hepatitis c nut and bolts (2008) - nevah-rubin, ilan
TRANSCRIPT
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Hepatitis C
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Characteristics
RNA virus + sense9.6 Kb in lengthFlaviviridae → hepaciviridae → HCV
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HCV HBV HIV
Infected Persons (US) Undiagnosed Persons (US)
HCV, HBV, HIV: Prevalence vs Undiagnosed Cases
* Extrapolated from small population study.
1. American Liver Foundation. Hepatitis C Factsheet. Available at: www.liverfoundation.org. Accessed May 11, 2007.2. NIAID. HIV Infection and AIDS: An Overview. 2005. Available at: www.niaid.nih.gov. Accessed May 14, 2007. 3. Lok A, et al. Hepatology. 2004;39:1-5. 4. Thompson MJ, et al. J Cancer Educ. 2002;17:222-226.
*
3.5 M
2.5 M
1.5 M
.5 M
0
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Statistics
• 170 Million infected worldwide
• 2.7-3 Million active infection nationwide
• High medical costs - $600 Million
• 30K New infections/year
• 10K Deaths/year
• Most important causes of Liver Disease
• OLT
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HCV Genotypes
• Hepatitis C virus– RNA virus–high mutation
rates– Evolved different genotypes
• 6 known genotypes– Genotype 1 (75%)– Genotype 2 (10%)– Genotype 3 (10%)
• The above 3 are the most common in the United States
• Little difference in mode of transmission or natural history of infection among different genotypes
Flamm SL. JAMA. 2003;289:2413-2417.
Distribution of HCV Genotypes
75%
10%
10%
5%
Genotype 1
Genotype 2
Genotype 3
Other
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Alcoholics~240,000
(11%–36%)5
HIV-infected ~300,000
(30%)4
Living below poverty level ~940,000(2.4%)6
Prevalence of HCVin Select Populations
Incarcerated ~330,000 to 860,000
(16%–41%)1
Veterans ~280,000 (8%)8
IDU~300,000
(80%–90%)2,3Homeless
~175,000 (22%)7
Children(6–18 years old) ~100,000 (.1%)9
Adapted from the following:
1. CDC. MMWR. 2003;52(RR-1):1-33. 2. Edlin B. Hepatol. 2002;36(5 suppl 1):S210-219. 3. NHSDA Report 2003. 4. Poles M, et al. Clin Infect Dis. 2000;31:154-161. 5. LaBrecque D, et al: Hepatitis C Choices. 2002:7-15. 6. Alter M, et al. N Engl J Med. 1999;341:556-562. 7. Nyamathi A, et al. J Gen Intern Med. 2002;17:134-143. 8. Bräu N, et al. Am J Gastroenterol. 2002;97:2071-2078. 9. Jonas M. Hepatol. 2002;36(5 suppl 1):S173-S178. 10. Armstrong GL, et al. Ann Intern Med. 2006;144:705-714.
Male (63%)
Female (37%)
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Hepatitis C Virus Infection Prevalence by Age
0
1.0
2.0
3.0
4.0
5.0
< 11 11-19 20-29 30-39 40-49 50-59 60-69 ≥ 70
Age Group
An
ti-H
CV
Po
siti
ve (
%)
Alter MJ, et al. N Eng J Med. 1999;341:556-562.
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HCV replication and infection
Adapted from Pawlotsky JM, Gish RG. Antivir Ther 2006;11:397-408
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Hepatitis C VirusFate of Acute Infection
15%
Chronic85%
Spontaneousresolution
Alter MJ, et al. N Eng J Med. 1999;341:556-562.
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Natural History
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Hepatitis C Virus InfectionNatural History
Stable80% (68%)
HCCLiver failure25% (4%)
Slowlyprogressive75% (13%)
Resolved15% (15%)
Acute HCV
Cirrhosis20% (17%)
Chronic HCV85% (85%)
ETOH
HIV
Fe
Hepatic
viruses
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Hepatitis C Virus InfectionPopulation at Risk
– Ever injected illegal drugs / intranasal cocaine use– Tattoo and Body piercing – Received clotting factors made before 1987 – Received blood/organs before July 1992 – Ever on chronic hemodialysis – Evidence of liver disease – Incarceration– Healthcare, emergency, public safety workers
after needle stick/mucosal exposures to HCV-positive blood
– Children born to HCV-positive women Centers for Disease www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm Control and Prevention. Hepatitis C fact sheet.
