HCV: Treat now or Defer. Todd Wills, MD ETAC Infectious Disease Specialist. Excerpted and adapted from: Seizing the Opportunity: Optimizing Today’s HCV Therapies, Exploring Their Role in Tomorrow’s Paradigm – Clinical Care Options - Hepatitis. HEPATITIS C TREATMENT EXPANSION INITIATIVE
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Todd Wills, MD
ETAC Infectious Disease Specialist
Excerpted and adapted from: Seizing the Opportunity: Optimizing Today’s HCV Therapies, Exploring Their Role in Tomorrow’s Paradigm – Clinical Care Options - Hepatitis
HEPATITIS C TREATMENT EXPANSION INITIATIVE
MULTISITE CONFERENCE CALL
JUNE 19, 2013
1. Kanwal F, et al. Gastroenterology. 2011;140:1182-1188. 2. Shaw JJ, et al. Expert Rev Gastroenterol Hepatol. 2011;5:365-370. 3. Poynard T, et al. Gastroenterology. 2002;122:1303-1313. 4. Craxi A, et al. Clin Liver Dis. 2005;9:329-346. 5. Shiratori Y, et al. Ann Intern Med. 2005;142:105-114.
Establishing patient candidacy
Assessing potential drug–drug interactions
Evaluating likelihood of SVR in treatment-naive and treatment-experienced patients
Applying response-guided treatment algorithms to maximize response and mitigate treatment failure
Optimally managing adverse events
1. Ghany MG, et al. Hepatology. 2011;54:1433-1444. 2. EASL. J Hepatol. 2011;55:245-264.
Pts Who Are Motivated and Understand . . .
Pts Who Want Tx
Pts Who Are Eligible for Tx
Advanced disease/ cirrhosis
Less favorable prognostic factors
Favorable prognostic factors
Must be eligible for pegIFN/ RBV
Large pill burden, TID dosing of PIs (at present); parenteral IFN
Challenging adverse events
High likelihood of resistance with treatment failure
Current PIs only effective for genotype 1
Possibility of resistance with poor adherence
Perhaps IFN free
Lower pill burden, less than TID dosing; perhaps all oral
May be better tolerated
May not generate resistance
Pangenotypic or at least more
Higher barrier to resistance with some classes
After first major complication
Pts at Risk, n
Fattovich G, et al. Gastroenterology. 1997;112:463-472.