Treatment of Hepatitis C in 2011: What Can We Expect?

Shiffman, Mitchell L.

doi:10.1007/s11894-009-0085-4

Cited by 17 publications

(15 citation statements)

References 23 publications

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“…Majority of RCT and community based studies found that high pretreatment viral load and presence of advanced fibrosis or cirrhosis are strong independent negative predictors of SVR in combined antiviral treatment [15,24,25,40,44,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62].…”

Section: Discussionmentioning

confidence: 99%

“…The 2002 NIH Consensus Development Conference and recent guidelines for double therapy including Lithuanian guidelines recommend that all patients with chronic hepatitis C (CHC) should be considered as potential candidates for this therapy [9][10][11][12][13][14][15]. These agents yield sustained virological response (SVR) rates of about 40-45 % in patients with genotype 1 and 75-80 % in patients with genotypes 2 and 3.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Treatment With Pegylated Interferon and Ribavirin in Patients With Chronic HCV Infection “Under Real Life“ Conditions

Speičienė

Kotovienė

Mickevičius

et al. 2014

Medicinos Teorija Ir Praktika

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Objective. To investigate the outcomes of combined therapy of hepatitis C (HCV) patients with peginterferon and ribavirin in ”real life” practice, to compare them with data obtained in randomized clinical trials (RCT) and to evaluate possible predictors of sustained virological response (SVR). Material and methods. The retrospective study of HCV patients routinely examined and treated in the Vilnius University Hospital Santariskiu Klinikos (2003−2009 yrs) was carried out. They had undergone the treatment with combination of peginterferon alfa and ribavirin according to the Lithuanian guide. Overall 203 patients were enrolled. SVR was evaluated in 179 patients. Results. The overall rate of SVR was 43 %: in 51,3 % of naives (genotype 1 − 38,8 %, genotype 2 – 100 %, genotype 3 − 82,6 % cases) and in 28,1 % of experienced patients (genotype 1 – 17 %, and genotype 3 – 64,3 % cases). Significant relations of SVR and HCV genotype was observed: 68,9 % having genotype1 were non-responders, whereas 80 % and 75,7 % ones with genotype 2 and 3 achieved SVR (p 0.005 and p = 0.01, respectively). The inverse relation with the age (p 0.01), degree of fibrosis (p = 0.039) and previous unsuccessful treatment was confirmed by multivariate analysis. Conclusions. Data of SVR obtained „on real life“ conditions are non unambiguous: SVR of naive and experienced patients overall and those with genotype 1 were similar or slightly lower, while for patients with genotype 3 significantly higher than results presented in clinical trials. Genotype 1, previous unsuccessful antiviral treatment, older age, and advanced fibrosis were strongest negative predictors for SVR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of Treatment With Pegylated Interferon and Ribavirin in Patients With Chronic HCV Infection “Under Real Life“ Conditions

Speičienė

Kotovienė

Mickevičius

et al. 2014

Medicinos Teorija Ir Praktika

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“…[16] This article will not describe novel IFNs, which are the subject of a recent review. [17] This article will also not discuss agents that have failed or been halted or abandoned at preclinical or clinical stages of development, or novel algorithms for determining duration of SOC therapy[18]—all of which have been well reviewed elsewhere. In addition, for a more detailed treatment of virus-host interactions, the reader is referred to a recent review in this journal.…”

Section: Hepatitis C: the Status Of The Epidemic And The Standard Of mentioning

confidence: 99%

“…Since protease and/or polymerase inhibitors are expected to remain as backbone elements of IFN-sparing regimens, this could make choosing a salvage regimen more difficult. [18]…”

Section: Projected Directions Of Future Developmentmentioning

confidence: 99%

“…[18] We feel, however, that attention should be paid not only to the “inventory” of patients awaiting therapy, but also to the inventory of novel drug classes available. We favor reserving the IFN-containing hybrid regimens for patients whose indication for therapy is urgent enough that awaiting the availability of an IFN-sparing regimen would pose an unacceptable risk of disease progression, and who are projected to tolerate and respond to an IFN-containing regimen.…”

