The European Association for the Study of the Liver (EASL) / American Association for the Study of Liver Diseases (AASLD)’s two day special conference, entitled “New Perspectives in Hepatitis C Virus Infection – The Roadmap for Cure“, started yesterday in Paris, France. The conference has gathered experts to review and analysis current hepatitis C treatment data, published and unpublished.

Hepatitis C Treatment Topics Presented at the Roadmap for Cure Conference (Part II)

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• The treatment approach for a patient with HCV type 3 by  Maria Buti

Summary: High cure rates

• Entry inhibitors for prevention and cure of HCV infection by Thomas Baumert

Summary: This summarizes the recent advances in knowledge about how the virus infects, reviews compounds in preclinical and clinical development, and discusses perspectives of entry inhibitors for antiviral therapy and prevention of liver disease and cancer.

• Treating the patient who has decompensated liver disease or is on the wait list for liver transplantation by Gregory T. Everson

Summary: Stabilization or improvement of liver disease and prevention of post-transplant recurrence of HCV infection are two reasons to treat patients who are waiting for liver transplants. Treating patients waiting for livers can also reduce post-transplant recurrence and deaths while on transplant waitlists. However, more research is required into whether treatment helps to lessen the need for transplant.

• How sustained virologic response impacts hepatic and extrahepatic outcomes of hepatitis C infection? by Zobair Younossi

Summary: This paper examines the clinical, PRO, and economic consequences/impact of hep C and calls for the benefit of treatment and achieving SVR to be assessed. This approach will help patients, healthcare providers and policymakers reach better informed decisions about this important disease, and its treatment to better benefit the patient and the society as a whole.

• Increasing treatment rate: strategies for a country and risk-adapted screening approach by Jordan Feld

Summary: For the elimination of hep C, mass screens must happen first; risk-based screenings aren’t enough. Screening strategies must also be uniquely designed to fit the epidemiology of infection. It must also fit with where the screen is taking place, the population it is targeting, and the population’s resources. Screening must be designed around access to resources, tests, and care.

• Hepatitis C therapy: Future perspectives and unresolved issues by Michael Manns

Summary: We are working toward hep C world elimination and in parts are improving mortality. However, access to treatment remains the major challenge. Whether hepatitis C becomes the first chronic viral infection to be eradicated without a prophylactic vaccine remains to be shown. However, a  vaccine is still desirable, but is still also only a future possibility.

• Understanding factors associated with hepatitis C spontaneous viral clearance: a meta-analysis by Dewi N. Alsyah, et al.

Summary: This study suggests that patients continue to spontaneously clear HCV up to at least 12 months following initial infection. Given the high costs of treatment, it may be important to give sufficient time for patients to spontaneously clear infection before initiating treatment.

• Natural NS3, NS5A and NS5B HCV resistance is common across HCV-genotypes 1 to 4, and specific substitutions can affect NS5A inhibitors efficacy in real-world clinical practice by Valeria Cento, et al.

Summary: Natural resistance-associated substitutions are common in all hep C genotypes, and up to 10% of patients show resistance, though only the so-called major mutations seem to have a clinical relevance. Thus, qualitative identification of only major natural resistance-associated substitutions (rather than all) is required to properly guide DAA treatment.

Please look for another blog post in this series about hep C treatment information and clinical trials that were discussed at the EASL / AASLD special conference in Paris this week. Part I of this blog series can be found here.

The European Association for the Study of the Liver (EASL) / American Association for the Study of Liver Diseases (AASLD)’s two day special conference, entitled “New Perspectives in Hepatitis C Virus Infection – The Roadmap for Cure“, started today in Paris, France. The conference has gathered experts to review and analysis current hepatitis C treatment data, published and unpublished. Their focus will be on:

• Epidemiology of hep C in different areas of the world
• Virology and pathogenesis
• Natural history of the disease and impact of the new treatments on the long term consequences of chronic hep C infection
• Assessment of the disease
• Therapy, with special emphasis on difficult-to-treat populations or unsolved issues
• Eradication strategies (EASL 2016)

Some Hepatitis C Treatment Topics to be Presented in Paris (Part I)

• The treatment approach for a patient with HCV type 2 by Alessandra Mangia

Summary: This looked at clinical trial results for three Sovaldi (sofosbuvir) based treatments and possible reasons for relapse. It ruled out the idea that “…the role of a potential incorrect recognition, by the commonly used inverse dot blot genotyping method, of a chimera 2k/1b virus…” as a reason for relapse with sofosbuvir and ribavirin in genotype 2 infected patients. Because of this, it is believed that treatments in phase III studies will cure all patients with genotype 2 HCV after only 8 weeks of treatments.

• Next generation DAAs- how short can we go? by David R. Nelson

Summary: Current clinical trial data has shown success in  curing in 3-4 weeks with DAA combos for “ultra-rapid responders”. As a result, it may be possible to individualize treatment times further in the future.

• Treatment of post-transplant patient by Xavier Foms

Summary: Treating post-transplant patients has become easier with the new treatments, but it still remains less than ideal because of three limitations. These limitations are: a lack of data looking at treatment without ribavirin (a drug hard to take by those with altered GFR and anemia); the increased chance of drug interactions; and lower SVR rates for patients with hep C genotype 3 virus and for those with liver cirrhosis.

• HIV-HCV Co-infection: few challenges remain by Susanna Naggie

Summary: Due to complex liver pathogenesis, higher risk of acute HCV infection and re-infection, and potential for drug interactions with antiretrovirals that are frequently not addressed in registration trials, those with HIV/HCV co-infection still pose challenges. These challenges will be looked at in this presentation.

• The treatment approach for a patient with HCV types 4-6 by  Imam Waked

Summary: This abstract outlines clinical results for those with hep C genotypes 4, 5, and 6. For example, the NEUTRINO trial with Sovaldi (sofosbuvir) plus PR for 12 weeks resulted in a cure rate of 96.5% for GT4 patients and 100% cure for patients with GT5 and GT6 hep C after 12 weeks. Another trial highlight examined Zepatier for GT4 (100%) with RBV added, and GT5 (75% with RBV, 25% without RBV) and GT6 patients (SVR12 80%).

A Quote from the Conference’s Abstracts

The sweetest quote read while reading through these conference abstracts was: “Recent studies from Europe suggested that geographical factors had an impact on possible lower rates of response at the time of genotype specific treatment.” (Alessandra Mangia) Could this mean that researchers may be passed an era of genotype specific treatment and if so, will patients soon be able to follow?

Lastly, this blog post will be continued tomorrow with more information about hep C treatment currently being discussed at the EASL / AASLD special conference in Paris.