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Testing Strategies for HCV
RF for HCVand/or Abn LFT’s
Anti HCV (EIA) testing
< 5% Chance of HCV
Prior exposure to HCV
HCV VL + Genotype
RIBA
NO HCV Exposed + Cleared
Refer forevaluation and Tx.
NO HCVHCV
VL + Genotype
positivenegative
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Hepatitis C VirusDiagnostic Testing
Diagnostic Test Type
Specifications Serologic VirologicMode of detection Antibodies Virus
Sensitivity > 95% > 98%
Specificity Variable > 98%
Detection postexposure
2-6 months 2-6 weeks
Use Screening Confirmation
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• False positives– Autoimmune disorders– Spontaneous resolution of viral infection
• False negatives– Chronically immune suppressed– Transplant recipients– Chronic renal failure on dialysis– HIV positive
HCV Antibody TestingLimitations
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Physical Exam
• Non Specific (Malaise / Weakness)
• Chronic liver disease
Palmar Erythema Temporal Wasting
Gynecomastia Spider Angiomas
Caput Medussa Dupuytren’s contracture
Clubbing Asterixis
Icterus Enlarged Parotid
Testicular atrophy HSM
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Extrahepatic Manifestations
• Autoimmune / Rheumatological– Mixed Cryoglobulinemia, Sjögren and Arthritis
• Hematological– NHL
• Endocrinological– Thyroid and DM
• Dermatological– PTC and Lichen Planus
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Laboratory Evaluation
• CBC
• BMP
• LFT’s
• TFT’s
• HIV
• Viral Hepatitis
• Genotype
• Viral Load
• Liver Biopsy
• A1C
• Hemochromatosis
(Fe Studies)
• A1-AT
• Wilson’s Dz
• Autoimmune
– ANA, RF, AMA
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Hepatitis C Virus InfectionLiver Biopsy
• Only test that can accurately assess– Severity of inflammation– Degree of fibrosis
• Determines the following– Risk for developing cirrhosis in future– Need for therapy– Need for ongoing therapy when initial
treatment has failed
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Liver Biopsy (Metavir)
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Who to treat?
Innocent until proven guiltyTreatment until proven otherwise
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Who to treat?
• Age 18
• Liver Enzyme elevation
• Liver Biopsy (Stage dependant ?)
• Compensated Liver Disease (Tbili, INR,
Alb, Plt, HE, Ascites)
• Hematologic parameters (Hb, WBC, Cr)
• Controlled depression
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Who NOT to treat?
• Major/Uncontrolled depressive disorder
• Renal/Lung/Heart Transplant
• Autoimmune Hepatitis
• Uncontrolled hyperthyroidism
• Pregnant – Unwilling to go contraception
• Age under 3
• Hypersensitivity
• Severe Disease: HTN, CHF, CAD, DM, COPD
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Goals of Treatment
• Sustained Virological
Response
• Prevent the progression of
Cirrhosis
• Reduce Risk of HCC
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Factors Associated With SVRPretreatment or fixed• Genotype• HCV RNA level• Histology• Race• HIV coinfection• Steatosis / IR?• Body weight• Adherence
Dynamic factors• Rapid virologic
response (HCV RNA negative at Wk 4)
• Early virologic response– Partial (HCV RNA decline of
> 2 logs at Wk 12)– Complete (HCV RNA
negative at Wk 12)
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SVR in Patients Who Achieved an RVR
90 282 257 9
GT 1 GT 2 GT 3 GT 4
100
868688
Patients With an RVR
RVR: HCV RNA negative (< 50 IU/mL) at Wk 4
Fried MW, et al. EASL 2008. Abstract 7.
0
20
40
60
80
100
SV
R (
%)
n =
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Calculating a Cure: Pretreatment Characteristics
• Likelihood of SVR depends on interactions of multiple factors
• Can individual probabilities of SVR be estimated?
