Tuesday, November 13, 2018

8-week Maviret HCV genotype 1-6 & compensated cirrhosis:The EXPEDITION-8 Study

Meeting Coverage @ infohep Keith Alcorn / 14 November 2018
An 8-week course of the combination of glecaprevir and pibrentasvir (Maviret) is highly effective in curing hepatitis C in people with compensated cirrhosis, across a wide range of genotypes, Robert S. Brown of Weill Cornell Medical College reported at the AASLD Liver Meeting in San Francisco this week. Maviret is a highly effective combination of an HCV protease inhibitor (glecaprevir) and an NS5A inhibitor (pibrentasvir) that has been shown to cure hepatitis C in 98% of people without cirrhosis after eight weeks of treatment. A previous study showed that a 12-week course of the combination cured hepatitis C in 99% of people with compensated cirrhosis. The EXPEDITION-8 study was designed to test whether an 8-week treatment course was as effective in previously untreated people with compensated cirrhosis as the rate of cure achieved in the previous 12-week study.
High SVR12 rate suggests 8-week treatment could be used for this population
Read more: https://www.medpagetoday.com/meetingcoverage/aasld/76333
Coverage @ MedPage Today Twitter @medpagetoday

Recommended Coverage
View updates on this blog (LINK), recommended coverage (LINK).

Presented at the AASLD: The Liver Meeting®
Preliminary efficacy & safety of 8-week GLE/PIB in patients with #HCV genotype 1-6 infection & compensated cirrhosis: The EXPEDITION-8 Study 

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Shared via @HenryEChang on twitter.





All adults should be screened for unhealthy alcohol use, new guidelines say

All adults should be screened for unhealthy alcohol use, new guidelines say
CNN
All adults should be screened for unhealthy alcohol use, new guidelines say. The negative consequences of too much alcohol include illness, injury, and death -- unhealthy alcohol use ranks as the third leading preventable cause of death in the US according to the task force. When pregnant women drink, birth defects and developmental problems in their children may follow.

By Susan Scutti, CNN
Updated 2:06 PM ET, Tue November 13, 2018
You can expect a "drinking checkup" when you visit the doctor. All adults, including pregnant women, should be screened for unhealthy alcohol use by their primary care physicians, the United States Preventive Services Task Force advises. For those patients who drink above the recommended limits, doctors should provide brief counseling to help them reduce their drinking, according to the new task force statement published Tuesday in the medical journal JAMA.

US Preventive Services Task Force Recommendation Statement 
November 13, 2018 
Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults
JAMA. 2018;320(18):1899-1909. doi:10.1001/jama.2018.16789
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for alcohol use in primary care settings in adolescents aged 12 to 17 years. (I statement)

AbbVie's MAVYRET™ (glecaprevir/pibrentasvir) Shows High Virologic Cure* Rates in Treatment-Naïve Hepatitis C Patients with Compensated Cirrhosis

The Liver Meeting® 2018
Meeting Updates 
View all updates on this blog, (LINK), coverage elsewhere, (LINK).
Related Links:
High SVR12 rate for 16 week glecaprevir/pibrentasvir regimen in HCV GT1

Today's Press Release
AbbVie's MAVYRET™ (glecaprevir/pibrentasvir) Shows High Virologic Cure* Rates in Treatment-Naïve Hepatitis C Patients with Compensated Cirrhosis

- EXPEDITION-8 is the first Phase 3b study evaluating 8 weeks of MAVYRET™ in treatment-naïve chronic hepatitis C virus (HCV)-infected patients with compensated cirrhosis across all major genotypes (GT1-6)[1] 

- In cohort one, 100 percent of genotype 1, 2, 4, 5 and 6 treatment-naïve chronic HCV patients with compensated cirrhosis achieved SVR[12] with 8 weeks of MAVYRET per protocol analysis[1]
- Cohort two of the study is ongoing, evaluating treatment-naïve genotype 3 (GT3) patients with compensated cirrhosis 

- MAVYRET is currently approved as an 8-week, pan-genotypic treatment for treatment-naïve patients without cirrhosis

NORTH CHICAGO, Ill., Nov. 13, 2018 /PRNewswire/ -- AbbVie (NYSE: ABBV), a research-based global biopharmaceutical company, today announced new data for its pan-genotypic chronic hepatitis C virus (HCV) treatment, MAVYRET™ (glecaprevir/pibrentasvir), in treatment-naïve patients with compensated cirrhosis. Results from the Phase 3b EXPEDITION-8 study showed that with 8 weeks of MAVYRET, 100 percent (n=273/273) of genotype 1, 2, 4, 5 and 6 patients achieved a sustained virologic response 12 weeks after treatment (SVR12) per protocol analysis.1

These data are being presented today as a late-breaking, oral presentation at The Liver Meeting® 2018 organized by the American Association for the Study of Liver Diseases (AASLD) in San Francisco, California.

