HCV Treatment in People with Fibrosis & Cirrhosis

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HCV Treatment in People with Fibrosis & Cirrhosis

From : HCV Advocate Newsletter :March

2010

—Alan Franciscus, Editor-in-Chief

With newer medications expectedto be approved and available for use in 2011-2012 itmay seem like an easy decision to postpone treatment.

Waiting for some people, however, can bedangerous – some people need to be treated now and the

reality is that there are no guarantees thatthe new medications will work foreveryone.

The medications will also bring about more treatmentchallenges since the new HCVprotease inhibitors will be combined with pegylated interferonplus ribavirin.

The group of people who are at greatest risk for severe diseaseprogression are those with advanced fibrosis and cirrhosis.Unfortunately this is the group of people with HCV who are less likelyto respond to current HCV medications.

There are also concerns about treating people with severefibrosis and cirrhosis because of a greater risk of side effects.The results of a new study “Efficacy and Safety of PeginterferonAlfa-2a (40KD) Plus Ribavirin in Hepatitis C Patients with AdvancedFibrosis and Cirrhosisâ€1 conducted by Savino Bruno and colleaguesis sure to help people who are debating whether or not to starttreatment now or wait for the new protease inhibitors.This study analyzed data obtained from three large internationalphase III studies of people who were treated with pegylatedinterferon alfa-2a (40KD) – Pegasys

Pegasys and ribavirin.

The data in this retrospective analysis included:

• 341 genotype 1 and 4 patients– 99 people had bridging fibrosis/cirrhosis (treatment duration= 48 weeks)• 1547 genotype 2 and 3 patients– 380 patients had bridgingfibrosis/cirrhosis (treatmentdurations = 24 weeks)

The sustained virological responserates (SVR-6 months HCVRNA negative 24 weeks post treatment)were:• Genotypes 1 and 4:o 60% – without advancefibrosiso 51% – with bridging fibrosiso 33% – with cirrhosis• Genotypes 2 and 3:o 76% – without advancedfibrosiso 61% – with bridging fibrosiso 57% – with cirrhosis

The analysis also revealed that the time it took to become HCVRNA negative was similar among the groups and it was the bestpredictor of achieving an SVR.Treatment of people with cirrhosis raises concerns about safety.In this analysis, however, the treatment was tolerated similarlyamong the people with and without bridging fibrosis or cirrhosis.Only one patient in their database discontinued treatment due to lowplatelets.It was not surprising to find that people with bridging fibrosis or cirrhosisdid not respond as well as people who did not have advancedfibrosis and cirrhosis.

However, if you are someone who has bridgingfibrosis or cirrhosis, this might be a really good time to think seriouslyabout treatment now – you don’t want the liver to become even moredamaged. The best thing to do is to have a good hard conversationwith your medical provider about whether treatment is needed nowor if it is safe to wait.

1Hepatology, Volume 51 Issue 2,Pages 388 - 397Check Out These Hepatitis CBasics Fact Sheets at:www.hcvadvocate.org/hepatitis/factsheets.asp• Hepatitis C Basics: Fatty Liiver• Hepatitis C Basics:

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