• Data from 2 registration trials of pegIFN-2a + RBV used to identify important factors related to SVR
• Modeling used to vary important baseline characteristics
Foster GR, et al. Scand J Gastroenterol. 2007;42:247-255.
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Everyone Is Special
Pro
bab
ility
of
Ach
ievi
ng
an
SV
R
100
80
60
40
20
0Patients Number 1 2 3 4 5 6 7 8
9789
74
52
36
19 147
Cirrhosis No No No No No No No Yes
ALT quotient 7 2 2 2 2 2 1 1
Age in years 20 20 43 43 43 60 60 60
BMI 20 20 26 26 26 30 30 30
HCV RNA, IU/mL x 103 40 40 40 1200 9000 9000 9000 9000
Foster GR, et al. Prediction of sustained virological response in chronic hepatitis C patients treated with peginterferon alfa-2a (40KD) and ribavirin.
Scandinavian Journal of Gastroenterology. 2007;42(2):247-255.
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VS.
Pegasys 180 mcg/week
Copegus 1000 / 1200 mg/day
(75kg)
PEG-intron 1.5 mcg/Kg/week
Rebetol 1000 / 1200 mg/day
(75kg)
Genotype 1/4
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VS.
Pegasys 180 mcg/week
Copegus 800 mg/day
PEG-intron 1.5 mcg/Kg/week
Rebetol 800 mg/day
Genotype 2/3
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Current Therapy of Hepatitis C
Based on HCV genotype
• Genotype 148 weeks
PEG IFN alpha 2a 180 ug per week andRBV 1000-1200mg per day ORPEG IFN alpha 2b 1.5ug/kg per week andRibavirin 800-1400mg/day
• Genotype 2 or 324 weeks
PEG IFN alpha 2a or 2b andRibavirin 800mg/day
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Definition: Viral Responses• Sustained Virological Response (SVR)
• End of Treatment Response (ETR)
• Non-Responders (NR)– Breakthrough and Null responders
• Relapser (R)
• Rapid Virological Response (RVR) – 4wk
• Early Virologcal Response (EVR) – 12wk– cEVR
– pEVR
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RVR
cEVRpEVR
4 12 24 48 72
NR
BT
ETR SVR
Rel>2log ↓
Undetectable HCV RNA <50IU/ml
Definition: Viral Responses
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Efficacy of current HCV combination therapy by genotype
1. Hadziyannis SJ, et al. Ann Intern Med 2004;140:346-355;2. Fried MW, et al. N Engl J Med 2002;347:975-982;3. Manns MP, et al. Lancet 2001;358:958-965;4. Zeuzem S, et al. J Hepatol 2004;40:993-999
12 or 3
42–52% response rate1–3
Genotype
76–93% response rate1–4
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Current Therapy of Hep CTreat Algorithm
Stop therapyNon responder
< 2 log drop
Virus positive
Virus presentNon responder
Virus negativeSVR
Virus presentRelapser
Check viral Load 24 weeks after therapy
Virus negativeET Responder
End of Treatment Viral Load
Treat till 48 weeks
Virus negative
Treat till week 24Check Viral Load again
> 2 log drop but virus positive virus negative
Viral Load at week12
Genotype 1
Treat for 24 weeks
Genotype 2 or 3
Start Therapy
?
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Ferenci P, et al. J Hepatol. 2005;43:425.
Pa
tie
nts
wit
h S
VR
(%
)
HCV RNA StatusWeek 4 Negative ≥2 log <2 log ≥2 log <2 log Week 12 Negative Negative Negative ≥2 log ≥2 log Week 24 Negative Negative Negative Negative Negative
PEG IFN -2a 180 mg+ RBV 1000–1200 mg
91
72
60
4843
0
20
40
60
80
100
*Negative predictive value = 74%; positive predictive value = 75%.*Negative predictive value = 74%; positive predictive value = 75%.
