Wednesday, January 30, 2019

Listen: Liver Cancer After Treatment For Hepatitis C

HCC After DAA Treatment
Listen to Dr. Behnam Saberi of the Icahn School of Medicine at Mount Sinai discuss; “HCC After DAA Treatment” using case based scenarios in this easy to access webinar series provided by HepCure.


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Liver Cancer After Treatment For Hepatitis C
Index of articles with current data investigating the possible risk of developing liver cancer (hepatocellular carcinoma HCC) during and after direct-acting antiviral therapy in patients with hepatitis C.

Dicerna Announces Phase 1 Trial of DCR-HBVS for Chronic Hepatitis B Virus

Clinical Proof-of-Concept Data Expected in Second Half of 2019

CAMBRIDGE, Mass.--(BUSINESS WIRE)--Jan. 28, 2019-- Dicerna Pharmaceuticals, Inc. (NASDAQ: DRNA), (the “Company”) a leading developer of RNA interference (RNAi) therapeutics, today announced the dosing of the first human volunteer in its Phase 1 clinical trial of DCR-HBVS, the Company’s investigational GalXCTM-based therapy for the treatment of chronic hepatitis B virus (HBV) infection in adults. The Company anticipates human proof-of-concept data from the Phase 1 trial, which is known as DCR-HBVS-101, in the second half of 2019.

“The dosing of the first human in the DCR-HBVS-101 trial brings us a step closer to the potential availability of an innovative therapy for patients with chronic hepatitis B, a serious liver infection that can lead to advanced hepatic disease or liver cancer if not treated effectively,” said Ralf Rosskamp, M.D., chief medical officer of Dicerna. “We are hopeful that this three-part Phase 1 trial will validate RNA interference as a viable clinical strategy against chronic hepatitis B infection, based upon our encouraging preclinical data on DCR-HBVS.”

DCR-HBVS is comprised of a single GalXC molecule that targets HBV messenger RNAs (mRNAs) within the hepatitis B surface antigen (HBsAg) gene sequence region. Preclinical studies with a standard mouse model of HBV infection showed DCR-HBVS led to greater than 99% reduction in circulating HBsAg, suggesting superior HBsAg suppression (both in magnitude and duration of suppression), compared to targeting within the X gene sequence region.

“RNAi-based therapy has the potential to change the treatment paradigm for patients with chronic HBV infection. By silencing not only the S antigen but also other viral genes, through a powerful and long-acting mechanism, RNAi-based therapy could tip the balance toward allowing the patient’s own immune system to mount an effective immune response. This approach could help eradicate HBV and remove the need for life-long therapy,” said principal investigator Edward Gane, MBCHB, M.D., deputy director and hepatologist of the New Zealand Liver Transplant Unit at Auckland City Hospital and clinical professor of Medicine at the University of Auckland School of Medicine. “Given the encouraging inhibitory activity of DCR-HBVS in animal studies, as well as its favorable preclinical safety profile, we eagerly anticipate the first results from healthy volunteers in the DCR-HBVS-101 trial, and then in the second part of the study, from patients with chronic hepatitis B.”

About the DCR-HBVS-101 Trial
The DCR-HBVS-101 clinical trial is a randomized, placebo-controlled study designed to evaluate the safety and tolerability of DCR-HBVS in normal healthy volunteers (NHVs) and in patients with non-cirrhotic chronic HBV. Secondary objectives are to characterize the pharmacokinetic (PK) profile of DCR-HBVS and to evaluate preliminary pharmacodynamics (PD) and antiviral efficacy on plasma levels of HBsAg and HBV in blood. The study is divided into three phases or groups:

In Group A, 30 NHVs are to receive a single ascending-dose of DCR-HBVS (0.1, 1, 1.5, 3, 6, or 12 mg/kg), with a four-week follow-up period.

Group B is a single-dose study of DCR-HBVS (3 mg/kg) in eight patients with HBV who are naïve to nucleoside analog therapy; these patients will be followed for at least 12 weeks. The Company expects to initiate Group B dosing in the third quarter of 2019.

Group C is a multiple ascending-dose study of DCR-HBVS (1.5, 3, or 6 mg/kg) in 18 patients with HBV previously treated with nucleoside analogs with a follow-up period of 24 weeks or more. The Company expects to initiate Group C dosing in the second quarter of 2019.

For more information about the DCR-HBVS clinical study, please visit and use the identifier NCT03772249.

Fibrosis Markers Tied to Mortality After Liver Cancer Surgery

Fibrosis Markers Tied to Mortality After Liver Cancer Surgery
By David Douglas

NEW YORK (Reuters Health) - Noninvasive markers of fibrosis are associated with perioperative mortality and survival after liver resection for hepatocellular carcinoma, a retrospective study suggests.

Such markers can improve selection criteria, Dr. Felipe B. Maegawa told Reuters Health by email. Moreover, "Resection remains as the preferred therapy for this disease, but it can be associated with significant morbidity and mortality if offered to the wrong patient. Tumor ablation and transplant are excellent curative alternatives."
Read more:

Tuesday, January 29, 2019

Major progress against hepatitis C by 2030 is possible, but will need vast improvements

Lancet Article 
Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model
Alastair Heffernan, MRes Prof Graham S Cooke, DPhil Shevanthi Nayagam, PhD Prof Mark Thursz, MD Prof Timothy B Hallett, PhD

Open Access 

Full-text online
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Further improvements in blood safety and infection control, expansion or creation of PWID harm reduction services, and extensive screening for HCV with concomitant treatment for all are necessary to reduce the burden of HCV. These findings should inform the ongoing global action to eliminate the HCV epidemic.

Published: January 28, 2019

Press Release
The Lancet: Major progress against hepatitis C by 2030 is possible, but will need vast improvements in screening, prevention and treatment
First global estimates to determine the impact of improved prevention, diagnosis and treatment, and examine how achievable the WHO elimination targets are.

A comprehensive package of prevention, screening, and treatment interventions could avert 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030 - equal to an 80% reduction in incidence and a 60% reduction in deaths compared with 2015, according to the first study to model hepatitis C interventions globally published in The Lancet.

The estimates suggest that the interventions modelled in the study would reach the elimination targets set by the World Health Organization (WHO) to reduce the number of new hepatitis C infections by 80%, but narrowly miss the target to reduce mortality by 65% - which would instead be reached by 2032.

