Saturday, July 1, 2017

Weekend Reading: July Hep C Newsletters & Rebuttal over Cochrane Review of DAAs

July Hep C Newsletters & Headlines
Welcome folks, here is this months index of wonderful newsletters filled with invaluable information about viral hepatitis.

In The News
It's always great when the media is alive with news about HCV, right? Well, maybe not in this case. The HCV community was blindsided last month when an article with a somewhat "clickbait" headline was released by The Guardian.

The Article
The Guardian reported on a systematic review published by the Cochrane Collaboration that suggested achieving SVR (cure) for patients using hepatitis C direct-acting antivirals (DAAs) doesn't correlate with any long term benefits.

So what's the good news? Thanks to social media both the Guardian article and Cochrane review was highly debated on Twitter, organized nicely by Henry E. Chang.

The Rebuttal - It Started On Twitter
Tweeted by Henry E. Chang
Reactions from Hepatitis C Community on a Recent Cochrane Review of DAAs
Cochrane Review Group's fallacious conclusions are missing real issue of access to effective and highly curative therapy for chronic HCV infection. Irresponsible reporting by news media of the results risks even more harm than the original review.
Begin here....

A special thanks to Henry E. Chang for sending us to each rebuttal and all ongoing media coverage.

The Real News
The European Association for the Study of the Liver (EASL) published a response to the Cochrane Systematic Review, as did the Lancet on June 22, and more recently in the July issue of the Lancet. 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. In addition Hepatitis C Trust responded with concern over media coverage, citing the Guardian article. Published under letters on 13 June 2017, 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. Lucinda K. Porter, explained Cochrane’s findings in an easy to read article: Horrendous Hepatitis Headlines.  Published over at MD Blog at the end of June experts elaborate on improvement of underlying fibrosis to extrahepatic manifestations following SVR, here is the article: The Cochrane Review Conclusion for Hepatitis C DAA Therapies is Wrong.

In the weeks following the Cochrane review, Sony Salzman from MedPage Today wrote about the show of support from the medical community and advocates; Hep C Experts Condemn Cochrane Review Dissing Direct Antivirals. Here is an excerpt:
Research demonstrates that while SVR markedly reduced liver-related complications and liver cancer, some long-term risk for liver cancer remained in those who were cured of Hepatitis C. But after direct-acting antiviral therapy does the risk of developing liver cancer increase?
Continue reading...

More Recent Commentary:
HIV and ID Observations
July 19th, 2017
Mystifying Cochrane Library Review on HCV Therapy Elicits Strong Response from IDSA
Last month, The Cochrane Review published a controversial paper on HCV therapy that left many ID doctors and hepatologists rather perplexed.
After reviewing 138 randomized clinical trials using directly acting, non-interferon based therapies, they came to the following conclusions:
  • The use of sustained virologic response (“SVR”) — or “cure”, if you want to use plain English — as a valid endpoint for clinical outcomes is questionable.
  • There is insufficient evidence that treatment with DAA-based regimens improves clinical outcome.
  • The studies reviewed were at high risk of bias, so tended to overestimate benefits and minimize harm.
  • More randomized clinical trials are needed.
Anyone — clinician, researcher, or patient — who has experienced the miraculous advances in HCV therapy that started in 2014 could easily be scratching their heads at these conclusions.
The FDA might be surprised as well, since they have allowed permanent clearance of HCV RNA as an appropriate surrogate marker of the effectiveness of HCV therapy.
Fortunately, we now have a focused, persuasive response by the IDSA, just published in Clinical Infectious Diseases; Download PDF here....
Continue reading.......

IDSA, AASLD critical of Cochrane review of HCV drugs
July 26, 2017
The IDSA and AASLD wrote a joint response, which was published in Clinical Infectious Diseases, to the Cochrane review that concluded that direct-acting antiviral (DAA) drugs have not been shown to reduce risks for HCV-related morbidity or all-cause mortality. The review also claimed that prior trials have underestimated DAA adverse effects.
Continue reading....