Rapid Virologic Response (RVR)
91 90 90 90
65
ETR
SVR
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RBV dose(mg/day) =
Berg800
Sanchez-Tapias800
Ferenci1000-1200
33
16
31
46 44
77
0
20
40
60
80
100
SV
R (
%)
Slow-to-Respond Patients: Extending Therapy
Berg T, et al. Gastroenterology. 2006;130:1086-1097. Sanchez-Tapias JM, et al. Gastroenterology. 2006;131:451-460. Ferenci P, et al. AASLD 2006. Abstract 390.
72 weeks48 weeks
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Pearlman BL, et al. Hepatology. 2007;46:1688-1694.
SVR rate 72 wks treatment in G1 pts with pEVR
• PegIFN alfa-2b 1.5 µg/kg/wk + RBV 800-1400 mg/day
• HCV RNA positive at Wk 12 but HCV RNA negative at Wk 24 (N = 101 slow responders)
• Continued treatment through 48 vs 72 wks
• Baseline characteristics– 48% black
– 78% high HCV RNA
– 26% F3/4 fibrosis
– 34% BMI > 30
– 18% high fasting glucose
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SVR rate 72 wks treatment in G1 pts with pEVR
Response, % 48 Wks 72 Wks P Value
EOT 45 48 NS
SVR 18 38 .03
Relapse 59 20 .004
Treatment cessation
14 15 NS
Pearlman BL, et al. Hepatology. 2007;46:1688-1694.
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Shiffman ML, et al. N Engl J Med. 2007;357:124-134.
Patients infected with HCV genotype 2/3
(N = 1291)
RVR: yes67%
(871 / 1291)
SVR
378/461 370/410
55/205 105/215
0%
20%
40%
60%
80%
100%
0%
20%
40%
60%
80%
100%
SVR
ACCELERATE Trial: SVR G2/3 Pts With and Without an RVR
82%
27% 49%
90%
16 wks24 wks
16 wks24 wks
RVR: no33%
(420 / 1291)
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Reddy KR, et al. AASLD 2005. Abstract 596.
Influence of Cumulative RBV: Wks 1-12 on SVR in G1
Cumulative RBV Exposure (Wks 1-12)
SV
R (
%)
0
20
40
100
6657
62
45
425
< 60%60% to 79%80% to 96%≥ 97% Total
80
60
n = 325 56 44 0
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*HCV RNA–negative (< 50 IU/L) patients at Week 24 randomized to continue treatment with/without RBV at Week 26.
Bronowicki J, et al. Gastroenterology. 2006;131:1040-1048.
PegIFN alfa-2a 180 µg/wk + RBV 800 mg/day
(n = 173)PegIFN alfa-2a 180 g/wk
+ RBV 800 mg/day(N = 516)
PegIFN alfa-2a 180 µg/wk(n = 176)
Week 26
Follow-up
Discontinuing RBV on G1 Patients Responding to Therapy
Week 24: HCV RNA negative*
Week 48 Week 72
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Discontinuing RBV oif n Patients Responding to Therapy:
SVR
Bronowicki J, et al. Gastroenterology. 2006;131:1040-1048.
Outcome %
Treatment During Last 24 Wks
P ValuePegIFN alfa-2a + RBV
(n = 173)
PegIFN alfa-2a
(n = 176)
SVR (ITT) 68.2 52.6 .004
SVR (PP) 71.5 56.7 .006
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Complication / Side Effect
• PEG-Interferon alfa 2 a/b– Flu-like symptoms– Depression / Mood instability– Cytopenias (WBC / Plt)– Thyroid (hypo / hyper)– Alopecia – Nausea / Vomiting /Abdominal pain
• Ribavirin– Hemolytic anemia– Rash
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Non-Responder / Relapser
• New Molecules (STAT-C)
• Clinical Trials
• Retreatment with different PEG molecule
• Infergen (Consensus IFN)?
• Induction Therapy?
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Future Therapies
• Viral Entry Inhibitors– HC Ig. and Monoclonal Ab.
• HCV RNA Translation Inh.
• Post Translational Processing Inh.– NS3-4A Serine Proteinase Inh.
