, Kristina Fobian, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud

First published:
Editorial Group: Cochrane Hepato-Biliary Group
DOI: 10.1002/14651858.CD012143.pub3  View/save citation
Cited by (CrossRef): 0 articles Last updated
Authors' conclusions
The evidence for our main outcomes of interest come from short-term trials, and we are unable to determine the effect of long-term treatment with DAAs. The rates of hepatitis C morbidity and mortality observed in the trials are relatively low and we are uncertain as to how DAAs affect this outcome. Overall, there is very low quality evidence that DAAs on the market or under development do not influence serious adverse events. There is insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs may reduce the number of people with detectable virus in their blood, but we do not have sufficient evidence from randomised trials that enables us to understand how SVR affects long-term clinical outcomes. SVR is still an outcome that needs proper validation in randomised clinical trials.

Initial Conclusions - June 6, 2017
Version 2
Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kiran Kumar Katakam, Kristina Fobian, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud

First published:
Editorial Group: Cochrane Hepato-Biliary Group
DOI: 10.1002/14651858.CD012143.pub2

Authors' conclusions
Overall, DAAs on the market or under development do not seem to have any effects on risk of serious adverse events. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs seemed to reduce the risk of no sustained virological response. The clinical relevance of the effects of DAAs on no sustained virological response is questionable, as it is a non-validated surrogate outcome. All trials and outcome results were at high risk of bias, so our results presumably overestimate benefit and underestimate harm. The quality of the evidence was very low.


Janus C Jakobsen, Emil Eik Nielsen, Joshua Feinberg, Kristina Fobian, Kiran Kumar Katakam, Goran Hauser, Goran Poropat, Snezana Djurisic, Karl Heinz Weiss, Milica Bjelakovic, Goran Bjelakovic, Sarah Louise Klingenberg, Jian Ping Liu, Dimitrinka Nikolova, Ronald L Koretz, Christian Gluud
Article first published online: 5 Apr 2016 | DOI: 10.1002/14651858.CD012143

The Experts Weigh In: Rebuttals
The European Association for the Study of the Liver (EASL) published a response to the Cochrane Systematic Review, as did the Lancet in this June editorial, and in the July issue of the Lancet; What is the impact of treatment for hepatitis C virus infection? The American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) put out this statement. In Australia a joint Position Statement was released by Australian Health Organisations urging medical professionals and patients not to be influenced by the report. Here is an Australian podcast as well; The Cochrane Collaboration assessment of hepatitis C drug trials comes under review from our resident hep C expert Carla Treloar. In addition Hepatitis C Trust responded with concern over media coverage, citing a Guardian article. Finally, under letters the Guardian published; Hepatitis C antiviral drugs are effective, with this subtitle, "The Cochrane analysis casting doubt on this life-saving therapy is flawed and may deter patients from seeking it, say clinicians and scientists."

Moving on, Lucinda K. Porter explained Cochrane’s findings in an easy to read article: Horrendous Hepatitis Headlines. Published over at ACGBLOG at the end of June, experts wrote; The Cochrane Review Conclusion for Hepatitis C DAA Therapies is Wrong.  MedPage Today's article was all about a show of support from the medical community and advocates; Hep C Experts Condemn Cochrane Review Dissing Direct Antivirals. Commentary was offered over at HIV and ID Observations; Mystifying Cochrane Library Review on HCV Therapy Elicits Strong Response from IDSA and at Healio; IDSA, AASLD critical of Cochrane review of HCV drugs, as well. 

Recommended Reading
Justin Chan • Neliswa Gogela • Hui Zheng • Sara Lammert • Tokunbo Ajayi • Zachary Fricker • Arthur Y. Kim • Gregory K. Robbins • Raymond T. Chung
Treatment of chronic HCV with modern DAA therapy was associated with a significant improvement in LSM by VCTE measurement, suggesting possible early improvement in liver fibrosis along with resolution of inflammation over the first year after treatment completion....
Link Tweeted By @HenryEChang

Treatment with DAAs reduces the risk of mortality in the first 18 months after the completion of treatment
Michael Carter
Published:10 August 2017
The study – published in Clinical Infectious Diseases – matched people who received therapy with all-DAA regimens with untreated controls. Mortality rates in the first 18 months after therapy were significantly lower among people who received DAAs. After controlling for other factors, treatment with DAAs was associated with a 57% reduction in the risk of death....

Photo of Mr. Chang gently borrowed from his twitter feed, thinking he sort of looks like a super hero. Well, he is and does to me!

Tina

Wednesday, September 20, 2017

Glecaprevir/Pibrentasvir for HCV Genotype 3 Patients with Cirrhosis and/or Prior Treatment Experience

Hepatology. 2017 Sep 19. doi: 10.1002/hep.29541. 

Glecaprevir/Pibrentasvir for HCV Genotype 3 Patients with Cirrhosis and/or Prior Treatment Experience: A Partially Randomized Phase III Clinical Trial.
Wyles D1, Poordad F2, Wang S3, Alric L4, Felizarta F5, Kwo PY6, Maliakkal B7, Agarwal K8, Hassanein T9, Weilert F10, Lee SS11, Kort J3, Lovell SS3, Liu R3, Lin CW3, Pilot-Matias T3, Krishnan P3, Mensa FJ3.

