Saturday, May 27, 2017

New drug reduces transplant and mortality rates significantly in patients with hepatitis C

New drug reduces transplant and mortality rates significantly in patients with hepatitis C
Public Release: 
Intermountain Medical Center

Patients with hepatitis C who suffer from advanced stages of liver disease have renewed hope, thanks to findings by researchers who have discovered that a new drug significantly reduces their risk of death and need for transplantation.

The research team, led by clinical researchers at Intermountain Healthcare's Intermountain Medical Center in Salt Lake City, studied nearly 1,900 hep C patients and found that the number of patients needing transplants was reduced by 40 percent after they were given a regimen of the drug, sofosbuvir.

Results of the study will be presented at the 2017 International Joint Congress of ILTS, ELITA & LICAGE in Prague, Czech Republic, on Friday, May 26, 2017.

About 3.3 million people in the United States have chronic hepatitis C infection, which causes inflammation of the liver and eventually leads to serious liver problems like cirrhosis, which is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.

Researchers studied longitudinal data to learn the impact sofosbuvir had in treating patients with advanced stages of cirrhosis. They compared the outcomes of 1,857 patients prior to the United States Food and Drug Administration's approval of sofosbuvir in Dec. 2013 with 623 similar patients who were treated with sofosbuvir after approval of the drug.

"Prior to FDA approval of sofosbuvir, patients with the most advanced stages of cirrhosis either died from their disease or ended up receiving a transplant," said Michael Charlton, MD, lead researcher from Intermountain Healthcare's Intermountain Medical Center Transplant Program, and current president of the International Liver Transplantation Society. "We found that by treating those patients, who were on the verge of needing a transplant, with sofosbuvir-based therapies, we greatly reduced the liver transplant and mortality rates." Only three percent of patients on sofosbuvir ended up needing a transplant, compared to ovder 40% of untreated patients.

Data used in the study included an integrated database of four separate, prospective, multicenter, multinational randomized controlled clinical trials of sofosbuvir-based therapies in patients with advanced stages of cirrhosis, and compared them with patients who were on the United Network for Organ Sharing (UNOS) waitlist for a liver transplant between 2008-2013.

"We found the sicker a patient was, the more benefit they experienced by using sofosbuvir," said Dr. Charlton. "However, many people around the world who might benefit most from this therapy don't have access to it because the regulatory authorities haven't felt it safe for use in patients with advanced stages of liver disease due to hepatitis C. Our research shows the benefits of this drug include significantly improving the health of even the sickest patients, allowing them to return to their normal life sooner."

Study authors conclude the study by recommending that treatment of the hepatitis C virus using sofosbuvir should be considered in all patients with cirrhosis, even those in advanced stages of the liver disease.

Members of the Intermountain Medical Center Liver Transplantation Program involved in the study include Li Dong; Michael Leise; Richard Gilroy, MD; Jake Krong; Anu Osinusi; Michael P. Curry; Michael Manns; Nezam Afdhal; Diana M. Brainard; and Michael Charlton, MD.

Image Credit Intermountain Medical Center.

Friday, May 26, 2017

Do HCV DAAs Increase HCC Recurrence Risk or Not?

Published in Clinical Thought

Do HCV DAAs Increase HCC Recurrence Risk or Not?
Paul Y. Kwo, MD - 5/25/2017
More from this author
Does the administration of direct-acting antiviral (DAA) therapy increase a patient’s risk of hepatocellular carcinoma (HCC) recurrence?

Recent data presented at EASL 2017 from Reig and colleagues extended their previous findings of an unexpectedly high rate of HCC recurrence following previous complete response to resection, ablation, or transarterial chemoembolization in the DAA era. Of 77 patients who initiated DAA therapy after presumed control of HCC, confirmed by radiologic assessment, 24 (31.2%) developed recurrence of HCC. Most individuals were Child-Pugh A (86%) and BCLC 0/A stage (97%).
Continue reading....

MedPage Today
Published in AGA Reading Room      

New Hep C Treatment Not Linked to Liver Cancer
by Liz Highleyman
Contributing Writer, MedPage Today
5/25/2017
Contrary to some earlier research, most recent studies see no association between response to DAAs and HCC.

