Wednesday, October 4, 2017

Hepatitis C Patients Delay Treatment Due to Cost Concerns

In Case You Missed It
Hepatitis C In America 2017 was conducted online May 3, 2017 – June 26, 2017 and released through Health Union’s online community, HepatitisC.net

If you missed the following survey, I highly suggest you read the results over at  HepatitisC.net.

Published August 28, 2017 
A diagnosis of hepatitis C affects more than just the body. Many don’t realize the full impact hepatitis C can have on someone’s life. We conducted a survey to better understand the symptoms and experiences of people living with hep C. The Hepatitis C In America 2017 online survey gathered insights from 609 individuals who tested positive for hepatitis C infection and have been diagnosed with chronic hepatitis C infection. Of the 609 survey-takers, 49% were reported to be cured of hep C and 51% were not yet cured at the time of the survey.

Published Oct 4, 2017
Survey: Hepatitis C Patients Delay Treatment Due to Cost Concerns

— Most Uncured Respondents Not Actively Treating the Disease —

October 4, 2017
“Hepatitis C In America,” a new Health Union national survey of 609 individuals diagnosed with chronic hepatitis C infection, shows that more than one-third of uncured respondents were not currently under the care of a healthcare provider (HCP), typically due to financial concerns.

While new Hepatitis C treatment options are revolutionizing care, many patients report financial challenges (53 percent) and insurance denial/lack of insurance coverage (25 percent), along with apprehension about treatment and side effects, as common barriers to accessing treatments. The survey also found most (86 percent) respondents with current chronic Hepatitis C infection were not actively treating their condition at the time of the survey.

Hepatitis C is the most common blood-borne infection in the United States and can lead to serious complications including cirrhosis and liver cancer. According to the Centers for Disease Control and Prevention (CDC), Hepatitis C is the leading cause of liver transplants in the U.S.

In this year’s survey, 49 percent of respondents reported they were cured of Hepatitis C and 51 percent were not yet cured at the time of the survey. Seventy-three percent of all respondents had received treatment for Hepatitis C from their healthcare professional; however, 21 percent of treated patients did not achieve a sustained viral response – considered “cured.”

Of those who had been treated, 38 percent reported waiting more than five years from diagnosis to begin treatment. Additionally, one out of four treated patients reported they had to stop a treatment early, often due to medication side effects.

The survey also found a desire to know more about the condition, with most respondents wishing they had more information at the time of diagnosis, particularly about Hepatitis C’s impact on their bodies and long-term complications of the virus. Prior to their diagnosis, one-third of respondents were not aware of Hepatitis C.
“Typing in those words, ‘Hep C,’ causes a lot of trauma,” said Karen Hoyt, a HepatitisC.net patient advocate. “But we also want to find out what’s going on in our own bodies. An online support network like HepatitisC.net helps us know we’re not alone and provides a sense of connection for us.”
The survey also showed many people living with Hepatitis C make lifestyle changes following their diagnosis. Some of these changes include staying hydrated, avoiding alcohol, maintaining a healthy diet, getting more sleep, and managing stress.

“There’s nothing like the fear of a serious health condition to motivate you,” Hoyt added, “and making lifestyle changes can fight feelings of powerlessness and lack of control.”

“The findings from ‘Hepatitis C In America’ reflect opportunity for the pharmaceutical industry and patients alike,” said Health Union Senior Vice President, Insights, Anna McClafferty. “Among respondents who aren’t cured, more than half have never been treated. For these patients, financial concerns, lack of health insurance, and worries about the treatments themselves are primary barriers to starting therapy. Given these findings, it’s not surprising to see so many people with Hepatitis C interested in clinical trials and aware of new treatments in development.”

More details about the survey may be available upon request; email Insights@health-union.com.
https://health-union.com/news/hepatitis-c-patients-delay-treatment-due-to-cost-concerns/

Tuesday, October 3, 2017

ACP Internist - Primary care takes on opioid addiction

ACP Internist

Primary care takes on opioid addiction
There's a lot that primary care clinicians can do to treat opioid addiction, but stigma about the condition, as well as laws and other regulations, throw up barriers.

People with opioid use disorder who receive opioid agonist treatment with methadone have less than one-third the mortality risk of those who do not receive it, according to a systematic review and meta-analysis published in 2017 by The BMJ. Opioid agonist treatment with buprenorphine also appears to be associated with a reduction in mortality, although this finding was based on fewer studies, the reviewers said. Patients who discontinued treatment with either drug had increased mortality risk.
                