Section: Projected Directions Of Future Developmentmentioning

confidence: 99%

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Mixing the right hepatitis C inhibitor cocktail

Gelman

Glenn

2011

Trends in Molecular Medicine

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Therapy for hepatitis C virus (HCV) infection is on the cusp of a new era. Until now, standard of care (SOC) therapy has involved interferon (IFN) and ribavirin. With the first successful phase 3 trials of specific targeted antiviral therapy for HCV (STAT-C) compounds, as well as three trials in progress giving the first glimpse of IFN-free combinations of STAT-C agents, this review looks ahead to the new classes of anti-HCV agents currently in clinical development. Successful pharmacologic control of HIV and TB frames the discussion, as well as consideration of the mutation frequency of HCV replication. Maximizing synergy between agents and minimizing cumulative toxicity will be critical to the design of future IFN-free STAT-C regimens.

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Economic model of a birth cohort screening program for hepatitis C virus

et al. 2012

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Recent research has identified high hepatitis C virus (HCV) prevalence among older U.S. residents who contracted HCV decades ago and may no longer be recognized as high risk.We assessed the cost-effectiveness of screening 100% of U.S. residents born 1946-1970 over 5 years (birth-cohort screening), compared with current risk-based screening, by projecting costs and outcomes of screening over the remaining lifetime of this birth cohort. A Markov model of the natural history of HCV was developed using data synthesized from surveillance data, published literature, expert opinion, and other secondary sources. We assumed eligible patients were treated with pegylated interferon plus ribavirin, with genotype 1 patients receiving a direct-acting antiviral in combination. The target population is U.S. residents born 1946-1970 with no previous HCV diagnosis. Among the estimated 102 million (1.6 million chronically HCV infected) eligible for screening, birth-cohort screening leads to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer cases of hepatocellular carcinoma, 10,000 fewer liver transplants, and 78,000 fewer HCV-related deaths. Birth-cohort screening leads to higher overall costs than risk-based screening ($80.4 billion versus $53.7 billion), but yields lower costs related to advanced liver disease ($31.2 billion versus $39.8 billion); birth-cohort screening produces an incremental costeffectiveness ratio (ICER) of $37,700 per quality-adjusted life year gained versus riskbased screening. Sensitivity analyses showed that reducing the time horizon during which health and economic consequences are evaluated increases the ICER; similarly, decreasing the treatment rates and efficacy increases the ICER. Model results were relatively insensitive to other inputs. Conclusion: Birth-cohort screening for HCV is likely to provide important health benefits by reducing lifetime cases of advanced liver disease and HCV-related deaths and is cost-effective at conventional willingness-topay thresholds. (HEPATOLOGY 2012;55:1344-1355 H epatitis C virus (HCV) is the most common blood-borne viral infection in the United States, 1 affecting an estimated 3.6 million U.S. residents.2 The majority of infected individuals develop chronic hepatitis; persistent liver injury leads to cirrhosis in 5%-30% of cases 3 and may progress to advanced liver disease (AdvLD), which includes decompensated cirrhosis or hepatocellular carcinoma (HCC), leading to liver transplant and premature death. Costs of HCV in the United States are estimated to exceed $5 billion per year, 4 with projected HCV-related societal costs for the years 2010-2019 estimated to total $54.2 billion. 5For the last decade, the standard of care for treating HCV has been the combination of pegylated interferon (Peg-IFN) and ribavirin (RBV), 6 which successfully eradicates virus (sustained virologic response; SVR) in 40%-80% of treated patients. 7 This response is 40%-50% in patients with HCV genotype 1 and 80% for patients infected with HCV genotypes 2 and 3. However, the rece...

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Treatment of Hepatitis C in 2011: What Can We Expect?

Cited by 17 publications

References 23 publications

Efficacy of Treatment With Pegylated Interferon and Ribavirin in Patients With Chronic HCV Infection “Under Real Life“ Conditions

Efficacy of Treatment With Pegylated Interferon and Ribavirin in Patients With Chronic HCV Infection “Under Real Life“ Conditions

Mixing the right hepatitis C inhibitor cocktail

Economic model of a birth cohort screening program for hepatitis C virus

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