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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.