• HCV Replication Inhibitors– NS5B Polymerase Inh, Cyclophilin B Inh,
NS5A Inh, Helicase Inh
• Virus Assembly and Release Inh
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Targets for New Treatments
1) Virus Entry
2) Uncoating
3) Protein Synthesis
4) Cleavage
5) RNA Replication
6) Packaging
7) Maturation
8) Re-infection
Adapted from: Pawlotsky JM, Gish RG. Future therapies for Hepatitis C. Antivir Ther. 2006;11:397-408.
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• Randomized, placebo-controlled, phase II trial
TVR + PegIFN alfa-2a + RBV(n = 79)
PegIFN alfa-2a + RBV
TVR + PegIFN alfa-2a + RBV(n = 79)
TVR + PegIFN alfa-2a + RBV(n = 17)
PegIFN alfa-2a + RBV
Treatment-naive patients infected
with HCV genotype 1*
(N = 250)
Week 12
*Patients received TVR 1250-mg loading dose followed by 750 mg every 8 hrs or placebo based on the arm to which they were randomized. †Patients must achieve undetectable HCV RNA at Week 4 (< 10 IU/mL) and at last test before stopping therapy at 12 or 24 weeks.
Week 24 Week 48
24-week†
follow-up
PROVE 1: Telaprevir + PegIFN/RBV in Naive HCV GT1
24-week†
follow-up
Placebo + PegIFN alfa-2a 180 g/wk + RBV 1000/1200 mg QD(n = 75)
EOT
EOT
SVR
SVR
McHutchison J, et al. EASL 2008. Abstract 4.
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PROVE 1: Response Rates (ITT)
Treatment, % Week 4 Undetectable*
Week 12 Undetectable*
SVRRelapse
(n/N)§
PegIFN/RBV/placebo 48 wks (n= 75)
11 45 41 23 (8/35)
TVR/PegIFN/RBV 12 wks pegIFN/RBV 36 wks (n = 79)
81 80 67† 6 (3/51)
TVR/pegIFN/RBV 12 wks pegIFN/RBV 12 wks¶ (n = 79)
81 68 61‡ 2 (1/41)
TVR/pegIFN/RBV 12 wks¶ (n = 17)
59 71 35 33 (3/9)
*HCV RNA < 10 IU/mL.†P = .001 vs pegIFN/RBV/placebo 48 weeks. ‡ P = .02 vs pegIFN/RBV/placebo 48 weeks. ¶Only subjects who met the RVR criterion and stopped at 12 or 24 total weeks of treatment.§Relapse denominator is the number of subjects with undetectable HCV RNA at completion of assigned treatment duration.
McHutchison J, et al. EASL 2008. Abstract 4.
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PROVE 1: AEs Associated With TVR
• Gastrointestinal events, skin events (rash, pruritus), and anemia more frequent in TVR treatment arms – Moderate and severe rash more frequent in TVR-based
treatment arms
– Incidence and severity of other AEs similar to peginterferon alfa-2a and ribavirin alone
• Cumulative discontinuation due to AEs by Week 12 – TVR treatment arms: 18%
– Peginterferon alfa-2a and ribavirin only: 4%
• Hemoglobin levels lower in TVR arms for first 12 weeks
McHutchison J, et al. EASL 2008. Abstract 4.
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Treatment-naive patients
infected with HCV
genotype 1*
(N = 323)
TVR + PegIFN alfa-2a + RBV(n = 81)
TVR + PegIFN alfa-2a + RBV(n = 82)
TVR + PegIFN alfa-2a(n = 78)
Week 12
*Patients received TVR 1250-mg loading dose followed by 750 mg every 8 hrs or placebo based on the arm to which they were randomized. Patients received 12 or 24 weeks regardless of whether RVR occurred.
Week 24 Week 48
PROVE 2: TVR + PegIFN ± RBV in HCV G1 Naive Patients
Placebo + PegIFN alfa-2a 180 µg/wk + RBV 1000-1200 mg QD(n = 82)
PegIFN alfa-2a + RBV(n = 81)
Week 36
Follow-up
Follow-up
Follow-up
Dusheiko G, et al. EASL 2008. Abstract 58.
