Genotype 1? Treat early!

[zazza]

"LARGE SCALE AUSTRALIAN HEPATITIS C STUDY SHOWS NEED TO TREAT SOONER

An Australian led, international clinical trial, being presented at the European Association for the Study of the Liver Congress in Copenhagen this week has highlighted the benefits of treating hepatitis C sooner, rather than later.

The study involved more than 700 Australians with hepatitis C and 33 Australian hospitals. It found people living with the most common strain of hepatitis C who receive treatment when there is minimal, or no liver damage, may double their chance of a cure, compared to those treated in the later stages, where liver damage has become more advanced.

According to the lead investigator, Associate Professor Stuart Roberts, Director of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, the study enabled a close look at treatment strategies to see when they are most effective.

"The study confirmed that the current standard of care is effective. In addition, the study demonstrated that the cure rates in this common strain of hepatitis C may be a lot higher than we previously thought," he said.

"We found that that up to seven out of ten people, with the most common strain of hepatitis C (called genotype 1), may be cured if treatment starts before liver scarring or damage has occurred."

Over 200,000 Australians have chronic hepatitis C. In Queensland, approximately 40,000 people have been exposed to hepatitis C, yet studies have highlighted the lack of knowledge among Queenslanders about how the virus is transmitted. With more than 278, 000 people exposed to the virus across the nation, and 10,000 new infections happening every year, the World Health Organisation has compared hepatitis C to a "viral time bomb."

According to Stuart Loveday, Vice-President of Hepatitis Australia, this research provides those patients that have not yet received treatment with a good reason to consider their options.

"Currently, fewer than 2% of Australians with chronic hepatitis C are receiving treatment. Some people with hepatitis C risk ongoing liver disease, liver failure and ultimately liver transplantation if they do not undergo timely treatment," he said.

"This study confirms that cure rates are highest for people with hepatitis C genotype 1 when they have treatment early."

"The number of people with severe liver disease as a result of hepatitis C has risen from 35,900 to 47,600 in the last five years."

"The sad fact is, that liver transplant may be the only option for someone whose liver has stopped working. End stage liver disease due to chronic hepatitis C is already the most common cause of liver transplantation in Australia," Mr Loveday said.

Hepatitis Australia urges people with hepatitis C to contact their local hepatitis organisation to find out more about this study, and hepatitis C in general, and seek advice from their general practitioner or liver specialist about their treatment options.


Further information about hepatitis C can be found at www.hepatitisaustralia.com.au or you can call the national infoline, 1300 HEP ABC (1300 437 222)."

http://www.healthdirectory.com.au/article/News/697,14/Large%20scale%20Australian%20Hepatitis%20C%20study%20shows%20need%20to%20treat%20sooner/

[Marcia2202]

I love you guys, you are the best!!!

Wishing you all health and wealth and an abundance of love!

[Isobella]

You know how people have those sayings like...30 is the new 40..stuff like that??  Well, it seems like for the geno 1's with little damage, saying they are going to treat actually means waiting for the new drugs, lol!  

Seriously...it may be the riba distorting my brain, but it just seems like there are not alot of ppl in that situation starting tx now, unless they are in a trial.  I think they are waiting.....even if I didn't - my kid is.  

Willy-isn't it crazy how good comes from bad-or at least as good as we can say being diagnosed is ,lol!

JD-You are awesome....wishing you continued health

Isobella

[can-do-man]

I would be more inclined as a geno 1 with little damage to wait on the new drugs, BUT that said in 2 years there could be something that looks even better and we might be saying all this again, better drugs coming in a couple years. So at some time one has to decide to either tx or keep saying in a couple years.

I guess the stress factor for some knowing they have HCV should play the most important part.

Zazza thanks for posting it and i hope all is well......Take care

can can

[Willy50]

Here's hoping for that pass.....

I got my DX as a result of a divorce and getting life insurance for the kids; on the off chance that I should croak they would be cared for.  I didn't score so well on my pre insurance exam but well enough to qualify.  IF I had stayed in the terrible marriage (as I wanted at that time) I would have not gotten the test, would have remained undiagnosed and probably would have continued to drink a little.  The divorce may have saved my life.  ; )  

Willy

[jdwithhcv]

Thanks, I hope I can get a pass, health-wise, for a little while anyway.  Its funny how things work, though.  My cancer surgeon had seen my liver in the flesh when he had me open in August 2004.  In the summer of 2007 he saw a follow-up CT scan and called me right away.  He noted a lot of damage on the scan, and assured me that none of it had been there 3 years earlier.  He sent  me back to my GI doctor who diagnosed Hep C ordered a biopsy - result was grade 3/stage 3.  I was asymptomatic, so if not for the cancer follow-up there's no telling when I would have learned about the Hep.

For me there was no watchful waiting option - my doc said "NOW!!!", and I started tx just weeks after the biopsy.  None of that agonizing anticipation for me, it was like cancer - wham, bam, thank-you-ma'am!  Well, at least its all behind me now.