Abstract
BACKGROUND:
This study assessed the efficacy and safety of ribavirin (RBV)-free coformulated glecaprevir/pibrentasvir (G/P) in patients with hepatitis C virus (HCV) genotype (GT) 3 infection with either prior treatment experience and/or compensated cirrhosis, a patient population with limited treatment options.

METHODS:
SURVEYOR-II, Part 3 was a partially-randomized, open-label, multicenter, phase 3 study. Treatment-experienced (prior interferon (IFN) or pegIFN ± ribavirin or SOF plus ribavirin ± pegIFN therapy) patients without cirrhosis were randomized 1:1 to receive 12 or 16 weeks of G/P (300 mg/120 mg) once daily. Treatment-naïve or treatment-experienced patients with compensated cirrhosis were treated with G/P for 12 or 16 weeks, respectively. The primary efficacy endpoint was the percentage of patients with sustained virologic response at post-treatment week 12 (SVR12). Safety was evaluated throughout the study.

RESULTS:
There were 131 patients enrolled and treated. Among treatment-experienced patients without cirrhosis, SVR12 was achieved by 91% (20/22; CI 72-97) and 95% (21/22; CI 78-99) of patients treated with G/P for 12 or 16 weeks, respectively. Among those with cirrhosis, SVR12 was achieved by 98% (39/40; CI 87-99) of treatment-naïve patients treated for 12 weeks, and 96% (45/47; CI 86-99) of patients with prior treatment experience treated for 16 weeks. No adverse events (AEs) led to discontinuation of study drug and no serious AEs were related to study drug.

CONCLUSIONS:
Patients with HCV GT3 infection with prior treatment experience and/or compensated cirrhosis achieved high SVR12 rates following 12 or 16 weeks of treatment with G/P. The regimen was well tolerated.

This article is protected by copyright. All rights reserved.
http://onlinelibrary.wiley.com/doi/10.1002/hep.29541/abstract
© 2017 by the American Association for the Study of Liver Diseases.

Tuesday, September 19, 2017

Blog Updates on Hepatitis - Inactivated Zoster Vaccine, Harvoni Cures Hep C patient & Opioids

Thanks for stopping by, here's your blog updates from around the web.

Harvoni Cures Hep C patient Brenda in Clinical Trial part 1
September 19, 2017
This week on Life Beyond Hep C we’re hearing Hep C patient Brenda’s courageous Hep C treatment fight and experience.
Continue reading....

All Swiss hepatitis C sufferers can access costly drugs like Harvoni
swissinfo.ch
All patients suffering from hepatitis C can be treated with the drugs Harvoni and Epclusa from next month, after the Federal Office of Public Health lifted ...

Opioid overdoses shorten US life expectancy by 2½ months
Opioid drugs -- including both legally prescribed painkillers such as oxycodone and hydrocodone, as well as illegal drugs such as heroin or illicit fentanyl -- are not only killing Americans, they are shortening their overall life spans. Opioids take about 2½ months off our lives, according to a new analysis published in the medical journal JAMA.

States expand investigation of opioid makers, distributors
Geoff Mulvihill, Associated Press - Houston Chronicle
Attorneys general from most states are broadening their investigation into the opioid industry as a nationwide overdose crisis continues to claim thousands of lives. They announced Tuesday that they had served subpoenas requesting information from five companies that make powerful prescription painkillers and demanded information from three distributors. Forty-one attorneys general are involved in various parts of the civil investigation.
Continue reading...

Addiction clinics need physician education, lifted restrictions to treat HCV
HCV Next - HEALIO - Meeting News
Opioid agonist therapy clinics represent an important conduit for people who inject drugs to receive information, screening and treatment for hepatitis C. Within these clinics, however, physicians and addiction specialists self-reported low competence regarding current HCV treatments. Additionally, policies that restrict treatment for current and recent drug users present an ongoing barrier.
Continue reading....

My 2 cents: College friend doing good work
Tom Blackwell - National Post 
Faced with a widow's legal challenge, Ontario will transplant livers into almost 100 alcoholic-liver-disease patients, as evidence suggests they do as well as others.

What parents should know about tattoos
Posted September 19, 2017,
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications
These days, tattoos are increasingly common. According to a 2015 Harris poll, three in 10 American adults have a tattoo — up from two in 10 in 2012. They are particularly popular in young people; among Millennials, nearly half have a tattoo. To help parents make this tough decision, the American Academy of Pediatrics (AAP) released a clinical report entitled “Adolescent and Young Adult Tattooing, Piercing, and Scarification.” Here are some highlights — and some points parents and teens really need to talk about.
Continue reading....

