wow!apasl tailoring intf,nas according hbsag-MUST READ!

[stef2011]

this is a wonderful presentation from apasl, this is all data on how to presonalize interferon and nas according to hbsag, all types of combinations and response
i think there is a lot of disinformation about interferon, there is even data of hbsag clearance after interferon monotherapy being 31-66% after 7 years from interferon treatments, WHY THIS IS NOT REPORTED!WHY THEY JUST CHECK THE 48WEEKS TREATMENT IF THEY KNOW CLEARANCE IS IN THE FOLLOWING YEARS!WHY THIS IS THE FIRST TIME I READ INTERFERON MONO CLEARS HBSAG 31-66% AFTER 7 YEARS?

anyway the most important part is combo of nas and interferon and results to improve response and hbsag clearance.also interferon is not a one time shot, it can be repeted many times under continuous nas

anyway a must read for all of US since i bet normal doctors and liver specialists dont know about this and i am afraid some are not even able to do this....anyway the answer for clearance for most of us is here

https://docs.google.com/presentation/d/1ZwzTciUIWKOjhXNtmot-EW7UHgD-6Z3cPF083K4Oh8g/edit

[stef2011]

interferon rescues immune system and it keeps fighting even after interferon is fisnihed...some win hbv over the 5-10years period and others lose

anyway the schedule with highest response is nas, hbvdna suppression until some immune system is rescued and the interferon add on.the proble is what is stopping interferon from working tregs?
anyway interferon can be tried after 1 yr and if you fail again the second yr and so on until it works.it needs 12-24 weeks to see if it works or not

3. What exactly is Response Guided Treatment ? (I can figures out from the name but more details will help)

just personalized treatment according to hbsag response to nas and interferon.i know in pisa have already all the details to do this, maybe they already know what's needed in the t cells for interferon to responde

[4est]

nice presentation, thanks for that!
I have to closely read all of this, until then I agree with some of @StephenCastlecrag questions.
1. Combo NAs+ INF seams to be more powerful then any mono but we have to look on the combination (NAs first and INF after and NAs after, or NAs first and INF after and NAs after or NAs and INF on the same time and NAs after or ... ) and maybe the combination have to be personalized for each patient (if is under treatemnt or not, if have und DNA or not, .....).

2. What are the risk for long term INF or is beter to made INF stop for a while and start again (I read somewhere that INF have some action 7 year after stooping).

3. What exactly is Response Guided Treatment ? (I can figures out from the name but more details will help)

[stef2011]

1. There are many combination therapies involving Interferon and oral antiviral--sequential, together, interfron first or oral antivirals first, etc. Which is the most optimal?

too bad we are missing data anyway it is a fact that interferon response and immune system is suppressed by the presence of hbvdna in serum and liver, so the lower the hbvdna in the liver the higher immune system rescue and interferon response.
we have also seen clearly that potency of antivirals is a must, we started with almost no effect with lam, improved results with adv, ery good results with telbivudine and now best results from entcavir and tenofovir.i bet tdf has the most potent effect being the most potent antiviral and probably combo of tdf+etv is even more potent.
i think a good example is hcv therapy which started with combos from the begning, a good combo is sequential tdf+vit d and then addon tdf+vit d+sim+alinia+interferon

2. In China, I notice many patients are on long term Interferon treatment, some over 96 weeks.

i hope many can have possibility to add alinia, simvastatin and vit d3.i dont think we will see a trial on these cheap generic drugs so we have to try it ourselves.the good is alinia, sim and d3 have no relevant sides or resistance

3. I heard of the term, Response Guided Treatment, when dealing with Interferon. This is a good concept, but I doubt whether there are many doctors who are capable of carrying it out.

i know pisa researchers have this data already but they want a big trial so that when they publish these results can be applied as guidelines.they said with small trials nobody cares or apply data

4. Finally, I read some time ago, that the pegylated interferon that we are using these days has not been manufactured properly and the potency can vary from patch to patch. In fact, when properly manufactured, pegylated Interferon should be very potent. I wonder whether this is still the case.

i read this too and that human interferon was more potent and less sides but i have no idea if there is increased risk for infections from it, probably studyforhope knows about this.
i remember it was much more expesive and only available in a country in nothern europe, maybe norway

[OrientS]

7 years and 30-60% clearance of hbsag .. by monotherapy of interferon .. it is not very very good news or progress .. tenofovir or entecavir + 48-96 weeks of interferon is better ..

anyhow .. a bird in the hand worth ten on in the bush ..

[StephenCastlecrag]

Great resources. Thanks. Too early for me to comment, but I make a few quick points:

1. There are many combination therapies involving Interferon and oral antiviral--sequential, together, interfron first or oral antivirals first, etc. Which is the most optimal?
2. In China, I notice many patients are on long term Interferon treatment, some over 96 weeks.
3. I heard of the term, Response Guided Treatment, when dealing with Interferon. This is a good concept, but I doubt whether there are many doctors who are capable of carrying it out.
4. Finally, I read some time ago, that the pegylated interferon that we are using these days has not been manufactured properly and the potency can vary from patch to patch. In fact, when properly manufactured, pegylated Interferon should be very potent. I wonder whether this is still the case.

[StephenCastlecrag]

NAs - Nucloside/Nucleotide Analog - oral antivirals such as Tenofovir, Entecavir, Lam, etc.

[Cjb3695]

Sorry but what exactly is nas?

[stef2011]

qHBsAg for a response‐guided
therapy ffor strategy ffor
NAs or or PEG PEG‐IFN

http://www.lorenti.ch/apph/images/stories//ppt/HBV_English/SESSION%204%20BREAKOUT%202%20_Satawat%20Thongsawat.pdf

[stef2011]

http://www.lorenti.ch/apph/images/stories//ppt/HBV_English/SESSION%204%20BREAKOUT%202_Jose%20Sollano.pdf

The role of early on-treatment
serum HBsAg decline and HBV DNA reductio

[stef2011]

sorry i thought there was the data of interferon+nas combos at the end...but nothing.anyway it is a start and it is good to know correct managment of interferon can clear hbsag in 31-66%......

more presentations in this link, it was not apasl conference but  1st Asia Pacific Perspectives Forum taking place on 18–19 June, 2011 in Ho Chi Minh City, Vietnam.

http://www.lorenti.ch/apph/index.php?option=com_content&view=article&id=118&Itemid=132

[stef2011]

HBsAg quantification as a response-guided
therapy tool to guide clinical practice:        
InIn HBeAg HBeAg-negative negative patients patient

Conventional IFN therapy in HBeAg-negative:

Serum HBsAg loss observed  in 31.6 to 66.6%
of sustained  responders during 6–7 year follow-up

i guess combo with potent nas can drammatically increase this 66%

[stef2011]

sorry wrong link, this is correct link

http://www.lorenti.ch/apph/images/stories//ppt/HBV_English/SESSION%202%20Lecture%206%20Prof.%20Ferruccio%20Bonino.pdf

they are both about pisa researchers studies, the research center where i am treated.i ll have to read it at least twice to understand clearly all data

please 4est, steven comment too