"Current guidelines recommend a 12-week pan-genotypic regimen for people who have hepatitis C, are treatment-naïve and have compensated cirrhosis," said Robert S. Brown, Jr., M.D., the Gladys and Roland Harriman professor of medicine, Weill Cornell Medical College. "We are interested in investigating shorter treatment options, which may simplify care for patients with compensated cirrhosis while providing high cure rates."

This analysis is part of the ongoing Phase 3b EXPEDITION-8 study evaluating the safety and efficacy of MAVYRET in treatment-naïve chronic HCV patients with compensated cirrhosis across all major genotypes (GT1-6).1 The study includes two cohorts; cohort one with genotype 1, 2, 4, 5, 6 chronic HCV-infected patients, and cohort two with genotype 3 (GT3) chronic HCV-infected patients.1

"MAVYRET is already having a significant impact on people living with HCV. However, there are still groups of patients who may benefit from a shorter treatment option," said Janet Hammond, M.D., Ph.D., vice president, infectious diseases development, AbbVie. "We continue to investigate and understand the value of an 8-week treatment regimen for patients, something we recognize as an important step towards HCV elimination."

To date, no virologic failures have been reported in cohort one of the study and no patients have discontinued treatment due to adverse events.1 Adverse events (>5%) reported of the study populations include pruritus (9.6%), fatigue (8.6%), headache (8.2%) and nausea (6.4%).1 Six serious adverse events (2%) have occurred during the study, none of which were deemed to be related to glecaprevir/pibrentasvir.1 No new safety signals were identified in this study.

Data from the ongoing EXPEDITION-8 Phase 3b study will be presented as a late-breaking, oral presentation during the Late-breaking Abstract Oral Session II on November 13 at 8:30 a.m. PST.

MAVYRET is approved in the U.S. as a 12-week pan-genotypic treatment for treatment-naïve patients with compensated cirrhosis.2

*Patients who achieve a sustained virologic response at 12 weeks post treatment (SVR12) are considered cured of hepatitis C.

About the EXPEDITION-8 Study1
EXPEDITION-8 is an ongoing non-randomized, single arm, open-label, multicenter Phase 3b study evaluating the safety and efficacy of glecaprevir/pibrentasvir in treatment-naïve GT1-6 chronic HCV patients with compensated cirrhosis. The study investigated two cohorts of patients:
Cohort one: treatment-naïve genotype 1, 2, 4, 5, 6 patients with compensated cirrhosis (n=280)
Cohort two: treatment-naïve GT3 patients with compensated cirrhosis (n=60)

The primary endpoint is the percentage of patients achieving SVR12 in a per-protocol analysis and the secondary endpoints are on-treatment virologic failure and relapse rates. For cohort one, 280 patients were enrolled and seven patients were excluded from the SVR12 per-protocol analysis (n=273); five patients were lost to follow up, and two patients received less than 8 weeks of treatment (one of these two patients achieved SVR12).

Additional information on the clinical trials for MAVYRET is available at www.clinicaltrials.gov/.

About MAVYRET™ (glecaprevir/pibrentasvir)
MAVYRET™ is approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic hepatitis C virus (HCV) infection in adults across all major genotypes (GT1-6). MAVYRET is a pan-genotypic, once-daily, ribavirin-free treatment that combines glecaprevir (100mg), an NS3/4A protease inhibitor, and pibrentasvir (40mg), an NS5A inhibitor, dosed once-daily as three oral tablets, taken with food.

MAVYRET is an 8-week, pan-genotypic option for patients without cirrhosis and who are new to treatment, who comprise the majority of people living with HCV. MAVYRET is also approved as a treatment for patients with specific treatment challenges, including those (GT1) not cured by prior treatment experience to either a protease inhibitor or NS5A inhibitor (but not both), and in patients with limited treatment options, such as those with severe chronic kidney disease (CKD) or those with genotype 3 chronic HCV. MAVYRET is a pan-genotypic treatment approved for use in patients across all stages of CKD.

Glecaprevir (GLE) was discovered during the ongoing collaboration between AbbVie and Enanta Pharmaceuticals (NASDAQ: ENTA) for HCV protease inhibitors and regimens that include protease inhibitors.

Full prescribing information can be found here.