Fighting Hepatitis in Cambodia: Beginnings and Endings
Theresa Chan - Theresa is an MSF doctor, currently working at a hepatitis C clinic in Cambodia.
Beginnings and endings have been leaking into my to-do list as well. Right now I’m working on writing the MSF guidelines for treating hepatitis C, which will be the basis for the Cambodian national guidelines one day when our clinic is turned over to the Ministry of Health, so even as we are recovering from the busy beginning of this clinic, we are contemplating its end.
Continue reading....

Inactivated Zoster Vaccine Soon to Be Approved — Should Patients Wait for It?
Paul E. Sax, MD - Contributing Editor NEJM Journal Watch 
For the last year or so, conversations with patients about getting the zoster vaccine have gone something like this:
Patient: So should I get the shingles vaccine? I saw an ad for it on TV.
Me:  Well, yes … and no.
Patient (confused — he/she has never heard me say anything but an enthusiastic “Yes!” to vaccines):  What does that mean?
Me:  There’s a better shingles vaccine coming soon, likely within a year. So I’d wait.
Now it looks like that wait is almost over.
Continue reading.....

Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?
Kristine Novak - Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology.
Reducing dietary fructose for as little as 9 days decreases liver fat, visceral fat, and de novo lipogenesis and increases insulin sensitivity, secretion, and clearance in children with obesity and metabolic syndrome, researchers report in the September issue of Gastroenterology. These findings support efforts to reduce sugar consumption.
Read more 

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use
SEPTEMBER 19, 2017
Gail Connor Roche - MD Magazine
Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.
Continue reading....

Adolescents With HCV Achieve 98% Cure Rate in Direct-Acting Antiviral Study
Gail Connor Roche - MD Magazine
Adolescents treated for hepatitis C achieved a 98% cure rate with a direct-acting antiviral drug (DAA) therapy, a study has found.
Continue reading....

HCV Drug Resistance: Infrequent, and Frequently Overcome
Kenneth Bender - MD Magazine
Hepatitis C virus (HCV) mutations that can resist drug treatment are infrequent, and are unlikely to withstand longer treatment durations or the addition of a synergistic drug, according to new analysis of resistance testing, treatment response and re-treatment interventions. Resistance testing does appear to Wyles and Luetkemeyer to be indicated, however, in patients with genotype 1a before treatment with elbasvir/grazoprevir (Zepatier, Merck), and should be considered prior to treatment with ledipasvir/sofosbuvir (Harvoni) for those with genotype 1a and cirrhosis or with prior NS5A treatment failure...
Continue reading....

Hepatitis A: frequently asked questions
Paul Sisson Contact Reporter The San Diego Union-Tribune
In an effort to combat a deadly hepatitis A outbreak, San Diego will begin washing streets in ...
Q: If I've had hepatitis B or hepatitis C am I immune to hepatitis A?
Continuer reading.....

Cannabis in Gastroenterology: Physicians Lack Answers as Patient Interest Peaks
Healio Gastroenterology, September 2017
Despite a lack of high quality evidence due to federal regulations on research, many state medical marijuana programs have designated GI conditions like severe nausea, inflammatory bowel disease (IBD) and hepatitis C as qualifying conditions, and studies show that many patients are self-medicating with marijuana. Experts agreed physicians should equip themselves to explain the known risks and benefits to inquiring patients, and understand the legal frameworks of their state medical marijuana programs.
Continue reading...

On Twitter
Tweeted By Don Crocock, Follow here--->  @dcrocock   
Rationale for cannabis-based interventions in the opioid overdose crisis
Harm Reduction Journal https://doi.org/10.1186/s12954-017-0183-9
The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to consider the implementation and assessment of cannabis-based interventions in the opioid crisis.
Continue reading...

Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?

Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?
Kristine Novak
Reducing dietary fructose for as little as 9 days decreases liver fat, visceral fat, and de novo lipogenesis and increases insulin sensitivity, secretion, and clearance in children with obesity and metabolic syndrome, researchers report in the September issue of Gastroenterology. These findings support efforts to reduce sugar consumption. Consumption of sugar

Read more

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use
SEPTEMBER 19, 2017
Gail Connor Roche

Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.
          
But the authors conclude that treatment rates should improve in the interferon-free era, although the costs of DAA therapy could limit participation.
          
“The number of patients eligible for treatment will increase significantly as DAA therapies are recommended now in patients with decompensated cirrhosis,” Philip Vutien, MD, one of the study’s authors from Stanford University Medical Center, Palo Alto, California, said. “In addition, as DAA therapies are much better tolerated, we would expect patients and their providers to be much more willing to initiate treatment.”

Thyroid function starting at age 50 tied to life expectancy

Thyroid function starting at age 50 tied to life expectancy
Last Updated: 2017-09-18
By Anne Harding

NEW YORK (Reuters Health) - Low-normal thyroid function is associated with longer life expectancy in middle-aged people, according to data from The Rotterdam Study.

"At age 50, people with low-normal thyroid function live up to 3.5 years longer than those with high-normal thyroid function. Also, people with low-normal thyroid function live a longer life without cardiovascular disease (CVD) than those with high-normal thyroid function," Dr. Arjola Bano of Erasmus Medical Center in Rotterdam, the Netherlands, told Reuters Health by email.

