ACG 2013 - CARE Liver Disease Faculty Update

At this years’ CARE at ACG program Dr. Rob Myers (University of Calgary) presented on liver disease. He discussed key news in hepatology from the past year, focusing the majority of his presentation on HCV. What follows are the points discussed on this topic from a Canadian perspective.

Promising HCV Therapies Dominate Liver Discussion: Important Questions Remain Unanswered

  • A new era of HCV treatment is coming to Canada (cure rates > 90%, minimal toxicity, few pills/simple regimens).
  • With a higher cure rate, we can anticipate more patients being treated. Having gastroenterologists in community practice and primary care physicians treat is necessary for managing the impact of increasing patient numbers and/or decisions on screening for baby boomers (see abstract 228 below).
  • Some important questions remain unanswered: When will treatment become available? What is the cost? Who is paying? What will be the optimal regimen for patient subtypes/groups? 

Related Abstracts from ACG 2013

ACG 2013 Abstract #38: Sofosbuvir + Ribavirin With or Without Peginterferon Is Well-Tolerated and Associated With High SVR Rates: Integrated Results From 4 Phase 3 Trials in HCV Genotype 1–6. Kowdley, et al.

The objective of this study was to evaluate the safety and efficacy of sofosbuvir. The results showed no resistance in treatment failures, and treatment D/C is uncommon (0–2%) in all SOF arms. Since cirrhosis is usually difficult to see, it’s good to note the higher percentage that was included in the studies. This study has been submitted for Health Canada approval, and will hopefully be approved within the next year.
— CARE Liver Disease Faculty

ACG 2013 Abstract #39: Safety and Efficacy of Interferon-Free Regimens of ABT-450/r, ABT-267, ABT-333 +/- Ribavirin in Patients With Chronic HCV GTI Infection: Results From the Aviator Study. Kowdley, et al.

The objective of this study was to evaluate safety and efficacy. Results found that there was no difference between 12 and 24 weeks therapy, which is extremely high, and overall, this regimen appears quite safe.
— CARE Liver Disease Faculty

ACG 2013 Abstract #228: Effectiveness of Birth Cohort Screening for Hepatitis C: An Inner-City Experience. Olosunde, et al.

In our patient population, a detailed history of known risk factors for hepatitis C will detect the vast majority of patients with the disease. Age only was insufficient as the only criteria for screening. There were no patients within the age cohort 1945–1965 who were hepatitis C positive, who did not have at least one risk factor. In order to increase detection rate of hepatitis C, educating the community on the risk factors, and thereby increasing the awareness in the community would lead to more patients presenting for testing. In conclusion, birth cohort screening for hepatitis C infection alone may not be cost-effective, given the large number of negative results. Targeted screening based on at least one known risk factor may detect a higher percentage of undiagnosed new cases. Large community-based studies are needed before cost-effective guidelines are adopted.
— CARE Liver Disease Faculty

More exciting news to follow as well as further updates from AASLD 2013. The themes Dr. Myers discussed at ACG will be built out/discussed in more depth at the AASLD conference. One exciting late-breaking abstract that is scheduled to be presented is:

AASLD 2013 LBA #20: Rapid and Consistent Virologic Responses in a Phase 2 Trial of a New All-Oral Combination of Faldaprevir, Deleobuvir, and PPI-668, With and Without Ribavirin, in Patients With HCV Genotype-1a Infection. Jacob P. Lalezari, et al.