Monday, March 27, 2017

Hepatitis C - Medicare Part D: High costs put some drugs out of reach

Medicare Part D: High costs put some drugs out of reach
March 27, 2017 12:45 PM
By Katie Wedell / Dayton Daily News
DAYTON, Ohio — High-priced prescription drugs are driving up the cost of Medicare Part D catastrophic coverage, which is bad news for both patients and taxpayers, according to a new report from the Department of Health and Human Services Office of Inspector General.

Patients on specialty drugs for cancer, hepatitis C, multiple sclerosis and other diseases are seeing higher out-of-pocket costs because of inflated list prices that accelerate their move into a coverage gap known as the “doughnut hole,” the report says.

The government’s spending is only going to grow, as 3 out of 4 hepatitis C patients are baby boomers who are aging into eligibility for Medicare Part D.

Drugs like Harvoni are extremely effective, he said, but are beyond reach for many of those afflicted with hepatitis C....
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MSF joins Europe-wide action challenging patent on key hepatitis C drug

MSF joins Europe-wide action challenging patent on key hepatitis C drug

Patent opposition aims to increase affordable access to hepatitis C drug sofosbuvir for millions

State Health Registry issues ‘Cancer in Iowa: 2017’ report, highlights increase in liver cancer cases

Increase In Liver Cancer Cases

An excerpt from the report released by the Iowa State Health Registry is provided below, full press release available here

The report, based on data from the Iowa Cancer Registry and the Iowa Department of Public Health, is available online in the “Publications” section on the registry’s website or by calling the registry at 319-335-8609. The report includes county-by-county statistics, summaries of new research projects, and a special section focused on liver cancer.

Liver cancer is the 13th leading cause of cancer deaths in Iowa. However, unlike most other common cancers, both new cases of and deaths from liver cancer are on the rise in Iowa and throughout the U.S.

The rate of new liver cancer cases in Iowa has roughly tripled over the past 35 years, from two cases per 100,000 people in 1975 to 1979 to six cases per 100,000 in 2010 to 2014.

Michael Voigt, clinical professor of internal medicine and a specialist in gastroenterology and hepatology at University of Iowa Hospitals and Clinics, says that chronic infections of hepatitis B or hepatitis C are the major risk factors for liver cancer, and these infections are correlated with the increase in the number of cases.

“Liver cancer is predominantly due to hepatitis B or hepatitis C infection, and chronic viral hepatitis ultimately causes more deaths than breast cancer, heart failure, or prostate cancer,” Voigt says. “Deaths from hepatitis C are at an all-time high, and the number of cases in people under 30 years of age is increasing dramatically in Iowa.”

However, Voigt notes that because there is a vaccination for hepatitis B and effective treatment of both hepatitis B and C, liver cancer is highly preventable. “The Centers for Disease Control and Prevention (CDC) recommends that everyone born between 1945 and 1965 be tested for hepatitis C,” he says. “It is a silent killer, and the majority of people with hepatitis C are unaware of it.”

Though most cases of liver cancer prove to be fatal, national data show that in recent years deaths have been increasing slower than new cases. Iowa data shows a similar trend but has lower rates overall, possibly due to earlier detection and improvements in treatment of chronic hepatitis.

George Weiner, director of Holden Comprehensive Cancer Center at the University of Iowa, says that researchers consider the disease from all angles in order to reduce the number of cancer deaths.

“Cancer prevention, early detection, and therapy are all important as we seek to reduce the burden of cancer, including liver cancer,” Weiner says. “We are continuing to make progress through research in all of these areas.”

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The 2017 Hepatitis C Community Summit – a key step on the road to elimination

The 2017 Hepatitis C Community Summit – a key step on the road to elimination
In the lead-up to the annual International Liver Congress (ILC) in Amsterdam, Eberhard Schatz of the Correlation Network writes about the Hepatitis C Community Summit that will be held in Amsterdam on the 18-19th of April to focus on community related initiatives and their key role in the hepatitis C elimination movement. Read more about the Summit and register here.
Next month, April, brings the annual meeting of the European Association for the Study of the Liver (EASL), the International Liver Congress (ILC) 2017 in Amsterdam. The ILC serves as one of the most important international meetings on liver research in the calendar year. This year, also in Amsterdam just prior to the opening day of the ILC, the Correlation Network Hepatitis C Initiative has organized the two-day Hepatitis C Community Summit on the 18th and 19th of April.
It is now critically important to reach out to risk groups, such as networks of people who inject drugs, to involve and inform them about treatment options, to provide barrier-free access, and to meet people where they are.
To face the challenges ahead and to effectively provide access to all patients in need, we think the medical world, hepatologists, and consequently the International Liver Congress, must take into account crucial aspects of public health and community involvement to reach global hepatitis elimination goals.

Due to the fact that treatment with new direct-acting antivirals is quick and effective, it is now critically important to reach out to risk groups, such as networks of people who inject drugs, to involve and inform them about treatment options, to provide barrier-free access, and to meet people where they are: in community centres, harm reduction and low-threshold service settings, opioid substitution treatment centres, etc.

