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Medical Forum / Diseases and Disorders / Hepatitis / November 2007

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HCV becomes severe after failed combo therapy?

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mark - 14 Nov 2007 08:46 GMT
Hi All,

Kindly have a look at the referenced article.

http://www.newswise.com/articles/view/535281/
"Interferon Does Not Slow or Stop Progression of Hepatitis C in Certain
Patients."

The article reports on a major clinical trial: "Hepatitis C Antiviral
Long-Term Treatment against Cirrhosis (HALT-C)."  The trial determined
whether long-term interferon is helpful for people who had failed combo
therapy.  The answer is no.  All participants in the study, treated and
control arms, had previously failed combo (interferon/ribivirin)
therapy.  After 3.5 years, disease progression toward severe symptoms
(ascites, encephalopathy, liver cancer, cirrhosis or death) was equal
(about one third) regardless whether patients were on interferon
maintenance or not.

The study director concludes that this "... emphasizes the importance of
the ongoing search for new and more effective treatments."

Let me interpolate a bit.  It is quite common for people to have hep c
for decades without sesvere symptoms.  But after failed combination
therapy ..... maybe not.  Three and one half years out from failed combo
therapy, one third of patients progress to severe symptoms.  That seems
very fast.

Combo therapy makes sense for those who stand a good chance of success.
 But for people with resistant genotypes and/or long standing disease
and/or high viral counts, maybe HIV coinfection ... for these people the
chance of success is low.  And with failure, well, perhaps HCV becomes
more virulent.

At least that's how I read it. Your thoughts?

Mark
Thomas Wagner - 14 Nov 2007 17:32 GMT
>http://www.newswise.com/articles/view/535281/
>"Interferon Does Not Slow or Stop Progression of Hepatitis C in Certain
[quoted text clipped - 6 lines]
>very fast.
>[...]

That's a nonsensical conclusion. The study only looked at patients that
already had severe fibrosis levels (Ishak score R3) before going into
treatment. They were on maintenance therapy because it was believed that
this might help stop progression to more severe levels. Unfortunately,
it did not. That's all this study shows.

Thomas
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Ghamph - 14 Nov 2007 19:39 GMT
> >http://www.newswise.com/articles/view/535281/
> >"Interferon Does Not Slow or Stop Progression of Hepatitis C in Certain
[quoted text clipped - 14 lines]
>
> Thomas

That was my impression on that also.

The candidates had quite advanced issues which would have been problematic
regardless.

A point of no return was reached that maintenance didn't stop.

Other treatments in the pipeline might show promise in the next few years.

Advanced status patients could try enrolling in studies,

Jamffer
mark - 19 Nov 2007 11:03 GMT
Hello Thomas Wagner,

In my previous note I pointed out that the HALT-C study found a high
rate of serious disease progression among those who had failed
combination therapy.  Thanks for pointing out that the study group not
only had failed combination therapy but also had severe fibrosis.  This
does not however change the conclusion that about 1/3 of the study
population progressed to severe symptoms in less than 4 years (and that
this rate was unaffected by maintenance interferon).

1/3 of a population becoming overtly and seriously ill in less than 4
years.  That's a pretty rapid decline.  You indicate a firm certainty
that the decline is what one would expect from people with HCV and
severe fibrosis.  Any other conclusion is 'ridiculous.'  But I've
personally seen several people decline rapidly from almost normally
functional to very ill right after combo therapy.  So I've asked whether
the failed therapy and the rapid decline maybe are causally related.

It's not clear to me that we've got the data to answer whether the
decline is related to the failed therapy.  However, I point to a very
recent 10/07 Medscape review "The Progressive Nature of Cirrhosis:
Implications for an Aging Hepatitis C-Infected Population."  The article
indicates that one would expect progression from cirrhosis to
decompensation at about 4% per year.  That's a lot lower than the rate
of decline found in the HALT-C study post failed combination therapy.

Mark

---------------

>> http://www.newswise.com/articles/view/535281/
>> "Interferon Does Not Slow or Stop Progression of Hepatitis C in Certain
[quoted text clipped - 14 lines]
>
> Thomas
 
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