"Even though it narrowly falls short of the WHO targets for 2030, the impact our estimates suggest would be a tremendous stride forwards," says Professor Alastair Heffernan, Imperial College London, UK, who led the research. "Eliminating hepatitis C virus is an extremely challenging aim that requires improved prevention interventions and screening, particularly in high-burden countries such as China, India, and Pakistan. Across the globe, these options are currently well below the levels we estimate are needed to have a major impact on the epidemic. Research into how to improve this in all settings, as well as increased funding, will be needed if we are to reach these targets." [1]

Globally, it is estimated that 71 million individuals are chronically infected with hepatitis C virus, and 10-20% will develop liver complications including cirrhosis and cancer - which were responsible for over 475,000 deaths in 2015. In recent years, the number of deaths from viral hepatitis infection has risen.

Transmission is most commonly associated with blood transfusions, unsafe healthcare-related injections, and injection drug use. The first two causes of infection have declined globally, but remain an issue in lower income countries. However, infection from injecting drug use is the primary cause in countries where all other causes have been mostly eliminated.

In 2014, direct-acting antivirals were developed, which provide greatly improved cure rates along with reduced side effects and shorter duration of treatment, meaning that more patients can successfully complete treatment than before.

As a result, in 2016, all 194 member states of the WHO have committed to eliminating viral hepatitis as a public health threat. These targets include reducing mortality by 65% and reducing new infections by 80% by 2030, compared with 2015 rates. This is to be achieved by preventing transmission (by improving blood safety and infection control measures, and extending harm reduction services for people who inject drugs), and expanding testing, and increasing treatment with direct-acting antivirals (DAAs) for those already infected.

In the new study, the authors created a model of the global hepatitis C epidemic in 190 countries using data on demography, people who inject drugs, current treatment and prevention programmes, historic trends, prevalence and mortality rates. Using this they estimated the effects of four interventions - implementation of comprehensive blood safety and infection control measures; expansion of harm reduction services (such as opioid substitution therapy and needle and syringe programmes) for people who inject drugs; provision of treatment for all people as soon as they are diagnosed with hepatitis C infection; and expansion of hepatitis C testing, so 90% of people with hepatitis C are diagnosed and offered treatment by 2030.

If things continue as they are, the estimated number of people living with hepatitis C infection will gradually decrease to 58 million in 2050 but could rise by the end of the century. If treatment with direct-acting antivirals is not improved, outcomes could be even worse with considerably higher mortality and new infections.

Implementing comprehensive blood safety and infection control measures was estimated to reduce the number of new infections in 2030 by 58%, compared to if things continue as they are. In addition, extending harm reduction services to 40% of people who inject drugs could reduce the number of new infections by a further 7 percentage points. Together, this would prevent 14.1 million new infections by 2030, but these reductions would not immediately translate into reduced mortality.

To cut future mortality rates more substantially, expanding access to direct-acting antivirals will be essential. Replacing older treatments with direct-acting antivirals in all countries and offering these to all patients at the time of diagnosis could prevent 640,000 deaths from liver cancer and cirrhosis by 2030.

Combining all three interventions and adding screening so that 90% of people with hepatitis C are diagnosed and offered treatment by 2030, would result in the biggest reductions - averting 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030.

The authors note that reducing the global burden of hepatitis C depends on the progress made in just a few countries. Infections and deaths averted, after implementation of the comprehensive package of interventions, are concentrated in a small number of countries, in particular China, India, Pakistan, and Egypt, which are the countries that contribute most to projected new infections by 2030.

"Achieving such reductions requires a massive screening programme and demands a rapid increase in new treatment courses in the short term - namely, 51.8 million courses of direct-acting antivirals by 2030. In the following 20 years, by contrast, the total number required is a much more modest 12 million courses. The reduced treatment requirement after 2030 indicates that rapid testing and treatment scale-up is a means to control the epidemic in the long term, though this must be done within the context of improved hepatitis C prevention measures as well," adds Professor Tim Hallett, Imperial College London, UK. [1]

The authors flag that the efforts to eliminate hepatitis C will entail considerable practical challenges and costs - running into the tens of billions of US dollars by 2030 for a complete viral hepatitis strategy. However, many countries have made substantial progress despite this - with innovative screening strategies being rolled out in Egypt as 700,000 people were treated with direct-acting antivirals in 2016, and Australia negotiating a volume-based pricing model for direct-acting antivirals that encourages, rather than rations, the prescription of expensive treatment courses.

Writing in a linked Comment, Dr Stefan Wiktor, University of Washington, USA, says: "The concept of eliminating hepatitis is gaining traction with the adoption of the WHO strategy, mention of "combatting hepatitis" in the Sustainable Development Goals, and expansion of hepatitis services in some countries. Thus, it is encouraging that the analysis by Heffernan and colleagues shows that this concept is achievable. However, their analysis also indicates that the road to elimination will be difficult. The required expansion of hepatitis services will require political will and substantial new investments from national budgets and global funding sources. The authors do not address the cost of elimination but WHO estimated that implementing its strategy would cost US$11·9 billion for the period 2016-21. Identifying these resources will be particularly difficult at a time of reduced investment in global health and a shift in focus toward universal health coverage rather than disease-specific programmes."

Jan 8 2019
A Commission in The Lancet Gastroenterology & Hepatology studying how to accelerate the elimination of viral hepatitis was also published this month, and is available here:

Sunday, January 27, 2019

Hepatitis Stigma: Barriers To Treatment - Burden Of Disclosure

Stigma and Discrimination 
Welcome to weekend reading, its a cold Sunday here in Michigan, hope its warmer in your part of the world. Today we have an article and podcast for the people of Australia, covering the negative impact of stigma and discrimination associated with the hepatitis C virus (HCV). 

Barriers To Treatment 
Let's start with a review of an Australian study published in PLOS One over at NAM, titled: Barriers to HCV treatment access from the drug user's point of view: stigma, complex lives and damaged veins, written by Keith Alcorn. According to the PLOS One study, based on patient interviews, some participants reported they were treated poorly by health care professionals, for instance, physicians and pharmacists. An excerpt for the study; 

Finding supportive and non-judgmental care
Participants discussed their experiences of stigma and discrimination in health care settings. Examples included emergency doctors telling participants they ‘were sick of dealing with you junkies’ (male, group 3, 34 years) and pharmacists making participants wait for lengthy periods before being served, speaking to them in a poor manner and generally not observing common courtesies to customers with injecting histories. Often, discussion of stigma centred around participants’ sense that clinicians viewed them as inappropriate clients to be receiving DAA treatment, which resulted in the internalization of these messages. 
I still hide it, no matter what… I just won’t do it…um, and yeah that’s from fear of judgment I’d say but I don’t think it would have really mattered. It’s more from me… it’s the stigma within as much as the stigma without. (male, group 4, 56 years)
Read the patient-friendly article here, study here.
Follow NAM on Twitter, connect on Facebook, or sign up for Email updates.

