NEW THERAPIES AND DIFFICULT TO TREAT PATIENTS: HCV PD Dr. D. - - PowerPoint PPT Presentation

▶
new therapies and difficult to treat patients hcv
SMART_READER_LITE
LIVE PREVIEW

NEW THERAPIES AND DIFFICULT TO TREAT PATIENTS: HCV PD Dr. D. - - PowerPoint PPT Presentation

Aug 30, 2023 345 likes •742 views

NEW THERAPIES AND DIFFICULT TO TREAT PATIENTS: HCV PD Dr. D. Nierhoff University of Cologne NEW NEW SINCE AREVIR MEETING 2017 NEW THERAPIES (SINCE AREVIR MEETING 2017) Maviret Vosevi NEW THERAPIES (SINCE AREVIR MEETING 2017)

slide-1
SLIDE 1

NEW THERAPIES AND DIFFICULT TO TREAT PATIENTS: HCV

PD Dr. D. Nierhoff University of Cologne

slide-2
SLIDE 2

NEW

slide-3
SLIDE 3

NEW

SINCE AREVIR MEETING 2017

slide-4
SLIDE 4

NEW THERAPIES

(SINCE AREVIR MEETING 2017)

  • Maviret
  • Vosevi
slide-5
SLIDE 5

NEW THERAPIES

(SINCE AREVIR MEETING 2017)

  • Maviret
  • Vosevi

pangenotypic, first line

slide-6
SLIDE 6

NEW THERAPIES

(SINCE AREVIR MEETING 2017)

  • Maviret
  • Vosevi

pangenotypic, first line

Epclusa

(

Harvoni, Zepatier GT 1&4, first line Old

)

New

slide-7
SLIDE 7

NEW THERAPIES

(SINCE AREVIR MEETING 2017)

  • Maviret
  • Vosevi

pangenotypic, first line pangenotypic, second line

Epclusa

(

Harvoni, Zepatier GT 1&4, first line Old

)

slide-8
SLIDE 8

REAL WORLD

WITH PANGENOTYPIC THERAPIES

slide-9
SLIDE 9

REAL-WORLD WITH GP

slide-10
SLIDE 10

REAL-WORLD WITH GP

slide-11
SLIDE 11

REAL WORLD WITH SV

slide-12
SLIDE 12

REAL-WORLD WITH SVV

slide-13
SLIDE 13

DIFFICULT TO TREAT PATIENTS?

Choice of best treatment Time point of treatment Caution during treatment No licensed treatment

slide-14
SLIDE 14

DIFFICULT TO TREAT PATIENTS?

  • Relapser
  • Genotype 3 and LCI

Choice of best treatment

slide-15
SLIDE 15

DIFFICULT TO TREAT PATIENTS?

  • Relapser
  • Genotype 3 and LCI

Choice of best treatment

Only Vosevi available!

slide-16
SLIDE 16

100

ASTRAL-3 OPEN-LABEL TRIAL: SVR12, SAFETY WITH SOFOSBUVIR/VELPATASVIR IN GT3 HCV

Mangia A, et al. AASLD 2015. Abstract 249. Reproduced with permission. Foster GR, et al. N Engl J Med. 2015;[Epub ahead of print]. n/N =

SVR12 (%) 80 60 40 20

264/2 77 221/2 75 191/1 97 163/1 87 73/ 80 55/ 83 200/ 206 176/ 204 64/ 71 45/ 71

95 80 63 90 97 97 87 91 66 86 All Pts No Yes Naive Experienced Cirrhosis P < .001

(superiority)

SOF/VEL 12 wks SOF + RBV 24 wks

Slide credit: clinicaloptions.com

Treatment History

slide-17
SLIDE 17

NEW EASL GUIDELINE 2018

slide-18
SLIDE 18

GT3 WITH LCI SOF/VEL +/- RBV

slide-19
SLIDE 19

GT3 WITH LCI SOF/VEL +/- RBV

slide-20
SLIDE 20

GT3 WITH LCI SOF/VEL +/- RBV

slide-21
SLIDE 21

IF A PROBLEM WITH RBV …

slide-22
SLIDE 22

WITH REGARD TO PRICE …

Price (AVP) SV 12 W + RBV 34.957,44 + ca. 2.000 GP 12 (naive)- 16 W (experienced)

(KI for RBV)

52.436,16 - 69.914,88 SVV 8W (second line) 44.521,76

slide-23
SLIDE 23

DIFFICULT TO TREAT PATIENTS?

