Sunday, June 5, 2016

Hep C treatment, EASL 2016 Update and Dr. John Farley

Merck Pharmaceuticals was terrific to organize with Dr. G. Horvath and Dr. John Farley, Gasterenterologist to provide us a much needed presentation on Hepatitis at the lovely LaTerrazza  Italian Restaurant in Yaletown. I work with a half dozen other doctors at Doc Side Medical providing treatment to a wide variety of patients with IV drug use and alcoholism. Many have Hepatitis C and we identify their disease and the state of their liver disease on our intake history, physical and laboratory assessments. 
These are the rough notes that I took which don’t do justice to the topic.  The take home message though was that Hep C is treatable now thanks to the newer medications that are more directly anti viral, with better tolerance from a side effect profile and  now approved for a wider group of patients.  Merck has been at the forefront of research in the  area of Hepatitis so it’s not surprising that they were hosting the dinner.  The sooner treatment is begun the better the results but this is at variance right now with the existing protocols for public funding of treatment.

Dr John Farley

EASL2016 Update
- Hep C is curable disease
- moving away from interferon to oral more effective treatment using lessons learned from tx of HIV
- newer medications are direct acting anti vitals

Difficult cases
- advanced liver disease
Interferon failures

are a Couple of newer meds

New anti viral are protease inhibitors, polymerase inhibitors
Used in combination  (lesson learned from successful treatment of HIV)

Fewer side effects, better tolerance

Concern with medications which cost hundreds and thousands of dollars / with methadone patients they are getting daily witnessed ingestion so can do the same 
For others 3 and 7 day dispense not monthly

Expert guidance with decompressed cirrhosis
- avoid interferon
- be careful with protease inhibitors

3 large pop based studies
Hepa- C registry
SVR, safety and deaths HCV Tx

Death rate higher for cp B/C versus CP A

Data saying we should treat earlier

(Presently government doesn't fund early tx)

HCC Risk persists after DAA tx in puts with HCV- related cirrhosis
- hepacellular carcinoma risk is still 7.6% risk
HCC screening guidelines every 6 month in this population

EBR/GZR combination tx most effective in randomized studies and superior to interferon based tx

HCV reinfect ion rate 8.4 per 100 person years

SVR12 is endpoint = sustained virologic response for 12 months

Undetectable virus is outcome

Efficacy and safety obv/ptv/rtv with or without DSV or RBV
German Hep C restructuring cohort
Israel cohort 

Merck product better response in studies  

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