New Podcast - Burden Of Disclosure

Over at Hepatitis Victoria, Judith Gorst, a practice nurse and counsellor, talks about stigma and discrimination surrounding blood-borne infections; especially when disclosing status to friends, family and health care professionals. Listen below or here: Stigma & healthcare: Should you disclose your hepatitis status?

Listen To All Podcasts
Viral Hepatitis Playlist: Hepatitis Victoria

Hepatitis Victoria - Stigma and Discrimination

Unfortunately, people knowing, or thinking, you have hepatitis B and/or hepatitis C, can mean they treat you differently to other people. This can be distressing, and contribute to internal feelings of shame or other unpleasant feelings. It can also have a real effect on your social experiences, including the services you are provided with, and the quality of those services.

We aim to give you more information about stigma and discrimination: what it means; when you have to disclose you have hepatitis B and/or C; what your rights are if someone has treated you poorly; and, issues to consider if you work with people who have hepatitis B and/or C. 

Thanks for stopping by!

Parents worried about risks, still think opioids are best for kids' pain relief

Parents worried about risks, still think opioids are best for kids' pain relief

CHICAGO - Headlines filled with frightening news of opioid abuse, overdoses and reports that 90 percent of addictions start in the teen years could make any parent worry. Yet parents remain conflicted about opioids: while more than half express concern their child may be at risk for opioid addiction, nearly two-thirds believe opioids are more effective at managing their child's pain after surgery or a broken bone than non-prescription medication or other alternatives, according to a nationwide survey commissioned by the American Society of Anesthesiologists (ASA).

"The survey results shed light on the country's conflicted relationship with and understanding of opioids. While most parents said they were concerned about side effects and risks such as addiction, improper or recreational use and overdose, they still thought opioids work best to manage pain," said ASA President Linda J. Mason, M.D., FASA. "Opioids may not always be the best option. It really depends on the type of surgery and how long they are required. It is, however, important for parents to know that there are many alternatives available that are as - or more - safe and effective for pain management. But only about a third of parents whose children were prescribed opioids even asked their doctor about pain management alternatives."

Although short-term use of opioids can be effective when managed safely and the risks minimized, more than 2 million Americans abuse them and more than 90 people die of an opioid overdose every day. Opioid-related deaths among children and adolescents nearly tripled between 1999 and 2016, driven mostly by prescription opioids.* During Physician Anesthesiologists Week (Jan. 27 - Feb. 2), ASA wants parents to know that a physician anesthesiologist or other pain management specialist can create an individualized plan to best address patients' pain based on the condition or type of surgery and decrease the risk of opioid misuse and addiction.

The new survey of more than 1,000 parents of children aged 13-24, one-third of whom had been prescribed opioids, revealed that while 83 percent of parents believe they are prepared to safely manage their child's opioid use if prescribed, the facts don't quite bear out. The results suggest there is a need for improved awareness on: opioid alternatives; safe storage and proper disposal; talking to children about risks; and the benefits of naloxone, an emergency medication that reverses the effects of an opioid overdose.

Parents aren't asking about effective alternatives

While opioids can help with pain management for a few days after surgery or injury, there are effective alternatives that do not have the side effects and risks of opioids, including non-opioid medications and non-drug therapies. But the survey results suggest parents often don't ask about alternatives, or aren't aware of the range of options.

59 percent said they would talk to their physician about pain management options, but only 37 percent of those whose children were prescribed opioids actually did.

88 percent recognized non-opioid, over-the-counter medications, such as acetaminophen (Tylenol), ibuprofen (Advil or Motrin) and aspirin, are used to effectively help treat pain. However, few were aware the same applies to other non-opioid options, including steroids (23 percent), antidepressants (9 percent), and anti-seizure medications (7 percent).

15 percent incorrectly said antibiotics are an effective pain reliever.

Beyond medications, a number of non-drug therapies can help with ongoing pain, including nerve blocks, physical therapy, biofeedback, meditation, virtual reality, massage and acupuncture.

Parents are unaware that safe storage and proper disposal are key

More than half of people who misuse prescribed opioids get them from a friend or relative. That's why safe storage and proper disposal of the drugs are important to help curb the epidemic. But the survey results suggest parents don't fully understand the benefits and appropriate methods of safe storage and disposal.

Only 50 percent said they stored or would store opioids in a safe and secure place (not the medicine cabinet, where they can be accessed by others).

60 percent of those whose children took opioids said they needed fewer than were prescribed and, consequently, had leftover medication. But only 39 percent of all parents disposed or would dispose of leftover opioids as recommended, including taking them to a local pharmacy or health clinic, flushing them down the toilet or mixing them with dirt, kitty litter or coffee grounds before throwing them away.

Yet, 61 percent correctly identified the ideal method of disposing leftover opioids, which involves taking them to a collection center at a local police station or drug disposal program at a pharmacy or health clinic.

Parents understand importance of communication

When a child is prescribed opioids, parents need to have an open and honest discussion about the potential side effects and risks - not only with the child taking the medication, but other family members as well. Surveyed parents generally understood that.

74 percent said they have talked to their child about the dangers of abusing prescription and over-the-counter medications and 20 percent said they intend to have the conversation.

89 percent of those whose children have been prescribed opioids said they've had those discussions.

91 percent said they are confident their children know that prescribed and over-the-counter medications can be just as dangerous as illegal drugs.

Parents recognize naloxone saves lives

Naloxone (Narcan®) is a lifesaving medication administered via nasal spray or injection that rapidly reverses the effects of an overdose. It's important to know about naloxone because anyone who uses opioids - even if they've been prescribed by a doctor - may be at risk for an overdose.

The availability of naloxone varies by state. In most states it is available by prescription and some pharmacies sell it over the counter. Most parents recognize naloxone's value.

71 percent agreed that having naloxone on hand is the same as having other life-saving medication available for people who suffer from conditions such as allergies, asthma or diabetes.

29 percent were concerned that having it on hand encourages risky opioid use.

80 percent said they would be more comfortable having it at home if their child or another family member was taking opioids.

92 percent thought all first responders should carry it.

"It's critical that we recognize the gaps in opioid knowledge and work to correct them, ensuring everyone understands how to use them safely and minimize their risks. A physician anesthesiologist or other pain management specialist can help parents address their child's pain and decrease the risk of opioid misuse and addiction," said Dr. Mason. "We also need to reassure parents that naloxone saves lives and needs to be widely available."

