Today we discussed additional topics from the recent AASLD conference in San Francisco. First, there was the category of liver transplantation. We learned that the IL28B polymorphism cannot reliably predict HCV recurrence in the transplant population, which is contrary to earlier reports. There was no new data on post-transplant, antiviral treatment response rates with respect to IL28B donor-recipient combinations.
In a second study, we learned that there is a higher risk of death/delisting on the transplant waiting list at low-volume transplant centers (9-75 transplants/year); additional risk factors include older age, female gender, higher MELD score and longer wait time.
We learned that the number of transplants for NASH/probable NASH has risen from 5 to 13% between 2002 and 2009 (at UCSF). The 1 and 5 year survival rate in this cohort is 13% worse than non-HCV/non-NASH transplant indications.
The second portion of today’s review was about new HCV treatment data with the protease inhibitors (PI) and other pharmaceuticals in the pipeline. There were several take home messages:
– there is resolution of PI-resistance patterns within 1 year in nearly all cases
– SVR rates in African-American GT1 patients receiving PI remains lower than that of Caucasians (60% range)
– exciting new data for GT2/3 patients shows 12 weeks of treatment is associated with excellent SVR (Phase II study)
– exciting new data for quadruple therapy shows SVR rates of 100% (Phase II study)
– we may be 3-4 years away from using these new, non-interferon based regimens; if treatment can be delayed…delay.
– the IL28B gene polymorphism may be worth ordering in treatment-naive patients to help decide whether or not to treat
– lead-in phase viral kinetics is highly predictive of treatment response rates (if planning to use telaprevir)