The Rotterdam Study previously found that low-normal thyroid function was associated with an increased risk of diabetes or non-alcoholic fatty liver disease, while high-normal thyroid function was linked to an increased risk of atrial fibrillation or dementia, Dr. Bano noted. "The challenge for future research will be to integrate the associated risk of relevant adverse outcomes, in order to eventually define the clinically relevant normal ranges of thyroid function," she said.

Read the article, here...

Abstract
JAMA Intern Med 2017.

Monday, September 18, 2017

Costly drugs to weigh on U.S. employers' expenses in 2018: survey

Costly drugs to weigh on U.S. employers' expenses in 2018: survey
(Reuters) - U.S. employers are bracing for higher health care expenses in 2018 as spending on new drugs to treat diseases such as cancer, multiple sclerosis and hepatitis C is expected to rise more than 7 percent, according to consultancy firm Mercer.
Between 40 and 50 new specialty drugs are set to hit the market each year in the next five years, which could increase costs by $25 billion annually, Mercer said.

Sunday, September 17, 2017

Coverage OncLive - 2017 International Liver Cancer Association Annual Conference

Conference Website
2017 International Liver Cancer Association Annual Conference
September 15 - 17
Seoul, South Korea

Conference Coverage Available Online At OncLive 
http://www.onclive.com/conference-coverage/ilca-2017

Conference Multimedia
http://www.onclive.com/conference-videos/ilca-2017

Highlights
Study Shows DAAs Are Not Associated With Increased HCC Recurrence Risk
Angelica Welch
Published Online: Monday, Sep 18, 2017
Direct acting antivirals (DAA) are a novel and completely oral hepatitis C therapy that is associated with a high response rate. DAAs are used in most patients being treated for hepatitis C, including those with decompensated cirrhosis.

This type of treatment has now completely replaced interferon-based therapy for patients with hepatitis C, a therapy which was also associated with a decrease in hepatocellular carcinoma (HCC) incidence in 40% to 50% of patients.

Danielle Bucco
Published Online: Friday, Sep 15, 2017
“[At ILCA] we not only cover all of the clinical disciplines involved in the management of liver cancer but the presentations at this meeting include surgical oncology, transplant surgery, hepatology, interventional radiology, pathology, as well as medical oncology,” explained Richard Finn, MD, an associate professor of medicine at David Geffen School of Medicine at University of California, Los Angeles. “One of the most important things the audience will take away from the meeting is the latest data in not only systemic treatments, but also the role of treating hepatitis C in the setting of advanced and early-stage liver cancer. They will go home with some practice-changing observations.”

Danielle Bucco
Published Online: Saturday, Sep 16, 2017
Hepatocyte pERK-positive immunostaining and microvascular invasion were independent prognostic factors of recurrence-free survival (RFS) for patients with hepatocellular carcinoma (HCC) treated with adjuvant sorafenib (Nexavar); however, a predictive biomarker for recurrence was not uncovered, according to an analysis of the phase III STORM study presented at the 11th International Liver Cancer Association Annual Conference

Precision Screening May Improve Surveillance in HCC
Angelica Welch
Published Online: Saturday, Sep 16, 2017
“The highest rates of HCC are in east Asia and Africa, primarily driven by high rates of hepatitis B in those areas. While the incidence of HCC is lower in the United States and Europe, it is gaining a lot of attention because HCC has the largest increasing incidence among all solid tumors over the past 10 years as assessed by SEER,” said Singal, medical director of the Liver Tumor Program at UT Southwestern Medical Center. “Some projections have HCC becoming a top 5 cause of cancer-related death over the next decade in the United States. One of the key ways to curb this increased mortality is to increase rates of early tumor detection and curative treatment.”

Begin here..........

International Liver Cancer Association (ILCA) 
Patient information
What is liver cancer?
Liver cancer is defined by an abnormal and uncontrolled growth of cells within the liver. These altered cells progressively substitute the normal cells, collapsing the normal function of the liver, and invading other organs. These events irremediably lead to the death of the patients affected from this disease. We should distinguish liver cancer from benign tumors, that are also the result of an altered cellular growth, but they lack the invasiveness capacities of the malignant tumors (cancer). Therefore, the prognosis of benign tumors is excellent and in the majority of cases there is no need of treating them.
Continue reading...

Saturday, September 16, 2017

Deaths caused by viral hepatitis surpassed all chronic infectious diseases including HIV/AIDS, malaria and tuberculosis

Viral hepatitis kills more people than HIV, malaria or tuberculosis
Sept 15, 2017

World Hepatitis Alliance calls for immediate political action to counteract fatal trend

According to the Global Burden of Disease study released today, deaths caused by viral hepatitis have surpassed all chronic infectious diseases including HIV/AIDS, malaria and tuberculosis.

The study illustrates that in 2016, the total deaths caused by viral hepatitis, including liver cancer, acute cases, cirrhosis, hepatitis A, E, B, C and D account for 1.34 million deaths globally, exceeding tuberculosis (1.2 million), HIV/AIDS (1 million) and malaria (719,000).