The 17-question Engine CARAVAN® Omnibus Survey was conducted online November 25-December 2, 2018 among 1,007 parents of children ages 13-24. If their children were ever prescribed opioids, parents were asked to think of their child with the most recent prescription when answering the questions. If their children were never prescribed opioids, parents were asked to answer for their oldest child between the ages of 13 and 24.

Saturday, January 26, 2019

Hepatologist Urges Appropriate Hepatitis C Post-Cure Care

Hepatologist Urges Appropriate Hepatitis C Post-Cure Care
JANUARY 26, 2019
Kenneth Bender, PharmD, MA

Although virologic cure is achieved in most patients infected with hepatitis C virus (HCV) treated with direct-acting antivirals (DAAs), a noted hepatologist recently emphasized the importance of post-cure care to reduce risk of liver disease progression in those with advanced fibrosis and in those with ongoing risk factors for liver injury, as well as to reduce risk of reinfection and to monitor and manage related complications.

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Thursday, January 17, 2019
After The Cure: What’s Next? Hepatitis C Post-Treatment Management

Friday, January 25, 2019

Physical Activity Associated With Reduced Risk of Liver Cancer

The Clinical Advisor
Madeline Morr, Associate Editor

January 25, 2019
Physical Activity Associated With Reduced Risk of Hepatocellular Carcinoma
Higher total physical activity, as well as vigorous physical activity, was found to be associated with a reduced risk of hepatocellular carcinoma (HCC), according to a study published in the Journal of Hepatology 

Researchers used the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, a multinational prospective study that analyzes the link between diet, lifestyle, and environmental factors with cancer risk and chronic diseases, to identify the relationship between physical activity and hepatobiliary cancer risk.
Read more:

Baumeister SE, Schlesinger S, Aleksandrova K, et al. Association of physical activity and risk of hepatobiliary cancers: a multinational cohort study [published December 21, 2018]. J Hepatol. doi: 10.1016/j.jhep.2018.12.014

Discussion on critical points for a tailored therapy to cure hepatitis C virus infection

Clin Mol Hepatol. 2019 Jan 23. doi: 10.3350/cmh.2018.0061. [Epub ahead of print]

Discussion on critical points for a tailored therapy to cure hepatitis C virus infection.
Marascio N1, Quirino A1, Barreca GS1, Galati L1, Costa C2, Pisani V2, Mazzitelli M2, Matera G1, Liberto MC1, Focà A1, Torti C2.

Full Review

Hepatitis C virus (HCV) infects around 71 million people worldwide and in 2018 it is still a major health problem. Since 2011, anti-HCV therapy with availability of direct-acting antiviral drugs has revolutionized the clinical response and paved the way to eradication strategies. However, despite the high rate of sustained virological response, treatment failure may occur in a limited percentage of patients, possibly due to resistance-associated substitutions (RASs), either emergent or pre-existent even in minority viral populations. Clearly this problem may impair success of eradication strategies. With this background, several questions marks still exist around HCV treatment, including whether pan-genotypic treatments with complete effectiveness in any clinical conditions really exist outside clinical trials, the actual cost-effectiveness of genotyping testing, and utility of RAS detection in viral quasispecies by next generation sequencing approach. In this review, we describe these critical points by discussing recent literature data and our research experience.

PMID: 30669818 DOI: 10.3350/cmh.2018.0061

Thursday, January 24, 2019

New evidence shows needle and syringe programmes are highly cost-effective

In The News
New evidence shows needle and syringe programmes are highly cost-effective
Thu, 01/24/2019 - 14:55
Evidence from a new study shows that needle and syringe programmes providing clean injecting equipment are a highly cost-effective way of preventing hepatitis C transmission. New research led by the University of Bristol and London School of Hygiene and Topical Medicine reveals that rolling out these programmes could save millions of pounds in infection treatment costs in the UK. This is the first study to evaluate the cost-effectiveness of needle and syringe programmes in Western Europe.

The researchers used data from three cities with different levels of hepatitis C infection among people who inject drugs—Bristol (45%), Dundee (26%) and Walsall (18%). They estimated the cost-effectiveness of existing needle programmes in each city and their impact on hepatitis C transmission rates. Using mathematical models, they were able to project how hepatitis C transmission would increase if all needle and syringe programmes were stopped for the first ten years of a 50-year time period (2016-2065).

Their findings revealed that in all three cities, current needle and syringe programmes result in lower healthcare and treatment costs than if the programmes were stopped, with estimated cost-savings of £159,712 in Bristol and £2.5 million in Dundee.

Maintaining the needle and syringe programmes was also associated with a lower prevalence of hepatitis C and improvements in quality of life for people who inject drugs. Infections were projected to reduce by 8 per cent in Bristol and Walsall and 40 per cent in Dundee between 2016 and 2065 if needle and syringe programmes were maintained.

Even if hepatitis C treatment rates were to increase or treatment costs were further reduced, needle and syringe programmes would continue to save money, because of their effectiveness in preventing re-infection.

Responding to the findings of the study, Rachel Halford, CEO of The Hepatitis C Trust said: “Needle and syringe facilities are key to preventing the transmission of hepatitis C, yet we know that in many areas provision is insufficient or dropping.

While in recent years the numbers of people being treated and tested for the virus have increased, Public Health England estimates that prevalence has remained broadly stable due to new infections and re-infections. To achieve NHS England’s ambition to eliminate hepatitis C as a public health concern by 2025, we must ensure that numbers of new infections are falling.

This will require sustained investment in prevention initiatives. Now that we have clear evidence for the cost-effectiveness of needle and syringe programmes, there is no excuse for not expanding them significantly.”

You can read a full report of the study’s findings here.

Why Liver Transplant Waitlists Might Misclassify High-Risk Patients

Why Liver Transplant Waitlists Might Misclassify High-Risk Patients

A new study has uncovered that the standard method for ranking patients on the waitlist for lifesaving liver transplantation may not prioritize some of the sickest candidates for the top of the list.

"Ultimately, we hope this information will help clinicians recognize that certain patients with a high risk of mortality may not be captured by our current organ-allocation policy," said Vinay Sundaram, MD, director of Hepatology Outcomes Research at the Cedars-Sinai Comprehensive Transplant Center. He is the co-first author of the multicenter study published recently in the peer-reviewed medical journal Gastroenterology, the most frequently cited journal in its field.