Most Researchers Find No Link
The Barcelona group stood alone among several other research groups presenting at the EASL meeting that did not see an increased risk of HCC after taking into account other factors including liver disease severity:
  • Etienne Audureau from Henri Mondor University Hospital in Paris reported that lack of SVR -- not the type of treatment -- was the strongest predictor of liver cancer in cirrhotic patients; older age, alcohol use, and impaired liver function also predicted HCC
  • Hamish Innes from Glasgow Caledonian University said that HCC risk following SVR was associated with baseline patient risk factors, but not DAA use; in a multivariate analysis, HCC risk was similar for patients treated with either DAAs or interferon
  • Dong Ji from the Hong Kong Humanity and Health Medical Center in Beijing reported no increase in HCC incidence among patients cured with DAAs compared with interferon
  • Masaaki Korenaga from Kohnodai Hospital in Japan said that SVR after treatment with sofosbuvir/ledipasvir (Harvoni) led to a reduction in HCC incidence, similar to the drop seen in patients cured with interferon
  • Vincenza Calvaruso from the University of Palermo in Sicily reported no increase in the development of new HCC among patients who achieved SVR with DAAs, compared with those cured with interferon
Continue reading.......

Recommended 
Liver Cancer After Treatment For Hepatitis C
A collection of research articles investigating the possible risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after direct-acting antiviral therapy in patients with hepatitis C. 

Healio - Two DAA regimens produce high SVR12 rates in HCV genotype 4

Top Story
Two DAA regimens produce high SVR12 rates in HCV genotype 4
May 26, 2017
Treatment with Technivie plus ribavirin or Harvoni plus ribavirin were effective in patients with hepatitis C genotype 4, according to a recently published study.

“Worldwide, an estimated 15 million people are infected with hepatitis C virus (HCV) genotype 4 (GT 4). Because there is only moderate response to interferon-based therapy in these patients, this infection has been considered more difficult to treat,” the researchers wrote. “Although scarcer than for GT 1 patients, data from clinical trials on the efficacy of direct-acting antiviral agents (DAAs) in GT 4 patients suggest that interferon-free regimens with DAAs have the potential to achieve high rates of sustained virologic response (SVR) in GT 4 patients.”

Reference
Real-World Effectiveness and Safety of Oral Combination Antiviral Therapy for Hepatitis C Virus Genotype 4 Infection

Current therapy for chronic hepatitis C: The role of direct-acting antivirals.


Antiviral Res. 2017 Jun;142:83-122. doi: 10.1016/j.antiviral.2017.02.014. Epub 2017 Feb 24.

Current therapy for chronic hepatitis C: The role of direct-acting antivirals.
Li G1, De Clercq E2.

Read Full Text Article

Abstract
One of the most exciting developments in antiviral research has been the discovery of the direct-acting antivirals (DAAs) that effectively cure chronic hepatitis C virus (HCV) infections. Based on more than 100 clinical trials and real-world studies, we provide a comprehensive overview of FDA-approved therapies and newly discovered anti-HCV agents with a special focus on drug efficacy, mechanisms of action, and safety. We show that HCV drug development has advanced in multiple aspects: (i) interferon-based regimens were replaced by interferon-free regimens; (ii) genotype-specific drugs evolved to drugs for all HCV genotypes; (iii) therapies based upon multiple pills per day were simplified to a single pill per day; (iv) drug potency increased from moderate (∼60%) to high (>90%) levels of sustained virologic responses; (v) treatment durations were shortened from 48 to 12 or 8 weeks; and (vi) therapies could be administered orally regardless of prior treatment history and cirrhotic status. However, despite these remarkable achievements made in HCV drug discovery, challenges remain in the management of difficult-to-treat patients.

Highlights
• HCV genotype-specific drugs evolve to pan-genotypic drugs.
• Drug potency increases from moderate (∼60%) to high (>90%) levels of sustained virologic response.
• Treatment durations are shortened from a 48-week to 12-week or 8-week period.
• HCV therapies based upon multiple pills per day are simplified to a single pill per day.
• HCV therapies are administered orally regardless of prior treatment history and cirrhotic status.
Links

Article link provided by Henry E. Chang.
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C.