But the legal stipulations around providing such treatment reflect the stigma surrounding the disease, said ACP Member Laura Fanucchi, MD, MPH, a primary care internist for patients with HIV and addiction and assistant professor at University of Kentucky College of Medicine in Lexington.

Other obstacles to treatment include physicians' attitudes and beliefs. “I hear comments like, ‘We don't want those patients in our office, in our waiting room,’ etc., but the reality is that addiction doesn't discriminate,” said internist and researcher Chinazo Cunningham, MD, MS, professor of medicine at Albert Einstein College of Medicine and associate chief of the division of general internal medicine at Montefiore Medical Center in New York City. “So I tell people that ‘those patients' are your neighbors, your colleagues, your family members, your friends.” 

Read the article: http://www.acpinternist.org/archives/2017/10/primary-care-takes-on-opioid-addiction.htm

Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment

Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment
By Michelle Andrews

The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.

In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about $55,000 to $95,000 to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.

Read More: https://khn.org/news/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment/

In The News
Increasing number of individuals spending $50,000+ annually on prescription drugs
A tiny but growing population of individuals with complicated illnesses and special treatment needs are accounting for an increasingly significant amount of the nation’s overall prescription drug costs, according to a report from ExpressScripts, “Super Spending: U.S. Trends in High-Cost Medication Use.”

Related:
The controversy over expensive new drugs for hepatitis C
Link to research and news articles addressing the high cost of hepatitis C drugs; insurance restrictions - private insurers/Medicaid - and availability of generic versions/India, Egypt and other lower-income countries or through online "buyers clubs"

Merck to Present New Data on ZEPATIER® (elbasvir and grazoprevir) at The Liver Meeting® 2017

Merck to Present New Data on ZEPATIER® (elbasvir and grazoprevir) for the Treatment of Chronic Hepatitis C Virus Infection at The Liver Meeting® 2017

Merck (NYSE:MRK), known as MSD outside of the United States and Canada, today announced that data from the company's chronic hepatitis C clinical development programs and real-world studies are scheduled to be presented at The Liver Meeting® 2017. These data presentations include new analyses of ZEPATIER® (elbasvir and grazoprevir) in real-world settings and follow-up analyses from Phase 3 clinical trials, including findings from the C-EDGE CO-STAR three-year observational follow-up study evaluating chronic hepatitis C virus (HCV) reinfection incidence and risk behaviors in patients who were treated with ZEPATIER while on opioid agonist therapy (OAT). The Liver Meeting® 2017 will take place in Washington, D.C., from Oct. 20-24, 2017.

"Merck has been a leader in chronic hepatitis C for more than 30 years. Now, with the availability of treatments such as ZEPATIER, we believe our focus needs to be on understanding its application in the real world," said Dr. Michael Robertson (News - Alert), executive director of clinical research, Merck Research Laboratories. "Analysis of data from patients treated with ZEPATIER around the world provides important insights that may help inform elimination efforts, particularly among difficult-to-treat populations."

In the United States, ZEPATIER is indicated for the treatment of chronic HCV genotype (GT) 1 or 4 infection in adults. ZEPATIER is indicated for use with ribavirin in certain patient populations. The U.S. Prescribing Information for ZEPATIER contains a Boxed Warning about the risk of hepatitis B virus (HBV) reactivation in patients coinfected with HCV and HBV.
Key presentations at The Liver Meeting® 2017 will include:
ZEPATIER® (elbasvir and grazoprevir) 50mg/100mg tablets