Liver transplants are performed as a last resort for liver failure, when the vital organ is too damaged to sustain life. The most common damage is caused by cirrhosis—severe scarring that can result from various conditions, including injuries, the hepatitis C virus, metabolic disease and long-term alcohol abuse. While more than 8,000 liver transplants were performed in the U.S. last year, the need exceeds availability of viable organs. According to the United Network for Organ Sharing (UNOS), the nonprofit that manages the U.S. organ transplant system, more than 13,000 patients were on its liver-transplant waitlist as of Jan. 18.

To decide which patients should be first in line for liver transplants, medical professionals rely on a standardized assessment of liver and kidney function known as the MELD (Model for End-Stage Liver Disease) score. The goal is to determine who among the many patients needing transplants are the sickest and yet also able to withstand surgery and to recover and thrive. A lower score indicates less urgency for a transplant; a higher score indicates greater urgency.

The study found that the MELD score does not fully identify patients with a life-threatening syndrome known as ACLF-3, or acute on chronic liver failure grade-3. This syndrome involves a sudden worsening of chronic liver failure accompanied by multiple organ-system failures, such as circulatory, respiratory or neurologic failures.

"ACLF-3 patients, even with relatively low MELD scores, have the highest risks of being removed from the waitlist due to being too sick for a transplant or of dying while waiting for a liver transplant," Sundaram said. "We sought to understand how this happens and how the standardized system of prioritization can unintentionally disadvantage these patients."

The team analyzed UNOS data from 100,594 patients on liver-transplant waitlists from 2005 through 2016.

"Our study goals were twofold," Sundaram said. "First, we set out to determine the mortality rate of patients with ACLF-3 awaiting liver transplantation, and second to analyze how patients with ACLF-3 fared when they did receive liver transplants."

Sundaram said the team discovered that ACLF-3 patients are sicker than the MELD scores would indicate because that assessment takes into account only liver and kidney function, whereas ACLF-3 patients have other organ-system failures as well. They found that nearly 44 percent of ACLF-3 patients in a certain category died or were removed from the transplant waitlists within 28 days of listing.

The team also found that when transplants were performed within 30 days of ACLF-3 patients being placed on the waitlists, their one-year post-transplant survival rate was more than 80 percent—equivalent to patients without this syndrome.

They concluded that ACLF-3 classification may help identify candidates on the list who are at high risk for short-term mortality. "Time is of the essence because it is clear that survival declines with increased waiting time for these patients," Sundaram said.

Rajiv Jalan, MD, PhD, of UCL Medical School, London, is co-first author of the study, along with Sundaram. Robert J. Wong, MD, from the Alameda Health System, Highland Hospital, in Oakland, Calif., is the senior author. The study also involved Loma Linda University in Loma Linda, Calif., and Baylor University Medical Center in Dallas.

"This study makes a major step toward improving the clinical relevance of waitlists for liver transplant candidates," said Andrew S. Klein, MD, the Esther and Mark Schumann Chair in Surgery and Transplantation Medicine, director of the Cedars-Sinai Comprehensive Transplant Center, professor of Surgery and a co-author of the study. "If further research expands and confirms these findings, they can lead to better transplant outcomes."

The Cedars-Sinai Comprehensive Transplant Center recently was reported by the Scientific Registry of Transplant Recipients to have the best one-year survival outcome for liver transplants of all hospitals in California.

DOI: 10.1053/j.gastro.2018.12.007

Liver Cancer Recurrence Not Linked to Hepatitis Treatment

Hepatitis C Therapy Not Linked to Liver Cancer Recurrence
JANUARY 22, 2019
Kevin Kunzmann
New study results show that, despite recent international clinical analysis, direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is not associated with a greater recurrence of liver cancer in patients who have suffered from both conditions.

According to research from the University of Texas Southwestern Medical Center, rates of cancer aggressiveness and recurrence in DAA-treated patients with hepatitis C was no different from those not given antiviral therapy. The findings come as a benefit to patients and physicians alike; DAAs have been evidenced to provide a near-perfect rate of hepatitis C eradication in patients, with virus life cycle-targeting mechanism and proven tolerability.
Read more:

Liver Cancer Recurrence Not Linked to Hepatitis Treatment
Kristin Jenkins 
January 24, 2019 
The study was published online January 18 in Gastroenterology.

"Our results suggest use of direct-acting antivirals is safe and likely beneficial in hepatitis C–infected patients with a history of hepatocellular carcinoma," Singal told Medscape Medical News.

"We found no significant difference in the proportion of patients with recurrence or the aggressiveness of the recurrence between DAA-treated and untreated patients. Therefore, patients with a history of HCC who achieve complete response to cancer treatment should be referred for consideration of hepatitis C therapy," he said.

Read more:
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8 gastrointestinal, liver cancer stories you may have missed
January 24, 2019
Recently published studies have demonstrated new developments in the testing, diagnosis and treatment of gastrointestinal and liver cancers. In case you missed it, the…

Wednesday, January 23, 2019

Screen All New Cancer Patients for Hepatitis?

Article download shared by @HenryEChang via twitter... 

Medscape Medical News
January 23, 2019

With no identifiable risk factors in most cases, universal screening before cancer therapy may prevent life-threatening complications.

Screen All New Cancer Patients for Hepatitis?
Kristin Jenkins
A new study has found "a large reservoir of patients with cancer and undiagnosed hepatitis virus infections" and has reignited the question of whether all newly diagnosed cancer patients should be screened for hepatitis.

The Viral Screening in Newly Diagnosed Cancer Patients (S1204) study involved 3051 patients and found that 6.5% had previously been infected with hepatitis B virus (HBV), 0.6% had chronic HBV infection, 2.4% had hepatitis C (HCV) infection, and 1.1% were infected with HIV.

The study was published online on January 17 in JAMA Oncology.

Read more:
Free registration may be required

Tuesday, January 22, 2019

Treating alcohol-related liver disease from a public health perspective

Also See
Journal of Hepatology February 2019
Alcohol-related liver disease: Time for action
Ramon Bataller, Gavin E. Arteel, Christophe Moreno, Vijay Shah
The overall landscape of clinical hepatology has markedly evolved in the last few years. Recent major advances in the management of viral hepatitis B and C with highly effective therapies are decreasing the proportion of patients with viral-related end-stage liver disease in many countries.1 Consequently, increasing attention is being paid to fatty liver diseases (both alcohol-related liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]) as the main current and future driver of liver-related health burdens.

