In my last post, I discussed the “good news” from the 2013 Liver Meeting. In this post, I focus on presentations that are less hopeful.
- Real-life evaluation of current hepatitis C treatments using boceprevir and telaprevir unveiled disappointing data. An abstract by Adrian Di Bisceglie showed lower response rates than clinical trial data. Treatment-naïve was 58% for boceprevir, 61% for telaprevir. African-Americans had a shockingly low rate of less than 16%. Premature discontinuations of treatment were high with 42% for boceprevir, 35% for telaprevir. Adverse events were plentiful, particularly rashes with 32% for boceprevir, 63% for telaprevir.
- Hepatitis C continues to be underdiagnosed and undertreated. The numbers are shocking and disturbing. I hope that the trend changes beginning now. The hepatitis C-related death rate is increasing. Liver cancer (hepatocellular carcinoma or HCC) is increasing, and with it, the need for liver transplants for those with HCC-related hepatitis C.
- The most distressing presentation was Thierry Poynard’s Long term survival of liver fibrosis after virological cure in patients with chronic hepatitis C: The avenue of the scars? It contradicted previous research, in that rather than showing that curing hepatitis C also means curing liver damage, Poynard showed that patients who had previously developed significant fibrosis still needed careful medical follow-up. The implication is that patients who delay treatment in order to wait for easier hepatitis C treatments, may increase fibrosis risk, which could compromise their long-term health. The bottom line is that patients who successfully clear hepatitis C with treatment should have long-term follow-up.
A Grain of Salt?
Take all news, good or bad, with a grain of salt. We don’t know what will happen with the all-oral drugs when they are available to everyone. As for Poynard’s “avenue of the scars,” there are many studies showing that curing hepatitis C improves morbidity and mortality. A paper published by Jeffrey McCombs et al. in JAMA’s Internal Medicine (The Risk of Long-term Morbidity and Mortality in Patients with Chronic Hepatitis C November 05, 2013) showed improved outcomes for patients who successfully cleared hepatitis C with treatment.
I suspect that there is truth to be found in both sides of this. Curing hepatitis C is likely to improve longevity and quality of life, as long as we continue to make healthy choices. However, continued follow-up makes sense too. Fortunately, we can do both—treat hepatitis C and then work with our medical providers to monitor our health.