Do Patients with Chronic Liver Disease Face Higher Drug-induced Liver Injury Risk?

Meeting Coverage > AASLD

Do Patients with Chronic Liver Disease Face Higher DILI Risk? 
by Molly Walker, Staff Writer, MedPage Today
November 12, 2018
Research suggests a link of which drug developers should be aware, expert says

SAN FRANCISCO -- Individuals with certain types of chronic liver disease may be particularly susceptible to drug-induced liver injury (DILI), and the pharmaceutical industry should take this population into account during drug development, an expert said here.

Indeed, some research suggested that drug-induced liver injury is linked with a higher risk of poor outcomes in patients with pre-existing liver disease, said Naga Chalasani, MD, of Indiana University School of Medicine in Indianapolis.
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DAA Treatment and Hepatic Fibrosis Improvement in HCV: What's the Link?

Abstract
Presented at AASLD The Liver Meeting 2018. Study number 0603.
Kommineni VT et al.

Factors Associated with Lack of Improvement in Fibrosis Following HCV Treatment.

Monthly Prescribing Reference
DAA Treatment and Hepatic Fibrosis Improvement in HCV: What's the Link?
According to the results of a prospective cohort study, 57% of patients with hepatitis C virus (HCV) infection who achieved sustained virologic response (SVR) showed no improvement in hepatic fibrosis. The study, which took place at a tertiary liver center, aimed to determine whether direct-acting antiviral (DAA) therapy reduced fibrosis and assessed whether any predictors of treatment failure existed at 1-year follow-up. A total of 193 patients were divided into 2 groups: those who achieved SVR (N=143) and those who failed treatment or did not receive it (N=50). 

Conference Articles
By Cassandra Pardini, PharmD November 13, 2018 

Hepatitis C is detectable in rectal and nasal fluid

Conference Coverage @ infohep
Hepatitis C is detectable in rectal and nasal fluid

Keith Alcorn Published: 12 November 2018

High levels of hepatitis C virus (HCV) can be found in the rectal and nasal fluids of people with high hepatitis C viral loads even when blood is not present, Austrian researchers reported on Sunday at the 2018 AASLD Liver Meeting.

The findings reinforce the plausibility of HCV transmission through sharing up rolled-up bank notes or other equipment for snorting drugs.

The findings were presented by Dr David Chromy of the Medical University of Vienna on behalf of the Vienna HIV & Liver Study Group.


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The incidence of diabetes, stroke and kidney disease falls after hepatitis C cure

AASLD Liver Meeting news @ infohep
The incidence of diabetes, stroke and kidney disease falls after hepatitis C cure
Keith Alcorn Published: 12 November 2018 

The incidence of some of the most serious extrahepatic health problems caused by hepatitis C declines sharply after the infection is cured by antiviral treatment, a review of people treated for hepatitis C in the Canadian province of British Columbia has found.

The findings were presented by Carmine Rossi of the British Columbia Centre for Disease Control at the 2018 AASLD Liver Meeting in San Francisco on Sunday.

Hepatitis C infection is associated with a higher incidence of chronic kidney disease, diabetes and cardiovascular disease. Although the mechanisms leading to an increased risk of these conditions in people with hepatitis C are not fully understood, liver damage caused by hepatitis C is known to disrupt glucose metabolism. Chronic hepatitis C infection affects the cardiovascular system in numerous ways and also damages the kidneys.


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Sofosbuvir/ledipasvir cures most young children with hepatitis C

Sofosbuvir/ledipasvir cures most young children with hepatitis C
Liz Highleyman 
Published: 13 November 2018
Almost all young children ages 3 to 6 years with chronic hepatitis C achieved sustained virological response after 12 weeks of treatment using sofosbuvir/ledipasvir oral granules, according to findings presented at the 2018 AASLD Liver Meeting in San Francisco.

The prevalence of hepatitis C virus (HCV) infection is low among children in Europe and the US, though there is concern that the rate may be rising in the US as more young women become infected as a consequence of the burgeoning opioid epidemic. In some resource-limited countries such as Egypt, HCV among children is much more common.

The advent of direct-acting antiviral agents (DAAs) has revolutionised the treatment of hepatitis C for adults. These include Gilead Science's HCV polymerase inhibitor sofosbuvir (marketed alone as Sovaldi) and NS5A inhibitor ledipasvir, which are co-formulated in a 400/90mg once-daily tablet (Harvoni). 

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On Twitter 
Full-text article downloaded & shared via twitter by Henry E. Chang:
Safety & efficacy of LDV-SOF with or without RBV for chronic hepatitis C in children ages 6-11.