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5 th Paris Hepatitis Congress Workshop 30/1/2012 Managing complications of DAAs : Case 1

5 th Paris Hepatitis Congress Workshop 30/1/2012 Managing complications of DAAs : Case 1. Dr Samuel S. Lee University of Calgary. Case 1. 51 year old Caucasian man HCV discovered 2009 on routine examination Remote history of injection drug use age 19 No symptoms

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5 th Paris Hepatitis Congress Workshop 30/1/2012 Managing complications of DAAs : Case 1

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  1. 5th Paris Hepatitis CongressWorkshop 30/1/2012Managing complications of DAAs: Case 1 Dr Samuel S. Lee University of Calgary

  2. Case 1 • 51 year old Caucasian man • HCV discovered 2009 on routine examination • Remote history of injection drug use age 19 • No symptoms • Alcohol: 8-10 beers/week, mostly on weekends • Smokes 3-4 cigarettes/d; occasional marijuana • asymptomatic

  3. Case 1 • Physical exam: weight 81kg, BMI 28 • few spider nevi, but no other abnormalities • Labs: • ALT 2 x N • Bilirubin, PT-INR, albumin, N • Hb 151 g/L, WBC 7.1, ANC 2.9, plts 145 • Ultrasound: coarse liver echotexture – fatty liver? Borderline splenomegaly. No ascites

  4. Case 1: further investigations and course • HCV genotype 1a • 1.1 million IU/mL HCV RNA (2009) • Fibroscan: 10.2 kP (stage 3?) • Liver biopsy (from 2009): moderate activity, grade 1, bridging fibrosis, stage F3 • No previous treatment – patient did not wish to suffer side effects • Had heard of ‘new treatment’ and wished to proceed with triple-Rx

  5. Case 1: treatment • Started triple-Rx with PEG a-2a + RBV 1200mg/d + boceprevir 800mg tid (after 4-wk lead-in) • Qual HCV RNA detectable at wk 4 lead-in (no RVR) • Wk 8 and 12 RNA undetectable • Hb 118, ANC 1.2, plts 101 after lead-in • Moderate fatigue, flu-like symptoms

  6. Case 1: course • Wk 6: Hb 101, ANC 0.9 • RBV decreased to 800mg/d • Wk 8: Hb 93; fatigue worsening • ANC 0.7 • RBV decreased to 600mg/d; PEG decreased to 135ug • Wk 10: Hb 94, ANC 0,8 • Wk 12: Hb 92, ANC 0.7 • Wk 16: Hb 89, ANC 0.9; patient working at 60%

  7. Case 1: further course • Wk 7: metallic taste in mouth. Pt advised to take plenty of water, small frequent meals • Wk 10: still slight dysgeusia but improved • Weight loss 5kg by wk 16 • Currently at wk 24, stable at PEG 135, RBV 600mg, boceprevir. • In view of suspected cirrhosis and drug reductions, plan to continue Rx for 48wk

  8. AE summary Flamm et al. AASLD 2011

  9. Anemia AEs Flamm et al. AASLD 2011

  10. Flamm et al. AASLD 2011

  11. NeutropeniaAEs

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