These staggering death rates occurred despite recent advances in hepatitis C medications that can cure most infections within three months and the availability of highly-effective vaccinations for hepatitis B.

"It's outrageous, but not surprising, that the Global Burden of Disease Report found that deaths related to viral hepatitis have surpassed HIV, TB and malaria" said Charles Gore, President of the World Hepatitis Alliance. "This is largely due to a historic lack of political prioritisation coupled with an absent global funding mechanism".

The study shows that viral hepatitis remains amongst the top ten leading global killers which include heart disease, road accidents, Alzheimer's disease, amongst others. If we are to reverse this trend, immediate action must be taken at both a regional and national level.

One such action is the scaling up of testing and diagnosis. Globally, only 5% of people living with viral hepatitis are aware of their condition, greatly increasing the chance of infecting others and missing the opportunity to access life-saving treatment. Because viral hepatitis has few noticeable symptoms, many people are either misdiagnosed or do not come forward for testing.

"World leaders and national decision-makers must heed these findings and note that with targeted funding, political prioritisation and specific interventions, hepatitis deaths can be avoided." said Raquel Peck, CEO of World Hepatitis Alliance.

Reducing hepatitis related deaths by 65% by 2030 is a key component of the World Health Organization's (WHO) Global Hepatitis Strategy. The Strategy, which was adopted by 194 governments, sets out a list of key targets, which, if achieved will eliminate viral hepatitis by 2030.

On 1- 3 November, hundreds of policymakers, patients, civil society and public health experts will gather at the World Hepatitis Summit, in São Paulo, Brazil to discuss how advance the elimination of viral hepatitis.

The three-day event, which is a joint initiative between WHO and the World Hepatitis Alliance, will focus on key ways to implement WHO's Global Hepatitis Strategy, with a specific focus on how to improve surveillance data, scale up testing and treatment at a national level, and support service delivery amongst vulnerable populations. The event will also encourage innovation in research and have a dedicated focus on sustainable financing for elimination, all of which are needed to eliminate viral hepatitis by 2030.

Find the full report here: www.thelancet.com/gbd

Future complications of HCV in a low-risk area - projections from the hepatitis c study in Northern Norway

BMC Infectious Diseases

Future complications of chronic hepatitis C in a low-risk area: projections from the hepatitis c study in Northern Norway
H. Kileng, L. Bernfort, T. Gutteberg, O.S. Moen, M.G. Kristiansen, E.J. Paulssen, L.K. Berg, J. Florholmen and R. Goll

https://doi.org/10.1186/s12879-017-2722-0
Received: 6 January 2017
Accepted: 8 September 2017
Published: 16 September 2017

Conclusion
"Based on the registration of patients with HCV in a low risk area, we estimate a relatively slow fibrosis progression within the first 20–25 years of infection, followed by an accelerated fibrosis progression, especially in subjects with HCV genotype 3. This may have important implications in the clinical management of patients infected with genotype 3. Furthermore, we estimate a gradual increase in future complications with an estimated peak around 2040. The projected scenario implies a substantial increase in HCV-related morbidity and mortality in the coming years. An increased number of patients need to be treated to have an impact on the future burden of HCV disease."

Full Text
View Online

Abstract
Background
Hepatitis C (HCV) infection causes an asymptomatic chronic hepatitis in most affected individuals, which often remains undetected until cirrhosis and cirrhosis-related complications occur. Screening of high-risk subjects in Northern Norway has revealed a relatively low prevalence in the general population (0.24%). Despite this, late complications of HCV infection are increasing. Our object was to estimate the future prevalence and complications of chronic HCV infection in the period 2013–2050 in a low-risk area.

Methods
We have entered available data into a prognostic Markov model to project future complications to HCV infection.

Results
The model extrapolates the prevalence in the present cohort of HCV-infected individuals, and assumes a stable low incidence in the projection period. We predict an almost three-fold increase in the incidence of cirrhosis (68 per 100,000), of decompensated cirrhosis (21 per 100,000) and of hepatocellular carcinoma (4 per 100,000) by 2050, as well as a six-fold increase in the cumulated number of deaths from HCV-related liver disease (170 per 100,000 inhabitants). All estimates are made assuming an unchanged treatment coverage of approximately 15%. The estimated numbers can be reduced by approximately 50% for cirrhosis, and by approximately one third for the other endpoints if treatment coverage is raised to 50%.

Conclusion
These projections from a low-prevalence area indicate a substantial rise in HCV-related morbidity and mortality in the coming years. The global HCV epidemic is of great concern and increased treatment coverage is necessary to reduce the burden of the disease.

Keywords Disease burden Fibrosis development Hepatitis C Markov modelling Natural course

Friday, September 15, 2017

HCV TGIF: Patient Voice Lacking in HCV Cost-effectiveness Research, Baby Boomers, and Liver Cancer

TGIF! Here's your HCV news with blog updates from around the web.

