Hepatitis C in Limelight Again at Liver Congress

Miriam E. Tucker

April 06, 2016

BARCELONA, Spain — Hepatitis C will top the agenda at the International Liver Congress (ILC) 2016, as it did last year, with presentations on treatment regimens for difficult-to-treat patients, the cost burden of the new direct-acting antiviral therapies, and real-world data.

"In hepatitis C, the big wave was 2 years ago. Now that we're beyond a 90% cure rate, it's a different landscape," said Laurent Castera, MD, who is secretary-general of the European Association for the Study of the Liver (EASL).

The cost of the new treatment regimens is a major problem, and a late-breaker study from Australia on an imported generic direct-acting antiviral treatment will likely draw a large audience. And several presentations of real-world data could provide reassurance that regimens proven highly effective in controlled clinical trials are achieving the same results in clinical practice.

"Hepatitis C still dominates the field, but the focus is shifting to difficult-to-treat patient groups, other genotypes, and a lot of real-life data," said EASL Vice-Secretary Tom Hemming Karlsen, MD, PhD.

Other hepatitis C trials will address regimens for difficult-to-treat patients, such as those infected with genotype 3, transplant patients, and patients who failed previous treatment with a direct-acting antiviral. There will also be discussions on post-treatment monitoring for patients with hepatitis B or hepatitis C, who could still be at risk for hepatocellular carcinoma.

Hepatitis C still dominates the field, but the focus is shifting to difficult-to-treat patient groups, other genotypes, and a lot of real-life data.

A group from China will present results from a randomized trial comparing systematic transient elastography monitoring with liver biopsy in patients with hepatitis B. "The issue is whether the noninvasive method can assess regression of fibrosis and cirrhosis in patients treated for hepatitis C and hepatitis B," Dr Castera told Medscape Medical News.

With previous interferon-based treatment, "there was a significant decrease in hepatocellular carcinoma risk, but some risk persisted," he explained. "With the new direct-acting antivirals, we don't know. We anticipate that the risk might be even lower, but it's difficult to identify these patients. You still need to monitor all these patients, even though only a few will develop carcinoma."

"The point is, the story isn't over with the cure of the virus," Dr Karlsen explained.

Care delivery is now an issue. "How should hepatitis C care be administered? Is it done by hepatologists, or more broadly within the healthcare system? This is an interesting discussion that will emerge now that the regimens have become easier and easier," he reported.

Beyond Hepatitis C

Among the other late-breaker topics are phase 2 data on norursodeoxycholic acid for the treatment of primary sclerosing cholangitis, a first-in-class hepatitis B virus core inhibitor (administered alone or in combination with pegylated interferon), and a new oral therapy for patients with cirrhosis and high MELD scores at baseline.

One of three general sessions will examine several different antiviral regimens for chronic hepatitis B, a marker for mortality in nonalcoholic fatty liver disease, a genome-wide association study identifying risk loci for alcoholic hepatitis, and a phase 2 study of a bone marrow stem cell treatment for cirrhosis.

New EASL clinical practice guidelines on autoimmune hepatitis, nonalcoholic fatty liver disease, benign liver tumors, vascular liver disease, and liver transplantation will be presented during dedicated sessions at the congress. As well, updated hepatitis C treatment guidelines from EASL and from the World Health Organization (WHO) will be released.

Some of the guidelines will be issued jointly with other liver societies, and there will be two sessions held in conjunction with the WHO.

Dr Karlsen said he is most excited by the global outreach aspect of the congress, which began as strictly a European meeting but now welcomes more than 10,000 attendees from all over the world.

"There is a strong direction toward collaborative efforts among the major liver associations — European, American, Asian, and Latin American," he said. "You will see some very concrete output from that collaborative effort at a global level being presented and showcased at the meeting."

Much of the global cooperation was spurred by the advances in hepatitis C, but it has now expanded to include collaboration in other liver diseases, Dr Karlsen reported.

"The hepatology arena has become very global. It's a healthy direction, to see the field moving concertedly, along with the other associations, all in the same direction. It makes me happy," he said.

Dr Castera has served on the speaker's bureau for Echosens, which manufactures the FibroScan elastography device. Dr Karlsen has disclosed no relevant financial relationships.


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