Journal of Hepatology February 2019
Volume 70, Issue 2, Pages 223–236
Treating alcohol-related liver disease from a public health perspective
Theresa Hydes†, William Gilmore†, Nick Sheron, Ian Gilmore

Herein, we describe the evolving landscape of alcohol-related liver disease (ALD) including the current global burden of disease and cost to working-aged people in terms of death and disability, in addition to the larger spectrum of alcohol-related heath complications and its wider impact on society. We further review the most effective and cost-effective public health policies at both a population and individual level. Currently, abstinence is the only effective treatment for ALD, and yet because the majority of ALD remains undetected in the community abstinence is initiated too late to prevent premature death in the majority of cases. We therefore hope that this review will help inform clinicians of the “public health treatment options” for ALD to encourage engagement with policy makers and promote community-based hepatology as a speciality, expanding our patient cohort to allow early detection, and thereby a reduction in the enormous morbidity and mortality associated with this disease.

Full Article: 

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant

Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
By Rachel Bluth
An estimated 17,000 Americans are on the waiting list for a liver transplant, and there’s a strong chance that many of them have alcohol-associated liver disease. ALD now edges out hepatitis C as the No. 1 reason for liver transplants in the United States, according to research published Tuesday in JAMA Internal Medicine.

One reason for the shift, researchers said, is that hepatitis C, which used to be the leading cause of liver transplants, has become easier to treat with drugs.

Another could be an increasing openness within the transplant community to a candidate’s history of alcohol and addiction and when a candidate combating these issues can qualify for a liver.

For years, conventional wisdom suggested that people with a heavy drinking past who did not have a period of sobriety under their belts would not be good candidates to receive a new liver. But, of almost 33,000 liver transplant patients since 2002 who were studied, researchers from the University of California-San Francisco found 36.7 percent of them had ALD in 2016, up from 24.2 percent in 2002.

“Across the country, and we show in a prior study, people are changing their minds,” said Dr. Brian P. Lee, the study’s lead author and a UCSF gastroenterology and hepatology fellow. “More and more providers are willing to transplant patients with ALD.”

The debate, roiling for decades, culminated in 1997 when a group of doctors and medical societies and the U.S. surgeon general published a paper that recommended patients with alcoholic liver disease be sober at least six months before they could be considered for transplant.

This “six-month rule” became the gold standard. The idea was that a patient who could stay sober for that long had a lower chance of returning to harmful drinking behavior. There was also concern that the public would stop donating organs if they thought livers would be going to people with alcohol addictions.

“Neither of those attitudes are based on any facts or data,” said Dr. Robert Brown, director of the Center for Liver Disease and Transplantation at Weill Cornell and New York Presbyterian.

The changing attitude plays out at many transplant centers where what once was viewed as a hard-and-fast requirement for six months of sobriety is now more nuanced. Specifically, a team of doctors, psychologists and social workers look at a range of factors, including financial stability and family support, to determine if a patient will relapse after the transplant.

An analysis published in 2010 by researchers from the University of Pittsburgh and a 2011 study in France showed that, in any given year, there was little evidence to suggest six months of abstinence before the transplant decreased the chance of relapse.

The central point, experts say, does not necessarily come down to a patient’s record of sobriety before the procedure. Foremost is determining that a patient is unlikely to drink again after receiving a new liver — that he or she is “committed to lifelong abstinence,” said Lee.

Five years after transplantation, patients who were abstinent for six months and those who weren’t had about the same survival rates, according to Lee’s research. After 10 years, the patients who didn’t have six months of sobriety before the procedure had slightly worse survival rates. Lee said more research is needed to find out exactly why.

There is nothing magical about six months, according to Dr. Michael Lucey, medical director of the University of Wisconsin liver transplant program. He said it shows a poor understanding of alcohol abuse as a “very complex behavioral disorder.”

“Drinking isn’t a stable phenomenon,” Lucey said. “People with ALD may have long periods of drinking and abstinence.”

Although advocates are glad that policy is changing, it didn’t change swiftly enough to save Chelsea Oesterle.

Oesterle, who was 24 and had battled alcohol addiction since age 16, went to the emergency room in Peoria, Ill., in 2013, already in liver failure. Doctors told her in the first few days that survival depended on a transplant.

When it became clear she wasn’t going to get that transplant, her mother, Terri Oesterle, had her daughter transferred to another hospital, and between both facilities she spent six weeks hospitalized. During that time, she was never put on a transplant list.

The stigma around her daughter’s condition was palpable, her mother said. Doctors and nurses lectured her about quitting drinking.

“They kept telling her she had to go to rehab,” Terri Oesterle said. “She couldn’t even leave the hospital, how on earth was she supposed to go to a rehab program?”

One doctor point-blank asked Terri Oesterle why she thought her daughter deserved a liver over someone else.

“She was dismissed from the get-go,” Terri Oesterle said. “It’s just heart-wrenching because she was such a sensitive soul. She was so scared and hopeful.”

Chelsea Oesterle died in the hospital July 4, 2013.

Alcohol use disorder has often been thought of as a “self-inflicted” disease that results from bad habits or moral failing, Lucey said. That attitude is changing in the medical community, but vestiges remain.

“For some people, it’s not accepting that alcohol use disorder is an illness,” Lucey said.

While support for the changing approach is growing, Lee, the new study’s lead author, said it continues to be a polarizing issue.

“There are still detractors and still strong opposition,” he said. “Our study suggests that is certainly present, because regional differences are disparate.”

That troubles Lee, because it means a patient’s life is dependent on the attitudes of local providers, creating an unequal system. There’s “certainly value” in a national policy on the issue, he said.

The United Network for Organ Sharing (UNOS), the organization that manages the U.S. transplant list, nearly two decades ago wrestled with the idea of formalizing the six-month rule, but never took final action.

As a result, some centers have such a sobriety rule, others don’t. And even when a transplant center gives its approval, insurers often have their own set of requirements about how long a patient must be abstinent before they will cover the transplant.

Dr. David Klassen, chief medical officer for UNOS, agreed that the “rule” is arbitrary and not evidence-based, but said that it should be up to transplant centers to decide who gets listed for an organ.

“From our perspective, dictating medical care doesn’t lead to the best solutions or the best outcomes,” Klassen said. “I think transplant programs and society as a whole are moving in generally the same direction.”

Monday, January 21, 2019

Opioid and HCV Epidemics - Spreading rapidly in new generations, but boomers bear biggest burden

For Patients: Basic HCV Information
In this program launched by PeerView, Dr. Mark Sulkowski heads an expert panel addressing the evolving opioid and Hepatitis C epidemics. The good doctor will discuss basic HCV information for both the baby boomer generation (born between 1945 and 1965) and a younger at risk population, people less than 40 years old. 