Saturday, October 21
  • Effectiveness of Elbasvir/Grazoprevir in Patients With Chronic Hepatitis C and Chronic Kidney Disease: Results From the Veterans Affairs System (Poster presentation, Abstract 1113, 2:00 p.m. - 7:30 p.m. EDT)
  • A Pragmatic Approach to Optimizing the Efficacy of Elbasvir/Grazoprevir Using Baseline Viral Load in Participants With Hepatitis C Virus (HCV) Genotype (GT)1a Infection: A Post Hoc Analysis of 11 Clinical Trials (Poster presentation, Abstract 1124, 2:00 p.m. - 7:30 p.m. EDT)
  • Impact of Treatment Duration and Ribavirin (RBV) Addition on Real-World Effectiveness of Elbasvir/Grazoprevir (EBR/GZR) in Select Patient Subgroups With Genotype 1 (GT1) Chronic Hepatitis C (HCV): Retrospective Data Analyses From the Trio Network. (Poster presentation, Abstract 1128, 2:00 p.m. - 7:30 p.m. EDT)
  • Real-World Cost-Effectiveness of Elbasvir/Grazoprevir (EBR/GZR) in Treatment-Naive (TN) Patients With Chronic Hepatitis C (CHC) Virus Genotype 1 (GT1) in the United States (US) (Poster presentation, Abstract 1155, 2:00 p.m. - 7:30 p.m. EDT)
Sunday, October 22
  • Safety and Efficacy of Elbasvir/Grazoprevir in Asian Participants With Hepatitis C Virus Genotypes 1 and 4 Infection: An Integrated Analysis of Data From 11 Phase 2/3 Trials (Poster presentation Abstract 1522, 8:00 a.m. - 5:30 p.m. EDT)
  • Co-Morbidities and Clinically Relevant Drug-Drug Interactions (News - Alert) (DDIs) in Patients Undergoing Treatment of Chronic HCV Genotype 1 (GT1) Infection With Elbasvir (EBR)/Grazoprevir (GZR): Results From the German Hepatitis C Registry (DHC-R) (Poster presentation, Abstract 1546, 8:00 a.m. - 5:30 p.m. EDT)
  • Utilization and Effectiveness of Elbasvir/Grazoprevir (EBR/GZR) in Treatment Naïve (TN) Genotype 1a (G1a) Chronic Hepatitis C Virus (HCV) Patients With/Without Baseline NS5A Resistance-Associated Substitutions (RASs) (Poster presentation, Abstract 1568, 8:00 a.m. - 5:30 p.m. EDT)
  • Safety and Efficacy of Elbasvir (EBR)/Grazoprevir (GZR) in Hepatitis C Virus (HCV) GT1- and GT4-infected Participants 65 Years and Older: An Integrated Analysis of Twelve Clinical Trials (Poster presentation, Abstract 1589, 8:00 a.m. - 5:30 p.m. EDT)
Monday, October 23
  • Hepatitis C Virus (HCV) Reinfection and Injecting Risk Behavior Following Elbasvir (EBR)/Grazoprevir (GZR) Treatment in Participants on Opiate Agonist Therapy: Co-STAR (News - Alert) Part B (Oral presentation, Abstract 195, 3:30 p.m. - 3:45 p.m. EDT)
ADDITIONAL STUDIES OF NOTE Saturday, October 21
  • Epidemiologic Impact of Expanding Chronic Hepatitis C (CHC) Treatment in People who Inject Drug (PWID) in the United States (US): A Mathematical Model Using Data From the C-EDGE CO-STAR Study (Poster presentation, Abstract 976, 2:00 p.m. - 7:30 p.m. EDT)
  • Economic Burden of Chronic Hepatitis C (CHC) in Medicaid and Commercially Insured Patients in the United States (Poster presentation, Abstract 1008, 2:00 p.m. - 7:30 p.m. EDT)
  • Perceived Barriers Related to the Management of HCV Infection Among Physicians Prescribing Opioid Agonist Therapy: The C-SCOPE Study (Poster presentation, Abstract 1064, 2:00 p.m. - 7:30 p.m. EDT)
For more information, including a complete list of abstract titles at the meeting, please visit: http:/www.aasld.org/events-professional-development/liver-meeting.


BMJ Case Reports - Man developed serious liver damage after taking epsom salts to treat gallstones


Man develops severe liver damage after taking epsom salts
October 02, 2017
A 38-year-old man developed serious liver damage after taking epsom salts to treat gallstones, reveal doctors in the journal BMJ Case Reports.

The man had lost his appetite and was jaundiced. He was tested for a range of common liver diseases, all of which were negative. But a biopsy specimen showed that he had signs of liver damage.

It emerged that he had been taking three tablespoons of Epsom salts in lukewarm water for 15 days. He had been advised by a naturopath that this would dissolve his gallstones.

Taking too much Epsom salts can cause diarrhoea, abnormal heart rhythm, and kidney damage.

In this case, the man took a large quantity of salts over two weeks, which prompted rapid worsening of fibrosis (tissue scarring).

And the doctors caution that certain conditions might heighten the risk of liver damage when combined with Epsom salts.

The man was advised to stop taking the salts, to drink plenty of fluids, and was given medication to prevent further liver damage. And after around six weeks, his liver function had returned to normal.