Of Interest
Hepatitis C Treatment: What to Expect in 2017
Sift through an index of current articles covering FDA approved and investigational regimens to treat the hepatitis C virus.  

Sofosbuvir-Daclatasvir-Simeprevir Plus Ribavirin in Direct-Acting Antiviral–Experienced Patients With Hepatitis C

Clin Infect Dis (2017) 64 (11): 1615-1618.
DOI:

Sofosbuvir-Daclatasvir-Simeprevir Plus Ribavirin in Direct-Acting Antiviral–Experienced Patients With Hepatitis C
Christophe Hézode Slim Fourati Stéphane Chevaliez Giovanna Scoazec Alexandre Soulier Anne Varaut Murielle François Isaac Ruiz Françoise Roudot-Thoraval Ariane Mallat Jean-Michel Pawlotsky

Abstract

We assessed the broadly used, off-label combination of sofosbuvir, daclatasvir, simeprevir, and ribavirin in direct-acting antiviral–experienced patients, as recommended in current guidelines despite scarce data. After 24 weeks’ treatment, sustained virological response 12 weeks after the end of treatment was achieved in 6 patients (60%). Two cirrhotic patients relapsed and 2 discontinued treatment due to serious adverse events.

View Article
PDF Download

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

Healio Highlights from DDW - New data on liver disease diagnosis and treatment

Digestive Disease Week
May 6, 2017 - May 9, 2017

Healio brings you the highlights from Digestive Disease Week. Refer back to this page often for the latest news from DDW, perspectives and interviews with leading researchers and clinicians, and to review archives of past meetings.

Hepatology highlights from DDW include microbiome, LT, HBV
May 26, 2017
Among the presentations at this year’s Digestive Disease Week, physician experts and clinical professionals discussed new data on liver disease diagnosis and treatment, including topics such as gut microbiota, liver transplantation, fatty liver disease and viral hepatitis, as well as advances in the world of telemedicine and unique approaches in patient management.


New Hep C Treatment Not Linked to Liver Cancer

Summary Of  Available Data:

New Hep C Treatment Not Linked to Liver Cancer
by Liz Highleyman
Contributing Writer, MedPage Today

Contrary to some earlier research, most recent studies see no association between response to DAAs and HCC

Most Researchers Find No Link
The Barcelona group stood alone among several other research groups presenting at the EASL meeting that did not see an increased risk of HCC after taking into account other factors including liver disease severity:
  • Etienne Audureau from Henri Mondor University Hospital in Paris reported that lack of SVR -- not the type of treatment -- was the strongest predictor of liver cancer in cirrhotic patients; older age, alcohol use, and impaired liver function also predicted HCC
  • Hamish Innes from Glasgow Caledonian University said that HCC risk following SVR was associated with baseline patient risk factors, but not DAA use; in a multivariate analysis, HCC risk was similar for patients treated with either DAAs or interferon
  • Dong Ji from the Hong Kong Humanity and Health Medical Center in Beijing reported no increase in HCC incidence among patients cured with DAAs compared with interferon
  • Masaaki Korenaga from Kohnodai Hospital in Japan said that SVR after treatment with sofosbuvir/ledipasvir (Harvoni) led to a reduction in HCC incidence, similar to the drop seen in patients cured with interferon
  • Vincenza Calvaruso from the University of Palermo in Sicily reported no increase in the development of new HCC among patients who achieved SVR with DAAs, compared with those cured with interferon

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


Push for generic drugs in India

Push for generic drugs in India
Even as India’s National Pharmaceutical Pricing Authority (NPPA) has fixed the prices of 31 more drug formulations, in yet another crackdown on prices, India's premier policy formulating agency Niti Aayog has proposed a change in the manner the government should identify drugs to be brought under price control....

While the Indian government is strongly backing generic drugs, a report from an international research team has found that the use of the generic versions of direct-acting antiviral (DAA) drugs that are available in India to treat hepatitis C virus (HCV) infection are not only cost effective, but actually save lifetime costs for treating infected patients in India....

The report states that the upfront costs of DAA are offset by the avoidance of costs incurred to treat late-stage disease....
Continue reading....

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HCV generics