HCV Review
Sept 15
If you are interested in a weekly news recap start with HepCBC.

In The News
Viral hepatitis accounts for 1.34m deaths globally
Sep 16
Viral hepatitis with 1.34 million deaths globally has surpassed all chronic infectious diseases including HIV/AIDS, malaria and tuberculosis, according to a study by Global Burden of Disease.

'Exciting' discovery on path to develop new type of vaccine to treat global viruses
Sept 15
Scientists at the University of Southampton have made a significant discovery in efforts to develop a vaccine against Zika, dengue and Hepatitis C viruses that affect millions of people around the world.

Update on the Cost Burden of HCV Treatments
Sept 15
With the recent availability of the interferon-free combinations of direct-acting antivirals (DAAs) for hepatitis C viral infection (HCV), patients now have a highly effective treatment without the dismal side effects that interferon-based therapies offered in years past.

Of Interest
Will Express Scripts and CVS Health open their Hep C Virus therapeutic class and add Marvyet alongside Harvoni?
AbbVie’s Mavyret Drug Pricing: A Challenge to the Pharmacy Benefit Manager Business Model
Sept 15
AbbVie’s pricing for its new Hepatitis C Virus drug Mavyret is disruptive to the current PBM business model because it forces the Big 3 PBMs to consider a drug for inclusion in their national formularies that is aligned with their clients interests — more cost-effective that Harvoni — but not aligned with their own interests — needing to squeeze out all the rebates they can from specialty drug therapeutic classes. At the very least, will Express Scripts and CVS Health open their Hep C Virus therapeutic class and add Marvyet alongside Harvoni? Or, will they expose themselves to claims of misalignment by excluding Mavyret?

Newly approved hepatitis drugs mark a milestone in treatment and access
Briefly Sep+Oct 2017
The Gilead Sciences HCV medication Vosevi (sofosbuvir 400 mg/velpatasvir 100 mg/voxilaprevir 100 mg) was approved on July 18 for the re-treatment of HCV in treatment-experienced people. Just two weeks later on August 3, the FDA approved the Abbvie medication Mavyret (glecaprevir 300 mg/pibrentasvir 120 mg) for the treatment of both treatment-naïve and treatment-experienced patients, including people living with HIV/HCV co-infection.

All too often, patients and advocates are told the medications are too expensive to cover and will wipe out Medicaid budgets, denying people treatment and/or making them wait until their liver health worsens so as to be eligible. This price significantly weakens this argument.
Again, there is nobody we can’t treat, and now we can afford to do it.

New At Behind The Headlines
Mice exposed to third-hand smoke developed brain and liver damage
Sept 15
"Third-hand smoke exposure can cripple your brain and liver, affecting your mannerisms, increasing your risk of neurodegenerative diseases, and ruining your metabolism," the Mail Online reports. But the study it reports on involved mice not people.

New At MD Magazine
A review of more than 1,000 studies found the vast majority of economic analyses of HCV therapies don’t incorporate patient input.

Worldwide HCV prevalence in 2017 dropped 2% from 2015 levels to 69.6 million viremic infections, thanks to increased treatment and prevention.

The fixed-dose combination of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) (Technivie, AbbVie), which is approved to treat HCV genotype 4, was combined with the pangenotypic DAA, sofosbuvir (SOF) (Sovaldi, Gilead), in addition to ribavirin for 12 weeks in patients having genotype 3 with cirrhosis, and with or without ribavirin in type 3 patients without cirrhosis. In addition, the regimen with ribavirin was administered for either 6 or 8 weeks to genotype 2 patients without cirrhosis.

New at Healio
Mavyret (glecaprevir/pibrentasvir), Vosevi (Sofosbuvir/Velpatasvir/Voxilaprevir) and Liver cancer:
HCV NEXT September/October Issue - Two Approvals Offer Even More Options for HCV Treatment

Of Interest
CATIE's HepCInfo Update 8.18 for August 19 to September 1, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

NATAP
"Eradication of HCV has been shown to reduce the risk of hepatocellular carcinoma, to improve liver fibrosis, and to decrease the risk of other complications of chronic liver disease (39). However, the effects of HCV eradication on the extrahepatic manifestations of HCV have not been well studied in the new era of DAAs. Our study supports the idea that HCV eradication leads to a reduction in HbA1c in patients with diabetes."

Liver Cancer
"Most HCV-infected patients in the United States will undergo DAA-based antiviral treatment in the next few years and the vast majority of them will achieve SVR. Our results suggest that DAA-induced SVR is associated with a 71% reduction in HCC risk (AHR 0.29, 95% CI 0.23-0.37) compared to treatment failure. The reduction in HCC risk associated with SVR was similar irrespective of whether SVR was achieved by DAA-ONLY, DAA+IFN or IFN-ONLY regimens. This suggests that eradication of HCV reduces HCC risk independently of how it is achieved. In contrast to prior reports that suggested an increased HCC risk in patients treated with DAAs[[3], [7]], we found that receipt of DAA-ONLY antiviral treatment was not associated with increased risk of HCC when compared to receipt of IFN-ONLY antiviral treatment.....We found no evidence that treatment with DAAs was associated with increased risk of HCC compared to treatment with IFN.