Australia - Podcast
The Cochrane Collaboration assessment of hepatitis C drug trials comes under review from our resident hep C expert Carla Treloar, while Annie Madden digs deeper into the drug decriminalisation debate as the World Health Organisation and the United Nations wade into the debate.

Now lets move on to those great July newsletters.

New On The Blog July 25:
Hepatitis Updates: Research and News From Around The Web
Welcome to a mix of research, blog updates and news about hepatitis C you may have missed over the last week.

The New York City Hepatitis C Task Force
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to work on projects in order to meet needs identified by the community.

July Updates
Email Campaign Archive

HCV Action
HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.

HCV Action e-update
05 Jul 2017

Weekly Bull
HepCBC is a non-profit organization run by and for people infected and affected by hepatitis C. Our mission is to provide education, prevention and support to those living with HCV.

Latest Issue: Weekly Bull

HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.

July Issue
International Liver Conference – Part 3 – Third Time’s the Charm – This is our final coverage in the HCV Advocate newsletter.
Begin here....

Hep Magazine
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and Hep Magazine are the go-to source for educational and social support for people living with hepatitis.

Hep Summer 2017 - Special Issue
Excellent Treatments, Still Room for Improvement
An analysis of forty-two clinical trials of all the approved direct acting antiviral HCV regimens.
Begin here..

GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online. The official newspaper of the AGA Institute was launched in partnership with IMNG in January 2007.

View all newsletters, here.

Hepatitis B and C Public Policy Association
The Association’s Newsletter covers clinical, epidemiological and policy developments in the field of HBV and HCV.

June Issue

British Liver Trust
The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services.
At the moment three quarters of people are diagnosed with liver disease in a hospital setting when they already have cirrhosis – which can be too late. Love Your Liver aims to change this by raising awareness of the risk factors of liver disease and improving early diagnosis...
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The National Native American AIDS Prevention Center (NNAAPC), located in Denver, Colorado, was incorporated in 1987 by a network of concerned Native people who advocated and promoted the need for HCV/HIV/AIDS prevention education created by and for Native communities.  NNAAPC has also worked in the area of Hepatitis C since 1995 and is continuing to develop prevention activities and efforts to fight this “silent epidemic” in Native communities.

Eliminating Hepatitis C in American Indian and Alaskan Native Communities: Focus on Price of Medications
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Healthy You

For Your Viewing Pleasure
The Liver - Super Foods & Supplements and Patient Friendly Video On Managing Medications With Liver Disease & Cirrhosis

NIH News in Health
Check out the July issue of NIH News in Health, the monthly newsletter bringing you practical health news and tips based on the latest NIH research.

Struggling to Sleep?
Most people who have breathing pauses while asleep, or sleep apnea, don’t realize it. It can leave you tired and put your health at risk.

Free eBooks on Health
Looking for free eBooks about the brain, stroke, low back pain, dementia, or other health topics? These and many other topics are available in formats that work with eBook readers, tablets, and smart phones.
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ACP Internist
Current Issue
Prediabetes: What can doctors call it?
Internists know to screen patients for diabetes, but may be unsure how to manage patients whose blood glucose levels are higher than normal but fall below the cutoff of the disease.
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New Online
Clinical Liver Disease (CLD) just launched; Pangenotypic regimens and the next generation hepatitis C virus therapy a multimedia overview of: Three new antiviral therapies for viral hepatitis C  anticipated in the next several months: GP, glecaprevir (protease inhibitor [PI])/pibrentasvir (NS5A inhibitor); SOF/VEL/VOX, sofosbuvir (NS5B inhibitor)/velpatasvir (NS5A)/voxilaprevir (NS3); and MK3, grazoprevir (NS3) + MK-3682 (NS5B) + NS5A inhibitor (elbasvir or Ruzasvir). 
Begin here...

Enjoy the holiday weekend!

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