  • Relapser
  • Genotype 3 and LCI

Choice of best treatment

2 options and a backup: Just a matter of price or RBV.

slide-24
SLIDE 24

DIFFICULT TO TREAT PATIENTS?

  • Decompensated liver cirrhosis
  • Patients with HCC

Time point of therapy

slide-25
SLIDE 25

Waiting list for liver Tx 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Germany 1948 2163 2161 2119 1868 1534 1351 1280 1157 1086

slide-26
SLIDE 26

INCIDENCE OF NEW HCC

No evidence for differential occurrence of HCC following SVR from DAA and IF.-based

  • therapy. Waziry et al., J Hepatol 2017
slide-27
SLIDE 27

RECURRENT HCC

No evidence for differential recurrence of HCC following SVR from DAA and IF.-based

  • therapy. Waziry et al., J Hepatol 2017
slide-28
SLIDE 28

DIFFICULT TO TREAT PATIENTS?

  • Decompensated liver cirrhosis
  • Patients with HCC

Time point of therapy

Rare Probably no harm to treat these patients, but maybe not helpful, if no LTx option.

slide-29
SLIDE 29

DIFFICULT TO TREAT PATIENTS?

  • HBV
  • Chronic kidney injury

Caution during treatment

slide-30
SLIDE 30
slide-31
SLIDE 31

Reaktivierung von Anti-HBc only unter DAA-Therapie!

slide-32
SLIDE 32

DIFFICULT TO TREAT PATIENTS?

  • HBV
  • CKI

Caution during treatment

If problems exists, it is rare. Check viral load during therapy.

slide-33
SLIDE 33

SOF-BASED DAA WITHOUT IFN IS A RISK FACTOR FOR EGFR DECREASE: GIVE WITH CAUTION AMONG PATIENTS AT RISK OF RENAL PROGRESSION

  • Linear mixed model of eGFR variations in a 2013–2016 monocentric retrospective
  • bservational cohort of 814 CHC patients
  • Median (IQR) age: 58 (52–66) years; 40% cirrhosis; 25% CKD risk factors

Without CKD risk factors With CKD risk factors

Mean (95% CI) eGFR, ml/min/1.73 m2

Before DAA (n=421; 1,266 measures) At DAA 
(n=740; 740 measures) Under DAA (n=640; 929 measures) After DAA (n=503; 1,040 measures) Median (IQR): 107 (340) wks Median (IQR): 24 (17) wks Before DAA (n=41; 100 measures) At DAA 
(n=74; 73 measures) Under DAA (n=64; 59 measures) After DAA (n=46; 71 measures) Median (IQR): 92 (204) wks Median (IQR): 23 (12) wks p=0.124 p=0.735 REF REF p=0.11 p=0.225 p=0.745 p=0.663

87 97 92 82 77

p<0.001 p=0.582 p=0. 945 REF REF p<0.001 p=0.122 p=0.014

90 96 94 92 86 84 88 82 72

eGFR variations among 740 CHC patients exposed to SOF-based DAA treatment eGFR variations among 74 CHC patients exposed to non-SOF-based DAA treatment

Mean (95% CI) eGFR, ml/min/1.73 m2

Linear mixed models of eGFR were stratified by CKD risk factors with SOF exposure as a fixed factor and with adjustments for baseline patient demographics and clinical characteristics Mallet V, et al. ILC 2018, #PS-037

slide-34
SLIDE 34

DIFFICULT TO TREAT PATIENTS?

  • HBV
  • CNI

Caution during treatment

If problems exists, it is rare. Check viral load during therapy. If problems exists, it is mild. Check GFR during therapy.

slide-35
SLIDE 35

DIFFICULT TO TREAT PATIENTS?

  • Children < 12 years
  • Acute hepatitis C

No licensed treatment

slide-36
SLIDE 36

DIFFICULT TO TREAT PATIENTS?

  • Children < 12 years
  • Acute hepatitis C

No licensed treatment

slide-37
SLIDE 37

DIFFICULT TO TREAT PATIENTS

Choice of best treatment Time point of treatment Caution during treatment No licensed treatment

GT 3 and LCI Relapser Patients with HCC

  • Decomp. LCI

HBV CKI Acute hepatitis Children < 12y

rare no harm check

slide-38
SLIDE 38

THE NEW STUFF IS NO LONGER NEW, AND THE DIFFICULT PATIENTS ARE NO LONGER DIFFICULT OR AT LEAST RARE!

SUMMARY

slide-39
SLIDE 39

THANK YOU VERY MUCH FOR YOUR ATTENTION