More Than Okay to Reduce Sorafenib Dose for Liver Cancer
In the treatment of hepatocellular carcinoma (HCC), it's "safe and reasonable" to start sorafenib (Nexavar, Bayer) at reduced dosages, conclude authors of a new retrospective analysis of nearly 5000 patients. Reduced dosing was not associated with inferior overall survival compared with standard dosing, report the study authors, led by Kim Reiss Binder, MD, a medical oncologist at the University of Pennsylvania in Philadelphia.

Review Article
Viral hepatitis and liver cancer - hepatitis B and C virus
Published:19 October 2017; volume 372, issue 1732

Medscape Medical News
Sofosbuvir Safe, Effective for HCV in Those With CKD
Sofosbuvir-based antiviral therapy cured hepatitis C virus infection in more than 80% of patients with chronic kidney disease, a retrospective cohort study found.

Lower GI Reading Room
Integrated care in prison systems key to reducing rates, transmission risk post-release

Medscape Gastroenterology
Updated Advice on Managing Liver Disease During Pregnancy
Dr Rowen Zetterman reviews the new American College of Gastroenterology guidelines on caring for pregnant patients with diseases ranging from liver masses to viral infections.

New at aidsmap
High prices of DAAs mean there's been little progress towards achieving WHO target of eliminating HCV by 2030
Sept 15
Only a handful of countries are on course to achieve the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) as a major public health concern by 2030, according to a study published in the Journal of Virus Eradication. Investigators estimated progress towards elimination by examining 2016 data on rates of cure after therapy with direct-acting antivirals (DAAs), HCV-related deaths and new HCV infections. An overall reduction in prevalence of 0.71% was observed in the 91 countries included in the study, and global prevalence fell by just 0.4%.

New at The Body PRO
This Week in HIV Research: 'Massive Loss of Life'
Sept 15
This week, a study finds that reducing U.S. foreign aid for HIV-fighting efforts is a really bad idea no matter which way you cut it. We also examine meta-analysis data regarding pregnancy and the "old" tenofovir; newly published findings regarding cancer risk among people with HIV; and data regarding the potential viability of a neighborhood-specific approach to reduce HIV disparities in the U.S. To beat HIV, you have to follow the science!

On Twitter
Tweets By - Henry E. Chang
In Case You Missed It  - DAA therapy for chronic HCV infection results in liver stiffness regression over 12 months post-treatment

Full Text Articles
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C.

Baby Boomers - New At HepatitisC.net 
Out of 3.5 million Americans chronically infected with HCV, 80% are “baby boomers” (born between 1945 and 1965). If you were born between 1945 and 1952, you're now eligible for a senior citizen discount. Turning 65 does have its perks, especially grandchildren, right? If you're a grandparent living with the hepatitis C virus, Karen Hoyt, has a few tips for you; What to Tell Your Grandchild About Hepatitis C. Jump over to HepatitisC.net and view all blog updates, here.

HCV Stigma - New at HEP
HCV Stigma is in the spotlight over at Hep, Rick Nash, always positive, writes about stigma from a fresh prospective; Stigma: It’s not me, it’s you. In addition, "Science over Stigma explores the discriminatory, biased, and unnecessary practice of requiring a period of sobriety prior to receiving HCV curative treatment." Read the article, here.

Triaging Hepatitis C Treatment: Why the Fibrosis Score Is Not Valid, is a look at the bottom line results, what they mean for patients seeking treatment, written by devoted HCV advocate Greg Jefferys. Read additional blog articles at Hep, here.

October issue of Attitude
Gay men with hepatitis C are suffering stigma not seen since the HIV/Aids crisis, read the article published in the latest issue of Attitude.

New At Hepatitis B Foundation 
Over at Hepatitis B Foundation is a three part series with easy to read information about the hepatitis B virus, last week part three was published: Part I is about how the virus is transmitted, and may have helped you determine how you were infected with HBV. In Part II we will discuss the people closest to you who may be susceptible to your infection. Part III is about preventing future transmission to others. View all blog updates, here.

The Doctor Weighs In
Sept 15
Examining the Federal Response to the Opioid Crisis
The disease of addiction has claimed so many young lives and shows no signs of relenting. Today, overdoses are the leading cause of death in Americans under the age of 50. An addiction specialist on the front lines of battling the opioid epidemic in Ohio provides her perspective on Drug Addiction Commission's interim report.

In Case You Missed It
Tina

Thursday, September 14, 2017

Antidepressants associated with significantly elevated risk of death, researchers find

Antidepressants associated with significantly elevated risk of death, researchers find
McMaster University

HAMILTON, ON, CANADA, Sept. 14, 2014 - Antidepressant medications, most commonly prescribed to reduce depression and anxiety, increase the risk of death, according to new findings by a McMaster-led team of researchers.

