1 / 14

NI Hepatitis B and C Network: Diagnosis and Treatment

NI Hepatitis B and C Network: Diagnosis and Treatment. Developments in 2011/12 Introduction of new treatments for hepatitis C Near patient testing for ethnic groups Treatment of HBV in pregnancy Closing the gap.

gaille
Download Presentation

NI Hepatitis B and C Network: Diagnosis and Treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NI Hepatitis B and C Network:Diagnosis and Treatment • Developments in 2011/12 • Introduction of new treatments for hepatitis C • Near patient testing for ethnic groups • Treatment of HBV in pregnancy • Closing the gap

  2. Annual incidence of new hepatitis C cases (antibody positive) in N Ireland 1994-2011

  3. Incidence of new hepatitis C antibody positive and confirmed PCR positive cases in N Ireland

  4. Treatment of Chronic Hepatitis C • Goal is to make patient PCR negative and have Sustained Virological Response (SVR) • SVR = PCR negative 6 months after stopping treatment • SVR affected by: • Genotype • Viral load • Fibrosis score • Obesity, gender, race, IL28B

  5. Treatment of Genotypes 2 and 3 • Current therapy: • Pegylated interferon plus Ribavirin • 16 to 24 weeks duration • Success rate 80-85% SVR • No good options for treatment failures

  6. Treatment of Genotype 1 • Best therapy up until 2012: • Pegylated interferon plus Ribavirin • 48 weeks duration • SVR 40% (depending on profile)

  7. New treatment for Genotype 1 HCV(Rx naïve patients)

  8. Direct Acting Antivirals (DAAs) • Telaprevir • 12 weeks triple therapy, then dual therapy 12-36wks • SVR 72-75% (v 44% PR control) • Side effects: anaemia, rash • Boceprevir • 4 week lead in, then triple therapy for 24-44 wks • SVR 63-66% (v 38% PR control) • Side effects: anaemia, dysguesia

  9. What about Genotype 1 patients with previous treatment failure?

  10. Definitions of failure on prior Peg-IFN/RBV therapy Null response Relapse Non-response 2 log10 drop HCV RNA level Partial response Detection limit Treatment Adapted from Shiffman M. Curr Gastroenterol Rep 2006;8:46–52Neumann A, et al. Science 1998;282:103–7; De Bruijne J, et al. Neth J Med 2008;66:311–22

  11. REALIZE (telaprevir): SVR in prior relapsers, partial responders and null responders Prior relapsers Prior partialresponders Prior null responders * * * * SVR (%) * * LI T12/PR4826/48 T12/PR4829/49 PR48 4/27 PR48 2/37 LI T12/PR4825/75 T12/PR4821/72 PR48 16/68 LI T12/PR48124/141 T12/PR48121/145 n/N= *p<0.001 vs PR48; post-hoc analysis Foster GR, et al. Hepatol Int 2011;5(Suppl. 1):14

  12. RESPOND-2 (boceprevir): SVR in prior relapsers and partial responders Prior relapsers Prior partialresponders Prior null responders were excluded from RESPOND-2 SVR (%) BOCRGT 23/57 BOC44/PR4830/58 PR48 2/29 PR48 15/51 BOC RGT 72/105 BOC44/PR4877/103 n/N= Bacon BR, et al. Hepatology 2010;52(Suppl.):430A

  13. DAA use in Northern Ireland • Commenced August 2012 • For all treatment naïve AND treatment experienced genotype 1 HCV patients (NICE) • Backlog treated first • Cost: approx £20,000 per patient • NOT applicable to genotypes 2/3

  14. The Future… • Next generation DAAs • Protease inhibitors • Polymerase inhibitors • Nucleoside analogues • NS5A inhibitors • Interferon-free regimens

More Related