View Article Online 
BMJ Case Reports 

Monday, October 2, 2017

The Abstract supplement for The Liver Meeting® 2017 is now available

The 68th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2017
Friday, October 20, 2017 - Tuesday, October 24, 2017

AASLD Website

The Liver Meeting

HEPATOLOGY
Special Issue: The 68th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2017

Abstract supplement for The Liver Meeting® 2017 
Oral Abstracts and Posters

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@AASLDtweets 

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The Liver Meeting® 2017

Patient-Friendly Links
HCV Sites With Key Data, Expert Review & Summary

Hepatitis C - Interferon-free therapy in elderly patients with advanced liver disease

Interferon-free therapy in elderly patients with advanced liver disease
The most recent issue of the American Journal of Gastroenterology assessed the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.

Interferon-free therapies have an improved safety and efficacy profile. However, data in elderly patients, who have frequently advanced liver disease, associated comorbidities, and use concomitant medications are scarce.

Dr Sabela Lens and colleagues assessed the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.

The team performed a retrospective analysis of hepatitis C virus (HCV) patients aged ≥65 years receiving interferon-free regimens within the Spanish National Registry (Hepa-C).

The researchers recorded data of 1,252 patients.

Of these, 76% were aged 65–74 years, 17% were aged 75–79 years, and 7% were aged ≥80 years at the start of antiviral therapy.

The team found that 86% had HCV genotype-1b, and 48% were previous non-responders. The rate of severe adverse events increased with age category
American Journal of Gastroenterology

A significant proportion of patients had cirrhosis, of whom 11% presented decompensated liver disease.

The researchers found that most used regimens were SOF/LDV, 3D, and SOF/SMV.

The team noted that ribavirin was added in 49% of patients.

Overall, the sustained virological response rate was 94% without differences among the 3 age categories.

Albumin 3.5 g/dl or less was the only independent negative predictor of response.

Regarding tolerability, the rate of severe adverse events increased with age category.

In addition, the team noted that the main predictors of mortality were age 75 years or more, and albumin 3.5 or less.

Dr Lens' team conclude, "Sustained virological resposne rates with interferon-free regimens in elderly patients are high and comparable to the general population."

"Baseline low albumin levels was the only predictor of treatment failure."

"Importantly, the rate of severe adverse events and death increased with age."

"Elderly patients or those with advanced liver disease presented higher mortality."

"Thus a careful selection of patients for antiviral treatment is recommended."

Source - https://www.gastrohep.com/news/news.asp?id=112812
Am J Gastroenterol 2017; 112:1400–1409
02 October 2017

Sunday, October 1, 2017

Weekend Reading - Sofosbuvir-Velpatasvir-Voxilaprevir for Chronic Hepatitis C – A Review

Weekend Reading
Greetings, hope you're enjoying this lovely Sunday, thanks for stopping by.

Vosevi (Sofosbuvir/Velpatasvir/Voxilaprevir)
We begin with a recent review article about Gilead's Vosevi, titled; “Sofosbuvir-Velpatasvir-Voxilaprevir for Chronic Hepatitis C – A Review” published September 22, 2017, in Gastroenterology & Hepatology.

HCV Genotype 3
Over at NEJM Journal Watch, a small study for HCV genotype 3 patients is reviewed by Atif Zaman, MD, MPH, published last week in Hepatology. The study; Glecaprevir/pibrentasvir for HCV genotype 3 patients with cirrhosis and/or prior treatment experience: A partially randomized phase III clinical trial, is available for download over at NATAP

New Online
Make sure to check out HCV Advocate's October Newsletter, published today!

Shared on Twitter, by @HenryEChang, is one must read article: Chronic hepatitis C virus infection: Everyone should be treated, published in the multimedia journal Clinical Liver Disease. Here are a few other updates over at CLD as well.

Reviews - Controversies in HCV Management
Chronic hepatitis C virus infection: Everyone should be treated
Authors Steven Flamm
First Published: 29 September 2017
Abstract
Full Text (HTML)
PDF (91.3KB)
PDF (91.3KB)
References
Watch a video presentation of this article
Watch the interview with the author

Reviews - Controversies in HCV Management
Authors Philippe J. Zamor, Mark W. Russo
First Published: 29 September 2017

Reviews - From Operation to the First 30 Days
Innovative care models after liver transplant
Authors C. Burcin Taner, Andrew P. Keaveny
First Published: 29 September 2017
Abstract
Full Text (HTML)
PDF (217.7KB)
PDF (217.7KB)
References
Watch a video presentation of this article
Watch the interview with the author

Begin here...

Enjoy the rest of your weekend!
Tina