Laird Harrison

November 06, 2015

SAN FRANCISCO — The latest trials of combination hepatitis C drugs aimed at specific genotypes will get top billing at this year's Liver Meeting.

"We have seen phenomenal change in hepatitis C treatment over the last 2 years, and this has not slowed down one bit," said Gary Davis, MD, from MedLogician Consulting in Simpsonville, South Carolina, who is cochair of the American Association for the Study of Liver Diseases scientific program committee.

For the difficult-to-treat patients with genotype 3 and advanced fibrosis, a couple of the new drug combinations are providing "much improved" results, Dr Davis told Medscape Medical News.

The large phase 3 studies for hepatitis C treatments will be featured during late-breaker oral and poster sessions.

ASTRAL 1 looks at the combination of sofosbuvir and velpatasvir for the treatment of patients with hepatitis C genotype 1, 2, 4, 5, and 6, and ASTRAL 2 compares the fixed-dose combination of sofosbuvir and GS-5816 with the combination of sofosbuvir and ribavirin in patients with genotype 2.

ALLY-3+ evaluates the combination of daclatasvir, sofosbuvir, and ribavirin for patients with genotype 3, and TOPAZ-II looks at the combination of ombitasvir and paritaprevir plus dasabuvir, with or without ribavirin, in patients with genotype 1a.

And the C-EDGE Coinfection Study looks at the combination of grazoprevir and elbasvir in patients coinfected with hepatitis C and HIV.

Hepatitis B, Fatty Liver Disease, and Liver Failure

Not all the cutting-edge research is focused on hepatitis C, Dr Davis pointed out. "The number of abstracts submitted on hepatitis B, fatty liver disease, and liver failure continues to increase, and we are starting to see novel therapeutic options in these areas."

Investigators will report on a pooled analysis of data from the PIVENS and FLINT trials looking at the efficacy and safety of vitamin E in patients with nonalcoholic steatohepatitis.

Another presentation will assess the efficacy of obeticholic acid in patients with primary biliary cirrhosis who have received more than 4 years of treatment.

And the ELAD trial explores the effect of extracorporeal C3A cellular therapy on patients with severe alcoholic hepatitis.

Now that hep C is an access problem, not a therapy problem, the next wave of liver disease we have to tackle is fatty liver disease.

"Now that hep C is an access problem, not a therapy problem, the next wave of liver disease we have to tackle is fatty liver disease," Nancy Reau, MD, from the Rush University Medical Center in Chicago, told Medscape Medical News.

Transplant, Cirrhosis, and Gene Expression

Recent studies on the inducement of immune tolerance in liver transplant recipients will be addressed by Sandy Feng, MD, from the University of California, San Francisco, during her Thomas E. Starzl Transplant State-of-the-Art Lecture.

And changes in the management of cirrhosis will be addressed by Guadalupe Garcia-Tsao, MD, from the Yale University School of Medicine in New Haven, Connecticut, during the Leon Schiff State-of-the-Art Lecture.

During his President's Choice Lecture, Nobel laureate Craig Mello, PhD, from the University of Massachusetts Medical School in Worcester, will discuss "how gene expression is controlled by biologic mechanisms that have been passed through living organisms for billions of years," Dr Davis said. "That should be fascinating."

And basic science lectures will look at the use of liver cell cultures to study drug toxicity and the way fatty liver develops.

Premier Meeting

This is "absolutely the premier liver disease meeting in the United States," Dr Reau told Medscape Medical News, and about 10,000 attendees are expected.

The organizers received almost 3300 abstracts, but only 264 will be presented orally.

"I would say that, in contrast to previous years — especially those 5 or more years ago — you need to do some careful planning on how you are going to spend your time at the meeting," said Dr Davis.

To help with that, organizers have restructured this year's meeting. The Special Interest Group symposia will be held on Friday, so as not to conflict with the regular meeting session, and Basic Science Programming will be grouped together to make it easier for scientists to attend.

In addition, the postgraduate course — Managing Liver Disease: Clinic to Community — has been shortened to a single day. And sessions with similar content are less likely to overlap, so attendees with a particular focus won't have to miss content in their area.

The meeting will also feature a lively reception on Saturday night. And between sessions, attendees will be able to take advantage of San Francisco's colorful neighborhoods, striking vistas, and sophisticated cuisine.

Dr Davis reports serving on data and safety monitoring boards for Bristol-Myers Squibb and Gilead Sciences. Dr Reau reports consulting for Gilead Sciences, AbbVie, Bristol-Myers Squibb, Merck, Janssen, Intracept, and Selix.


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