Evaluation amp; Management of Hepatitis C.ppt

Rapid Virological Response Undetectable HCV RNA at Week # 4 = RVR Genotype 1 individuals achieving ~91% SVR rate Those with favorable predictors (low viral level) may be just as well served with 24 weeks (rather than 48) Genotype 23 individuals achieving ~90% SVR rate Shortening course from 24 weeks increases relapsers Incomplete EVR HCV RNA decreases 2 log from baseline but remains detectable at Week #12 Also called Slow to Respond-er In those individuals that clear virus by Week #24 and complete therapy relapse is common resulting in 45% SVR rate Data suggests that extending therapy to 72 weeks decreases relapsers and improves chance of SVR Partial Response at Week #12 HCV decreases 1 log but less than 2 log = NR Conversion to daily Consensus Interferon (Infergen) with continued ribavirin can result in some SVR SVR rate ~10-20% Difficult to tolerate due to side effects Future Therapies STAT-C Drugs Specifically Targeted Antiviral Therapy for HCV Polymerase Inhibitors Protease Inhibitors (Phase III Studies in Progress) Telaprevir (Vertex) Boceprevir (Schering) (Helicase Inhibitors) Goals include ? RVR, ? Rx duration, and ? SVR “Far and away the best prize that life has to offer is the chance to work hard at work worth doing.” Theodore Rosevelt Evaluation Management HCV In Conclusion…. Populations at risk Disease overview Evaluation Standard of Care (SOC) Therapy Future Therapies THE END! Questions?! * * Evaluation Management of Hepatitis C Donald J. Hillebrand, MD. Division of GI-Hepatology Medical Director of Liver Transplantation Scripps Center for Organ Cell Transplantation Southwest Viral Hepatitis Summit November 2008 Material to Cover vs. Lecture Schedule Liver DiseaseSouthern California Approximately 1 out of 7 liver disease related deaths in the U.S. occurs in California! In 2003 there were 27,201 liver disease deaths in U.S.2 In California alone there were 3,832 deaths that year (14.1% of U.S. deaths) California Triple the incide