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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.

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NI Hepatitis B and C Network: Diagnosis and Treatment

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  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

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