COMMENTARY

Hepatitis C: Advances in Screening and Treatment

Digestive Disease Week 2011

Zobair Younossi, MD

Disclosures

May 17, 2011

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Hello I'm Zobair Younossi, Executive Director of the Center for Liver Diseases and Vice President of Research at Inova Health System in Falls Church, Virginia. I'm currently at Digestive Disease Week (DDW) 2011 in Chicago, and I'm going to be discussing some of the developments, both here and around this meeting, in hepatitis C.

I will be discussing some of the exciting data on screening and insurance coverage for hepatitis C. Moreover, I will discuss new data on IL28B genotyping for direct antiviral agents, and finally I'll discuss new data on the efficacy of direct antiviral agents for hepatitis C.

Screening for Hepatitis C

With respect to the screening project for hepatitis C, a study presented at DDW[1] using Markov modeling techniques showed that in comparison with the current risk-based screening for hepatitis C, screening the general population born between 1945 and 1970, a group that includes the so-called "baby boomers," can reduce cases of advanced liver disease and hepatitis C-related deaths, and will be cost-effective. This study has important implications for identifying the vast majority of hepatitis C-infected individuals.

Insurance Coverage and Hepatitis C

Another study presented here at DDW[2] used a large cohort of individuals from the NHANES [National Health and Nutrition Examination Survey], and showed that a large number of hepatitis C patients lack health insurance coverage. In fact, in this study, having hepatitis C infection was an independent predictor of not having health insurance. This study has very important implications for public health policy in the United States.

IL28B Genotyping

IL28B genotyping has been important and has been strongly associated with response to peginterferon and ribavirin combination therapy. In the United States, IL28B genotype distribution is 34% CC, 49% CT, and 16% TT. Using the 2-drug combination of peginterferon and ribavirin, sustained virologic response in the United States is 80% for patients with the CC genotype, 39% for [those with] the CT genotype, and 25% for [those with the] TT genotype.

Data presented here at DDW[3] suggest that IL28B and treatment-naive and treatment-experienced hepatitis C patients who are treated with telaprevir, peginterferon, and ribavirin triple combination therapy achieved higher sustained virologic response across IL28B genotypes. These data suggest that IL28B genotyping may not have as strong a predictive value for telaprevir-containing regimens as it does for peginterferon and ribavirin double-combination regimens.

Antiviral Therapies

Finally, 2 direct antiviral agents are close to approval: telaprevir and boceprevir. A great deal of new data about these 2 agents were presented at this DDW.

Boceprevir data[4] showed that treatment-naive individuals who are treated with 4 weeks of lead-in with peginterferon and ribavirin followed by 44 weeks of triple combination of boceprevir, peginterferon, and ribavirin achieved 63% to 66% sustained virologic response. In treatment-experienced patients treated with a similar regimen, 42% to 53% of patients achieved sustained virologic response. In terms of telaprevir data[5] for treatment-naive individuals who received telaprevir, peginterferon, and ribavirin for 12 weeks followed by double combination of peginterferon and ribavirin for either 24 or 48 weeks, 75% of patients achieved sustained virologic response. Importantly, 58% of patients who were treated with this triple combination of telaprevir, peginterferon, and ribavirin may have what is called "extended rapid virologic response," meaning they are negative in terms of their viral count at week 4 and 12 and require only 24 weeks of therapy. This of course would truncate therapy from 48 weeks to 24 weeks.

Another study presented at this DDW shows that treatment-experienced patients retreated with 12 weeks of telaprevir, peginterferon, and ribavirin followed by another 36 weeks of peginterferon and ribavirin for a total of 48 weeks showed very high sustained virologic response. In fact, in previous relapsers to double-combination therapy, 83% to 88% of these patients achieved sustained virologic response. In previous partial responders who became nonrespondent at the end of their earlier regimen, 54% to 59% achieved sustained virologic response. In previous null responders, who are the most difficult group to actually treat, 29% to 33% achieved sustained virologic response when they were retreated with telaprevir-containing regimens.

Again, this DDW meeting reiterated that these are exciting times for hepatitis C treatment. Thank you for joining us. This is Zobair Younossi for Medscape.

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