Current and Future Liver Treatment Options Rui Tato Marinho - - PowerPoint PPT Presentation

current and future liver treatment options
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Current and Future Liver Treatment Options Rui Tato Marinho - - PowerPoint PPT Presentation

Current and Future Liver Treatment Options Rui Tato Marinho ruitatomarinho@sapo.pt Department of Gastroenterology and Hepatology President of College of Hepatology of Portuguese Medical Association (2012-2015) Editor-Chief of Acta Mdica


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Rui Tato Marinho ruitatomarinho@sapo.pt

Department of Gastroenterology and Hepatology

Current and Future Liver Treatment Options

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President of College of Hepatology of Portuguese Medical Association (2012-2015) Editor-Chief of Acta Médica Portuguesa (2011-2016) Vice-President of Portuguese Society of Gastroenterology (2013-2017) President of Scientific Committee of SOS Hepatitis, patient NGO Member of Scientif Committee of Port. Ass. Haemophilia Infarmed – Coordinator of Consultive Panel for Hepatitis C (2014-2015) Direção-Geral da Saúde – National Strategy for Viral Hepatitis ACSS – referentiation group for digestive diseases Pedagogic Committee of Medical School of Lisbon (2014-2017) Scientific Committee of Masters in Palliative Care Elected Member of General Assembly of United European Gastroenterology, Advisory Member of Viral Hepatitis Prevention Board (WHO, CDC, ELPA, ECDC) Fellowship of EBGH, American College of Gastroenterology, Sociedade Brasileira de Hepatologia Conflict of Interests: Abbvie, BMS, MSD, Gilead, Janssen

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“Core Business” 32% with cirrhosis ~52-63% with F3/F4 A person with 52 years

Data from National Registry for HCV treatment, Infarmed Portugal, 2016

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Sustained Viral Response (SVR) = virological cure

HCV RNA negative 3 months after the end of therapy for ever and ever (>99%)

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Cure hepatitis C (genotype 1)

Adapted from Hepatitis C, stigma and cure. Marinho RT, Barreira D, World Journal Gastroenterology 2013

1986 1995 2000 2011 2013/2014

IFN SC 3Xw 24w IFN SC 3Xw + RBV 48w PEG-IFN SC 1Xw + RBV 48w PEG-IFN 1Xw + RBV 24-48w + Boceprevir / Telaprevir Oral DAAs 12w

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Risk of Hepatocellular Carcinoma

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Sustained Viral Response Non Response

N 130

2011

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Risk of Death

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No Response SVR -Response

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Daclatasvir Paritaprevir, Ombitasvir, Dasabuvir Simeprevir Sofosbuvir Sofosbuvir/Ledipasvir

DAA – Direct-Acting Antiviral

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Clinical Trials = Real Life

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Inc Including luding Haemophilia Haemophilia

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SVR 96% SOF/LDV

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EMA 26th May 2016

Velpatasvir/Sofosbuvir Grazoprevir/Elbasvir

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Future >2016?

  • New DAAs pangenotypic, decompensated cirrhosis
  • Coformulation, some 8 weeks, no more RBV
  • And the 5-10% that didn´t respond?
  • Health Public Issue (€€, politicians, health professionals,

pharmaceutical industry, patients, journalists, etc)

  • 1st chronic oncogenic virus that man is able to cure
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Future >2016?

Saving lives and Families

  • New DAAs pangenotypic, decompensated cirrhosis
  • Coformulation, some 8 weeks, no more RBV
  • And the 5-10% that didn´t respond?
  • Health Public Issue (€€, politicians, health professionals,

pharmaceutical industry, patients, journalists, etc)

  • 1st chronic oncogenic virus that man is able to cure
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“Liver Circle”

Acute Hepatitis

Chronic Hepatitis Compensated Cirrhosis Decompensated Cirrhosis

HCC

Transplant

Palliative Care

Death

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Thank´s a lot!!