Here are a few highlights to get you started, followed by tips for navigating the presentation.

Did you know?
Hepatitis C is spreading rapidly in new generations, but boomers bear the biggest burden.
Dr. Sulkowski: This group is critically important, because they’ve lived so long with the infection. They’re now presenting with liver disease, such as cirrhosis, decompensation—and they’re what’s behind the rise in liver cancer.. We’ll talk a bit more about that in a minute. And these individuals are dying about 15,000 deaths per year.

Dr. Sulkowski: So, let’s move into the first lecture portion of this, where we’re going to try to cover some of the basics about the burden of hepatitis C, where we stand with treatment and cure, and then we’re going to focus more on the local picture. Hep C is a major cause of mortality in America, more than any other infectious disease, even when you combine them. And I’ll come back to that with some actual data from the CDC. So, [HCV is] a major problem in the United States.

Opiate epidemic in the United States 
18-to 29-year-olds and 30- to 39-year-olds.
Dr. Sulkowski: In parallel with that is hepatitis C. One thing that characterizes this virus is it is very transmissible by blood contamination. But it’s not just reuse of needles; it’s reuse of any of the works, including water, that have been used to prepare drugs.

And it’s so contagious that people acquire it unknowingly. So, you can see that staggering increase in hepatitis C among this population, and that’s what’s driving that second hump on our epidemiology graphics in California but also here in Maryland.

A Closer Look at the Burden of HCV Infection in a New Era of Treatment and Cure
Hepatitis C and Injection Drug Use in the Urban Setting: Perspectives From the Front Lines 
Hepatitis C and Injection Drug Use in the Rural Setting: Perspectives From the Front Lines 
Practice Aids, Slides, Monograph and Live Roundtable Discussion Summary 
Experts discuss working with patients with substance use disorder 

For Patients: How To Navigate The Program 
Begin: Click here
-Select any specialty or profession
-The program will begin
-Interactive questions will appear; respond by clicking "N/A" or click "Next Button" on the top of your screen.
-Pause program click on the video presentation. 
-No registration is required

Recommended Reading
Screening For HCV Is Lacking - Baby Boomers
Screening strategies have been in place for baby boomers since 2012, but according to research, and the American Liver Foundation, "Few boomers are getting screened for hep C'

Screening For HCV Is Lacking - Young People At Risk
Screening young people most at risk for HCV is lacking as well, last month an article written by Michelle Andrews, published by Kaiser Health News (KHN) found facilities ready to serve people who use drugs are not always screening patients, read the article here.

The opioid epidemic is a major contributor to the current rise in HCV infections. Recently, HepVu launched a map on the impact of hepatitis C across the U.S. In some states the map shows a concentration of infections most impacted by the opioid epidemic.

Taking Down the Opioid Crisis 
Andrew Reynolds writes about the opioid crisis online at POSITIVELY AWARE (PA)
This article will provide you with a broad overview of the scope of the problem, basic information to understand what opioids are and how they lead to overdoses, and some harm reduction tips and resources so that you, or someone you know who uses drugs, can be safe. 
Read it here, follow Andrew on twitter. Visit Project Inform to read additional articles about the opioid crisis. 

Andrew Reynolds
Andrew Reynolds is the Hepatitis C Education Manager at Project Inform, and facilitates several HCV support groups in the San Francisco Bay Area. He's also a counselor on the HELP-4-HEP HCV phoneline (877-435-7443). Call him if you have any questions about HCV care and treatment.

Healio’s Opioid Resource Center
Healio’s Opioid Resource Center compiles the latest stories across a range of specialties, covering the latest research into the epidemic, FDA decisions on treatments and other related announcements.

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Liver cancer patients can be treated for hep C infection

Liver cancer patients can be treated for hep C infection
Newswise | January 21, 2019

A large, multi-center study refutes earlier suggestions that antiviral drugs for treating hepatitis C may lead to a higher recurrence of liver cancer.

Researchers at UT Southwestern Medical Center studied the records of patients who had been successfully treated for liver cancer at 31 medical centers in North America, comparing those who were and were not given direct-acting antivirals for hepatitis C. The study found no significant difference in the recurrence of liver cancer between the two groups. Similarly, the study found no difference in the aggressiveness of the cancer in those patients who did experience a recurrence.

“Our study was inspired by a single-center study from Spanish investigators in 2016. That study gained a lot of press and sparked fear about treating liver cancer patients for their hepatitis C,” said Dr. Amit Singal, associate professor of internal medicine and medical director of the liver tumor program. “Based on these new data, providers can feel reassured that it is safe to treat hepatitis C in these patients and allow them to receive the known benefits of hepatitis C therapy.”

Some 3.2 million individuals in the US, the large majority of them baby boomers, have chronic hepatitis C infection. Many of these individuals struggle with inflammation of the liver and impaired liver function, as well as cirrhosis, or scarring, of liver tissue. Since 2013, effective antiviral drugs have been available to treat hepatitis C infection.

Chronic hepatitis C infection is also one of the leading causes of liver cancer. According to the Centers for Disease Control and Prevention, half of all individuals with liver cancer have underlying chronic hepatitis C infection. The rate of new cases of liver cancer has been rising steadily in recent decades, and the state of Texas has one of the highest rates of occurrence in the country.

When liver cancer is diagnosed early, it can be effectively treated with surgery, ablation, or radiation therapy. Sometimes liver cancer patients have their tumor successfully removed, but the underlying chronic hepatitis C infection remains and continues to impair liver function.

In this study, published in the journal Gastroenterology, 42% of liver cancer survivors who were treated with direct-acting antiviral (DAA) therapy experienced a recurrence of their cancer, compared with 59% of patients who were not treated with antivirals.

“Our results suggest that use of DAA therapies is safe and potentially beneficial in hepatitis C-infected patients with a history of liver cancer,” said Dr. Singal, who holds the David Bruton, Jr. Professorship in Clinical Cancer Research and is clinical chief of hepatology.

Friday, January 18, 2019

Many Popular Dietary Supplements Can Yield Dangerous Liver Results

Many Popular Dietary Supplements Can Yield Dangerous Liver Results
January 15, 2019 
A recent paper from two U-M hepatologists highlights the liver dangers associated with consuming some herbal and dietary supplements designed to build muscle or lose weight.

Athletes often use over-the-counter products to help lose weight or improve their energy and performance levels.