The Hepatitis C Community Summit fills a gap in the world of hepatitis C virus (HCV) research, bringing together diverse partners from Europe to provide a platform for community inclusion with all those involved in HCV treatment, most notably civil society. The Summit will bring attention to bear on hepatitis C from the perspectives of medical experts and researchers, as well as patients and representatives of harm reduction and community services in order.
The Summit aims to provide an overview on existing (community related) initiatives, to address challenges and barriers ahead, and provide a platform for exchange across professional borders.
The Summit aims to provide an overview on existing (community related) initiatives, to address challenges and barriers ahead, and provide a platform for exchange across professional borders. In this regard, we are very happy that EASL, WHO, and other important stakeholders and speakers will be contributing to the event.

In addition to attending community members, patient representatives, service providers in community and harm reduction settings, researchers, and several policy makers, we invite ILC participants to join the two-day programme. There will be a welcome, keynote, short plenary speeches from the full spectrum of knowledge in the hepatitis field, and roundtable discussions on the first day as well as two plenary sessions, parallel workshop-style sessions, and a final reception during the second day.

The Summit will be concluded with the launch of a ‘Community Declaration’, a consensus statement highlighting the importance of community involvement in the process of eliminating HCV. This declaration will initially be endorsed by the Hepatitis C Community Summit organizing partners:
We look forward to seeing you in Amsterdam!

Source -

HIV and Hepatitis C are No Longer the Most Serious Infectious Threats to People Who Inject Drugs

Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases

HIV and ID Observations
An ongoing dialogue on HIV/AIDS, infectious diseases,
all matters medical, and some not so medical.

In Case You Missed It

HIV and Hepatitis C are No Longer the Most Serious Infectious Threats to People Who Inject Drugs

I had dinner with my daughter Mimi the other evening, and was ruminating about how things have changed since I started work as an Infectious Diseases doctor around 25 years ago.

Here’s an excerpt of our chat:

Me:  There are way more cases of endocarditis in young people than there used to be, a complication of injecting drugs. People in their 20s and 30s with life-threatening infections, getting admitted to the hospital, needing antibiotics for weeks, sometimes surgery … it’s awful. [I didn’t mean for this to sound like a cautionary speech to my 21-year-old daughter, but reading it now — guilty as charged.]
Mimi:  Endocarditis?
Me:  Infection of the heart valves. It’s an incredibly serious problem, much more difficult to treat than HIV and HCV. Even with our best antibiotics, some people need major heart surgery — their lives are never the same. And sometimes the infection spreads through the blood to the lungs, spine, brain… Some even die!

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Treat All - Are we nearing the end in the fight against hepatitis C?

Journal: Expert Review of Gastroenterology & Hepatology

Are we nearing the end in the fight against hepatitis C?
Joel V. Chua & Shyam Kottilil
Received 09 Jan 2017, Accepted 17 Mar 2017
Accepted author version posted online: 24 Mar 2017

View Article
Download PDF

With a robust choice of DAA regimens available, even patients that were in the past considered hard to treat such cirrhotic patients, or those previously excluded from treatment due to chronic kidney disease, now have therapeutic options.  For example, elbasvir-grazoprevir is preferred to be used in HCV-infected patients with chronic kidney disease; while decompensated HCV cirrhotic patient are able to be treated with sofosbuvir-ledipasvir-ribavirin, or sofosbuvirvelpatasvir-ribavirin, or sofosbuvir-daclatasvir-ribavirin regimens.  In addition, highly effective and safe pangenotypic DAA regimens such as the once daily fixed dose combination sofosbuvirvelpatasvir, as well as daclatasvir plus sofosbuvir, increases the breath of those that can be treated and cured.  These advancement in drug therapy against HCV, coupled with increasing availability of generic DAAs [6] outside of the U.S. will increase access to these highly efficacious cure drugs worldwide.

Though having safe and highly effective drug regimens that can “virtually” cure all HCV infected individuals is an integral part of any hepatitis C eradication strategy, it still is just one component to achieving disease elimination..
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Gilead hepatitis C drug patent faces European challenge

Gilead hepatitis C drug patent faces European challenge
International groups representing doctors and patients have launched a fresh challenge to the patent on Gilead Sciences' hepatitis C drug sofosbuvir at the European Patent Office in order to increase access to the treatment.

MSF and MdM, who have been joined by 28 groups from across Europe, said key patents on sofosbuvir had already been revoked in China and Ukraine, and decisions were pending in other countries, including Argentina, India, Brazil, Russia and Thailand.

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Saturday, March 25, 2017

Hep C Weekend Reading: Favorite quote of the week “Fight to treat your patients as early as possible.”

HCV Weekend Reading
Hope you all had a wonderful week, sit back and catch up on what you may have missed over the last week in this issue of Weekend Reading.

In a recent article published in Clinical Infectious Diseases, data suggested that delaying hepatitis C treatment regardless of fibrosis stage may be detrimental to patients, ya think?  Reuters Health reported: "Mortality is increased in patients with moderate or severe liver disease related to chronic hepatitis C, and progression from mild/moderate to severe disease cannot be predicted reliably." Here is a quote from Dr. Cepeda, a key author of the study; “Fight to treat your patients as early as possible.” Read the rest of the article, here.