It's widely known that brain serotonin affects mood, and that most commonly used antidepressant treatment for depression blocks the absorption of serotonin by neurons. It is less widely known, though, that all the major organs of the body--the heart, kidneys, lungs, liver--use serotonin from the bloodstream.

Antidepressants block the absorption of serotonin in these organs as well, and the researchers warn that antidepressants could increase the risk of death by preventing multiple organs from functioning properly.

The researchers reviewed studies involving hundreds of thousands of people and found that antidepressant users had a 33% higher chance of death than non-users. Antidepressant users also had a 14% higher risk of cardiovascular events, such as strokes and heart attacks. The findings were published today in the journal Psychotherapy and Psychosomatics.

"We are very concerned by these results. They suggest that we shouldn't be taking antidepressant drugs without understanding precisely how they interact with the body," says author Paul Andrews, an associate professor at McMaster University who led the research team.

Taken by one in eight adult Americans, antidepressants are among the most frequently used medications. They are often prescribed by family doctors without a formal diagnosis of depression, on the assumption they are safe. Since depression itself can be deadly--people with depression are at an increased risk of suicide, stroke and heart attack--many physicians think that antidepressants could save lives by reducing depressive symptoms.

However, McMaster researcher and co-author Marta Maslej, says, "Our findings are important because they undermine this assumption. I think people would be much less willing to take these drugs if they were aware how little is known about their impact outside of the brain, and that what we do know points to an increased risk of death."

Benoit Mulsant, a psychiatrist at the University of Toronto who was also involved in the study, says the findings point to the need for more research on how antidepressants actually do work.

"I prescribe antidepressants even though I do not know if they are more harmful than helpful in the long-term. I am worried that in some patients they could be, and psychiatrists in 50 years will wonder why we did not do more to find out," Mulsant says.

Interestingly, the news about antidepressants is not all bad. The researchers found that antidepressants are not harmful for people with cardiovascular diseases such as heart disease and diabetes. This makes sense since these antidepressants have blood-thinning effects that are useful in treating such disorders. Unfortunately, this also means that for most people who are in otherwise good cardiovascular health, antidepressants tend to be harmful.

New liver disease atlas points to significant variation across England

Liver Disease Atlas - News Release      

New liver disease atlas points to significant variation across England

The rate of people dying early from liver disease in some parts of England is almost 8 times higher than others, according to new data published by Public Health England (PHE) today. 

Liver disease is almost entirely preventable with the major risk factors: alcohol, obesity and Hepatitis B and C accounting for up to 90% of cases. The atlas will help health professionals to allocate their resources to improve patient outcomes. 

The Atlas shows premature mortality rates – dying before the age of 75 – ranged from 3.9 per 100,000 in South Norfolk CCG to 30.1 per 100,000 in Blackpool CCG, a 7.7-fold difference. 

The Atlas paints a mixed picture, with 10 indicators showing improvements including; a reduction of premature deaths and fewer hospital alcohol specific admissions for under 18s.

Nine of the indicators have become worse over time, including a doubling of hospital admission rates for cirrhosis from 54.8 per 100,000 to 108.4 per 100,000 people over the past decade. This indicator also varies significantly across the country with an 8.5 fold variation across CCGs and this gap has widened over the past decade.  

Liver disease is responsible for almost 12% of deaths in men aged 40 to 49 years and is now the 4th most common cause of Years of Life Lost in people aged under 75 after heart disease and lung cancer. 

Professor Julia Verne, head of clinical epidemiology at Public Health England said:
“Chronic liver disease is a silent killer of young adults, creeping up and showing itself when it’s often too late. However, around 90% of liver disease is preventable. 

“We hope local health professionals will make the most of this rich data source to inform how they reduce the burden of liver disease in their areas.”

The Atlas also lays bare the impact of the stark health inequalities in England. Inequality plays a role in the significant variation in risk factors of liver disease – excessive alcohol consumption, obesity, and hepatitis B and C. 

For example, there is a 7.4-fold difference in the rate of alcohol-specific hospital admissions across the country, with the majority of the higher rates being clustered in the more deprived areas. Also, in the most deprived fifth of the country, people with liver disease die 9 years earlier than those in the most affluent fifth.

These data will underline the importance of developing a strategy to tackle the rising burden of liver disease, especially in younger adults and even children. Liver disease can take 20 years to show up as symptoms.

The Atlas is made up of 39 indicators, 19 of which show trend data over time. It shows the degree of variation across the country, a national figure for comparison and commentary providing options for action and a list of evidence based resources for local health systems to improve.

The 2nd Atlas of Variation in risk factors and healthcare for liver disease in England will be published on the PHE fingertips website here: https://fingertips.phe.org.uk/profile/atlas-of-variation

LINK
Full Press Release
________________________________________________________

HCV NEXT September/October Issue - Two Approvals Offer Even More Options for HCV Treatment

"HCV Next" offers information on a range of topics, which include diagnosis, new combination therapies, side effects, drug/drug interaction, guidelines, practice management issues, to name a few.

The following articles appeared in the September/October edition of HCV NEXT, provided online at Healio.

Table of Contents

Cover Story