However, the vast majority of herbal and dietary supplements (HDS) never undergo formal efficacy or safety tests because their manufacturing, production and content are not closely regulated by the Food and Drug Administration, says Robert Fontana, M.D., University of Michigan’s medical director of liver transplantation, and Ammar Hassan, M.D., a U-M hepatology fellowship graduate, who have explored several over-the-counter HDS products linked to liver injury.

As the number of HDS products available in the United States continues to grow, more than 80,000 commercial products are available to consumers, with nearly 50 percent of adults reporting regular use of at least one kind of supplement. Many adverse effects are linked to consuming HDS products, including hepatotoxicity, or chemically induced liver damage, according to the Drug-Induced Liver Injury Network.

Fontana and Hassan explored several popular over-the-counter HDS products linked to liver injury in a recent article in Seminars in Liver Disease. Here is a rundown:

Bodybuilding supplement hepatotoxicity

The majority of bodybuilding HDS products that lead to liver injury appear to contain androgenic anabolic steroids (AAS) or are contaminated with these and other chemicals.

AAS are synthetic derivatives of testosterone. Some medical conditions require the use of AAS products, including primary male hypogonadism and hereditary angioneurotic edema, but athletes use many of these steroids without medical supervision for their performance-enhancing and muscle-building properties.

SEE ALSO: Troubling Trends in Drug-Induced Liver Damage

“The use of these products is very common among amateur and professional athletes, including many active-duty military personnel,” Fontana says. “Data suggests that 69 percent of these individuals use at least one HDS product, while 22 percent report using more than three a day.”

These products are often purchased at health food stores or online in bulk. Over the past two decades, a significant increase in the incidence of liver injury related to the illicit use of AAS has been reported.

“Bodybuilding supplements that contain AAS can lead to liver damage, including severe cholestatic hepatitis, which can take months to resolve,” Fontana says. “Additionally, various multi-ingredient nutritional supplements taken to enhance energy, increase performance and facilitate weight loss can lead to potentially severe, or even fatal, liver damage.”

Non-bodybuilding supplement hepatotoxicity

Some of the most frequently used non-bodybuilding supplements associated with hepatotoxicity include green tea extract and multi-ingredient nutritional supplements that contain both botanicals and other compounds. These products include familiar names like Hydroxycut, Oxy ELITE Pro and LipoKinetix.

Green tea extract, or GTE, is derived from unfermented leaves of the Chinese tea tree, Camellia sinensis. One of the active ingredients in GTE is epigallocatechin gallate, which is a catechin, or a compound that is abundant in teas, cocoa products and certain berries. It boasts purported weight-loss properties by stopping fat-causing lipogenic enzymes.

While the public tends to view HDS products as safer than most conventional medications because they are derived from plants and other “natural sources,” this is not always the case, Fontana says.

“Various animal studies have shown the hepatotoxic (and possibly deadly) potential of GTE,” he says. “Extreme levels of GTE will lead to elevated aminotransferase (enzymes) in mice that significantly reduce their survival rates.”

Further, the Drug-Induced Liver Injury Network reported a study in which six patients who took GTE-containing Slimquick weight-loss products suffered hepatocellular injury, while four of the six were also severely jaundiced. Additionally, three patients from this group were hospitalized, and one had to have a liver transplant.

Hydroxycut hepatotoxicity

The first reported incidents of hepatotoxicity attributed to ephedra-containing Hydroxycut involved 12 patients in the U.S. who developed severe hepatitis after consuming supplements. Of the patients, 75 percent were female, with a mean age of 38.

It took an average of just eight weeks for an individual to develop hepatocellular injury after taking Hydroxycut.

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Eight of these patients recovered from their liver damage, while three underwent liver transplantation, Fontana says. One patient died before transplantation.

At least 17 additional cases of Hydroxycut-associated liver injury have been reported with similar phenotypes of liver injury and outcomes. And in 2004, the FDA banned the sale of supplements containing ephedra.

In May 2009, the FDA published a warning about Hydroxycut-related hepatotoxicity, resulting in withdrawal of 14 Hydroxycut products from the market.

“Without regulations like standardized chemical analyses and product manufacturing guidelines, it is nearly impossible to determine the exact chemical makeups for these types of supplements,” Fontana says. “And that just adds another element of danger to consuming them.” 

Fontana has received research grants from AbbVie, Gilead Sciences and Bristol-Myers Squibb. He also provides consulting services for Alnylam Pharmaceuticals.

NHS England’s plan to eliminate Hepatitis C decisively backed by High Court

NHS England’s plan to eliminate Hepatitis C in England by 2025 is on track after all aspects of a High Court challenge by pharmaceutical company AbbVie were dismissed.
18 January 2019
The NHS’s single largest medicines procurement, a deal worth almost £1 billion over five years, was launched in April last year but contract start dates had to be delayed by six months after legal action by AbbVie.

The High Court today handed down the judgment decisively backing NHS England’s plans to eliminate Hepatitis C.

In the ruling, the judge rejected all challenges brought by AbbVie against NHS England’s smart procurement for the supply of curative, direct acting antiviral treatments and industry backed projects to find and treat people with the virus as quickly as possible.

John Stewart, director of specialised commissioning at NHS England, said: “Court cases such as this are a waste of NHS resources and taxpayers’ money, in this case resulting in an unavoidable delay in our efforts to tackle the threat of Hepatitis C, which disproportionately affects some of the most vulnerable and marginalised people in society.

“We remain committed to driving best value to help eliminate Hepatitis C in England by 2025 or sooner, and with this court case behind us we can now get on with the job.”

Hepatitis C is a cancer-causing infectious disease, spread by contact with an infected person’s blood.

In recent years, Public Health England estimated that around 160,000 people are infected with Hepatitis C in England, although around half are unaware of their infection.

The disease, which can go undetected until the liver becomes damaged, can now be successfully cured in weeks using new oral tablets.

In 2015, NHS England established 22 Operational Delivery Networks (ODNs) to support treatment and testing efforts across the country and over 32,000 patients have been treated so far with around 95% being cured of the disease. NHS England plans to eliminate Hepatitis C in England by 2025, five years earlier than World Health Organisation goals.

The Hepatitis C procurement is the latest in a series of ‘smart deals’ the NHS has delivered to drive value for the taxpayer and benefits for patients.

These include a £300 million saving after negotiating deals with five manufacturers on low cost versions of the health service’s most costly drug, adalimumab; striking the first full access deal in Europe for CAR-T therapy which can potentially cure some children and adults with blood cancers where other treatments have failed; and reaching a deal to make the life-extending lung cancer drug pembrolizumab, available for routine use on the NHS.