However, according to a report released this month from Trio Health, after patients are prescribed HCV therapy insurance companies are denying coverage, interim data from the study showed HCV treatment non-starts are up, from eight percent in 2014, to over 30 percent in 2016, for the most part because of payer coverage denials. The HCV regimens evaluated in the study include the following: Sovaldi®/Harvoni® (Gilead), Viekira Pak™ (Abbvie), Zepatier™ (Merck), Daklinza™ (BMS) and Epclusa® (Gilead). Read commentary on the report here, Trio press release here.

Annals of Internal Medicine, reported high cure rates, with few side effects, in a review article on various FDA approved regimens to treat chronic hepatitis C. Sustained virologic response (SVR) for genotype 1 (using different approved HCV regimens) was reported at over 95%. Sofosbuvir plus velpatasvir  or daclatasvir for 12 weeks in genotype 3 patients without cirrhosis appeared to seem most effective, for geno 3's with cirrhosis, a regimen of velpatasvir-sofosbuvir had higher response rates, the latter is  also highly effective (99% response rate) for genotypes 2, 4, 5, and 6, this summary was published in NEJM Journal Watch, read the full text article; Hepatitis C: Down but Not Out - Oral Direct-Acting Agent Therapy for HCV.

Weekly News Coverage
HEP offers hepatitis C research with daily news, a great place to start learning about HCV.
Over at HepCBC, each Friday a nice summary of news is available, read this weeks: Weekly Bull.

Daily news, updates and more over at Healio.
Check out the following March publications as well.
HCV Next
Healio Gastroenterology
Infectious Disease News

News Re-Cap
Author: Richard Pizzi Family Practice News
Publish date: March 21, 2017 - Hepatitis Outlook Late February 2017
Here’s a quick look at some notable news items and journal articles published over the past month, which cover a variety of the major hepatitis viruses.

Week Ending March 22, 2017
Hepatitis C | MD Magazine
Infectious Disease Special Edition
Don't miss recent articles written by your favorite bloggers over at HEP blogs. is a great site for patient resources and personal stories with daily articles.

In Case You Missed It

MD Whistleblower
Medical Marijuana Use - Ready, Fire, Aim!
Michael Kirsch, MD
Promoting medical marijuana use is hot – smokin’ hot. States are racing to legalize this product, both for recreational and medical use. In my view, there’s a stronger case to be made for the former than the latter.

Presently, marijuana is a Schedule I drug, along with heroin, LSD and Ecstasy. The Food and Drug Administration (FDA) defines this category as drugs with no acceptable medical use and a high potential risk of addiction. Schedule I contains drugs that the FDA deems to be the least useful and most dangerous. Schedule V includes cough medicine containing codeine.

Hepatitis C Foundation
How to Find a Liver Specialist Who Really Knows Hepatitis B
March 22, 2017
By Christine Kukka
If you have chronic hepatitis B or are newly-diagnosed, it’s important to see a liver specialist who has experience with hepatitis B.

Having a specialist with hepatitis B expertise on your team not only safeguards your health, it also lessens the stress of having a chronic liver disease. “My specialist gave me all the possible scenarios, but most importantly, he gave me my life back,” one hepatitis B patient recalled.

Date Released: Mar 8 2017
HCV Management In Liver Transplantation
Dr. Robert Brown discusses management of hepatitis C infection in patients undergoing liver transplantation, Dr. Nancy Sokol hosts.
Listen here...

Learning Activity
Watch - Release Date: 3/15/2017
Hepatitis C: New Paradigms for Evaluation & Management
Dr. Naudia Jonassaint discusses the new paradigms in regards to the evaluation and management of Hepatitis C. She reviews the basic epidemiology & scope of Hepatitis C, appropriate screening for Hepatitis C, basic Hepatitis C treatment options , identification of special populations, and post SVR Monitoring
Quick View, watch here...

Healthy You

Behind The Headlines
Overweight young men 'more likely to get severe liver disease'
"Men who are overweight in their late teens have a higher risk of developing liver cancer in later life, new research suggests," reports ITV News. Swedish researchers also found a link to other serious types of liver disease…

Updates On This Blog
HCV vaccines—back to the future?
Effects of Melatonin on Liver Injuries and Diseases
Resistance testing for the treatment of chronic hepatitis C with direct acting antivirals: when and for how long?
Future of liver disease in the era of direct acting antivirals for the treatment of hepatitis C
Study - Statin use may lead to: Decreased fibrosis and Reduced risk of developing liver cancer
Watch - Hepatitis C Overview
Chronic Hepatitis C And Functional Dyspepsia (FD) - A Feeling Of Discomfort In The Upper Abdomen
HCV - Fatty liver disease and genotype 3
HCV Genotypes/Treatment
Is There A Natural Way To Improve Liver Fibrosis?

Check back for updates, enjoy the rest of your weekend.