This week I became an official 5-year cancer survivor, and back in January I got SVR.  Life is sweet.

jd

[Willy50]

I know that in life it doesn't always work this way.......

But you should be "paid up" in full now.  Now more health issues for 100 years or so.
I hope it works out for ya that way.....

There are a few on the board who fought cancer first, before HCV.  "Florida Mouse" actually was in a coma and had instructions not to resusitate 20 years ago or so.  Someone thought otherwise.....

She just finished a LONG extended TX this week.  

I think the study is important.  I also think that some can still wait and the study suggests that some should not.  Personally, I'm wanting to treat sooner before everything collapses.  I jest..... but the economy is still mighty shaky.

Further, the longer one waits there are other types of collateral damage that can also occur even though ones staging may be fine.

best,
Willy

[jdwithhcv]

Yes, those were from treatment of cancer.  

[Willy50]

Were those from the treatment of cancer?

Many people only have a vague idea where they sit with damage.  I had a biopsy about 10 months ago and had a fibrosure earlier; both stage 1.

I'm aware of some people who have had a fibroscan that seemed to contradict the results of a biopsy.  Biopsies are the best we can do (I always say that autopsy is the gold standard) but even they are not perfect.  That means the results are not always representative of the actual state of the liver and then it appears that on occasion even interpretation of the slides can vary.  This can also give the impression that a large change has occurred in a short period of time, when in fact it could be attributable to the biopsy selection or the person who interprets it.

I sometimes think that we should look generally at the large statistical overview of the aggregate.  IF we only look at the exceptional cases one can certainly find one both sides of the treat now and the watch-n-wait camps.

I'm personally planning on treating in about 2 years, maybe 3.  That may be fine for me and not for the next guy.  There is some risk involved with either choice, IMHO.

best,
Willy

[jdwithhcv]

I went from no damage to stage 3 in 3 years.  That may be attributed to 5FU, Oxiliplatin, Xeloda, but I'll never know for sure.  A lot can happen in a couple of years.

[Willy50]

I was going to answer this but Jim did a more than adequate job.

For me it is as simple as asking; might you be better off treating now with SOC or in 2 yearswith triple therapy?  I don't think that many people with minimal damage would be negatively impacted in waiting 2 years.  I believe that we will soon see double the cure rate of SOC.  As you know not all genotype 1's treat for only 48 weeks.

Further, once TVR or Boceprevir are approved one might be able to do a little more aggressive forms of treating preloading SOC, Riba surge, double dose for a few weeks and a few other possible improvements could take the triple therapy success rate higher and yet still offer a 24 week treatment.

Interesting study and it does suggest that we can't wait forever, BUT there will be many ample improvements in just 2 years, I think.  We all must decide what to do based on our staging.  Having a more complete understanding aids that process; thanks.

best,
Willy

[jmjm530]

In the large scale WIN-R study, note that stage 3 has the same SVR rates as stage 0. (see chart titled "SVR Rated Across Individual Fibrosis Stages". It is only when you combine stage 3 and stage 4 (see chart above previous) that you see a difference. It is the combining of stage 3 and 4 that gave previous studies skewed results and may indeed be skewing the Australian study although it's hard to determine from what has been presented.

http://www.natap.org/2006/DDW/DDW_27.htm

[jmjm530]

Thanks for posting, but I disagree with Jd's suggestion that this runs contrary to the "with minimal liver damage you can wait for better drugs" aka known as watchful waiting.

First, the study itself, of which the actual data is unclear from what is posted. Specifically what they mean by "where liver damage had become more advanced".

I mention this because a large previous study concluded that all stages except stage 4 had an equal chance of SVR. So the question here is whether or not the Australian researchers lumped stage 4's together with stage 3's and stage 2's, as was done with some earlier American studies that therefore gave skewed results.

But let's assume for discussion's sake that they didn't include stage 4's in the data, and let's even assume that this study trumps the American study that suggests only stage 4's have a lower chance of SVR. Even with these hypothetical assumptions a good argument can still be made for watchful waiting. And that argument revolves around the exciting results coming out of trial with for example the PI's in triple therapy.

So even if -- and again we're assuming for discussion's sake -- treating earlier with SOC delivers better results than treating later, this does not hold if you compare treating now with SOC versus watchful waiting for the newer PI's. It doesn't hold because the PI"s promise twice the cure rates of SOC in half the time. Something that even this study doesn't promise.

Again, interesting study that really needs to be studied to see how they made the distinctions in the two groups as well as how it compares to the previous American study with seeming contrary results. Just don't see contrary to Watchful Waiting, which as I see it becomes more and more attractive the closer we come to the PI's hitting market.

-- Jim

[jdwithhcv]

Thanks for posting this very interesting information.  This is contrary to the "with minimal damage you can wait for better drugs" philosophy that is so prevalent.  I'm a big believer in early treatment, as we really don't have any way to predict how rapidly fibrosis can progress.  

jd