EASL recommendations for treatment from UK, just out

[candyce1953]

http://files.easl.eu/easl-recommendations-on-treatment-of-hepatitis-C.pdf

EASL recommendations for treatment from UK, (just out)

[candyce1953]

I can't sort thru all above

but I did read the Entire PDF from EASL

Which did say Olysio and Sovaldi as well as options for people like myself who can not take interferon

What I found most interesting was that they did not list the other pharmacy like Abbot, Merck etching as treatment option for DAA"s

Is Daclastasir , olysio, and Sovaldi licensed in Europe? I don't know????????

The other thing that jumped out at me, that made me very happy was that if there is a treatment failure with Sovaldi and Olysio you can retreat with with Sovaldi and Daclatasvir, OR if you fail with Sovadi and Daclastasir you can retreat with Oylsio and Sovaldi

Because there is a very LOW threshold to viral mutation with Sovaldi
So retreat net is possible with another DAA

[JimmyMose]

Nice thank you

I browsed through the EASL recommendations for treatment from UK.

These excerpts were done sort of quickly. They should be correct but  please verify by reading the source link.    

There are a lot of option recommendations including with PEG/RBV w the following drugs in the excerpts

Only selected a few combinations w/wo RBV for my non medical opinion
_____________________________________________________________
Daclatasvir should be administered at the dose of 60 mg (one tablet) once per day. It is overall well tolerated. Dose adjustments are not needed in patients with Child B or C disease. The most frequently reported side effects with daclatasvir were fatigue, headache, and nausea.

Sofosbuvir should be administered at the dose of 400 mg (one tablet) once per day. Currently, no dose recommendation can be given for patients with severe renal impairment (estimated glomerular filtration rate <30 ml/min/1.73m2

Simeprevir should be administered at the dose of 150 mg (one capsule) once per day. No dose recommendation can be given for patients with Child-Pugh Class B or C cirrhosis, due to higher simeprevir exposures (particularly in Child-Pugh C patients) that may be associated with increased frequency of adverse reactions.
--A number of compounds are contra-indicated in patients receiving simeprevir

Patients infected with HCV genotype 1 can be treated with an interferon-free combination of daily sofosbuvir (400 mg) and daily simeprevir (150 mg) for 12 weeks (Recommendation B1) (GT4 Recommendation B2)
Patients infected with HCV genotype 1 can be treated with an interferon-free combination of daily sofosbuvir (400 mg) and daily daclatasvir (60 mg) 12 weeks in treatment-naïve patients or 24 weeks in treatment-experienced patients, including those who failed on a triple combination of pegylated IFN-α, ribavirin and either telaprevir or boceprevir (pending data with 12 weeks of therapy in treatment-experienced patients) (Recommendation B1) (GT4 Recommendation B2)
The following ribavirin statement applies to those listed above for (GT1 Recommendation B1) (GT4 Recommendation B2)
Preliminary results do not indicate a major advantage of adding ribavirin to this regimen. However, adding daily weight-based ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg, respectively) should be considered in patients with predictors of poor response to anti-HCV therapy, especially prior non-responders and/or patients with cirrhosis (Recommendation B1)

The addition of another direct acting antiviral drug is likely to improve the prevention of HCV recurrence post-transplant. Therefore, patients with decompensated cirrhosis awaiting liver transplantation (Child-Pugh B and C) with genotype 1 to 4 infection should be treated with daily weight-based ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg, respectively), daily sofosbuvir (400 mg), and daily daclatasvir (60 mg) until liver transplantation in experienced centres under close monitoring (Recommendation B1)

Patients with post-transplant recurrence of HCV infection should be considered for therapy. Significant fibrosis or portal hypertension one year after transplantation predict rapid disease progression and graft loss, and indicate more urgent antiviral treatment (Recommendation B2)

Patients with HCV genotype 1, 3, 4, 5 or 6 infection can be treated with daily sofosbuvir (400 mg), and daily daclatasvir (60 mg), 12 to 24 weeks, with or without daily weight-based ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg, respectively), pending more data in this population (Recommendation B1)

Patients with HCV genotype 2 infection must be treated with daily weight-based ribavirin (1000 or 1200 mg in patients <75 kg or ≥75 kg, respectively), and daily sofosbuvir (400 mg), 12 to 24 weeks, pending more data in this population (Recommendation B1)
_____________________________________________________
My non medical opinion and guess.

1. Daclatasvir is listed because it's expected to be approved by the  European Medicines Agency in 2014 and has been approved for Compassionate-use by a one or more countries already

2. Similar to the hcvguidlines.org Simeprevir is not really recommended for Class B or C cirrhosis. hcvguidlines.org only recommends for Class A or F3/F4 needing imediate treatment as they expect better treatment opions in the a year or two. Although some exceptions have occurred with Class B because that was the only current and last option available (RBV exclusion criteria . A few are getting that treatment with lower fibrosis depending on their doctor and insurance   Simeprevir has many compounds that are contra-indicated. More serious side effects especially when Class B is progressing toward Class C

3. Unless Daclatasvir exhibits problems unknown as of now and other promising drugs have problems, the use of Simeprevir will probably drop off significantly starting in mid 2015. Although if patients with very specific medical  conditions and/or gene related where it remains the best treatment it may stay around longer. One maybe is severe renal impairment.    

The best news in a few years hopefully will be a vaccine and/or a one time cocktail care.  

[candyce1953]

Here is a working hyperlink to the EASL-European association of Liver disease brand new recommendations from conference going on now in UK

http://files.easl.eu/easl-recommendations-on-treatment-of-hepatitis-C.pdf