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PROVE 2: Response Rates (ITT)
Treatment, %Week 4
Undetectable*
Week 12 Undetectable
* SVR¶ Relapse
(n/N)§
PegIFN/RBV/placebo 48 wks (n = 82)
12 41 48 20 (9/45)
TVR/pegIFN/RBV 12 wks pegIFN/RBV 12 wks (n = 81)
69† 73† 68‡ 14 (8/56)
TVR/pegIFN/RBV 12 wks (n = 82)
80† 79† 62¥ 29 (18/63)
TVR/pegIFN 12 wks (n = 78)
51 62 36 48 (22/46)
Dusheiko G, et al. EASL 2008. Abstract 58.
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PROVE 2: Adverse Events• Skin events (rash, pruritus) more frequent in TVR treatment
arms – Rash most common reason for treatment discontinuation in TVR/pegIFN/RBV
treatment arms: 7% (12 of 163)• Macropapular rash which resolved after treatment discontinuation (median time to discontinuation:
~ 9 weeks)
• Cumulative discontinuation due to AEs by Week 12 – Both pegIFN/RBV/placebo 48 weeks and TVR/pegIFN 12 weeks: 10%– TVR/pegIFN/RBV 12 weeks: 12%– TVR/pegIFN/RBV 12 weeks pegIFN/RBV 12 weeks: 16%
• All treatment arms experienced comparable mean decreases in hemoglobin levels in the first 12 weeks– No incremental effect on neutrophil or platelet counts in TVR treatment arms
Dusheiko G, et al. EASL 2008. Abstract 58.
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SPRINT-1: Boceprevir + PegIFN/RBV in Naive HCV G1
Kwo P, et al. EASL 2008. Abstract 995.
PegIFN/RBV* PegIFN/RBV*+ Boceprevir†
48-week treatment arm
PegIFN/RBV*+ Boceprevir†
48-week treatment arm
PegIFN/low-dose RBV arm + Boceprevir†
PegIFN/RBV*
Follow-up
Week 72Week 48Week 4 Week 28Baseline Week 40: interim
analysis
Lead in
No lead in
*PegIFN alfa-2b 1.5 µg/kg/wk and weight-based RBV 800-1400 mg/day.†Boceprevir 800 mg TID.
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SPRINT-1: Undetectable HCV: Wks 4 / 12 of Boceprevir Therapy
Kwo P, et al. EASL 2008. Abstract 995.
0
20
40
60
80
100
Un
det
ecta
ble
* H
CV
RN
A (
%)
60
39
8
78 73
34
PegIFN/RBV lead-in pegIFN/RBV + boceprevir (n = 103)
PegIFN/RBV + boceprevir (n = 107)
PegIFN/RBV (n = 104)
*HCV RNA <15 IU/mL.
Duration 4 4 -- Boceprevir Rx 12 12 --
(weeks) 8 4 4 Total Rx 16 12 12
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SPRINT-1: Highest WHO Grade Anemia 28 Weeks of Treatment
• Epoetin-alfa treatment– PegIFN/RBV lead-in arm pegIFN/RBV + boceprevir: 48%– PegIFN/RBV + boceprevir: 45% – PegIFN/RBV: 25%
Kwo P, et al. EASL 2008. Abstract 995.
Anemia Severity
0
20
40
60
80
100
Pat
ien
ts (
%)
Grade 0
23 21
45
Grade 1 Grade 2 Grade 3 Grade 4
50 5446
27 25
1010 0 0 0 0
PegIFN/RBV lead-in pegIFN/RBV + boceprevir (n = 206)
PegIFN/RBV + boceprevir (n = 226)PegIFN/RBV (n = 104)
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STEALTH C-1: NTZ + PegIFN ± RBV in G4 HCV Patients
• Nitazoxanide (NTZ): broad-spectrum activity against parasites, anaerobic bacteria and viruses
Rossignol JF, et al. EASL 2008. Abstract 68.
180 µg/week pegIFN alfa-2a; weight-based RBV 1000-1200 mg/day; 500 mg BID NTZ.
NTZ NTZ + PegIFN
NTZ + PegIFN + RBV
PegIFN/RBV
Follow-up
Week 72Week 48Week 12Baseline
NTZ
NTZ NTZ + PegIFN
NTZ + PegIFN + RBVNTZ
n = 40
n = 28
n = 28
n = 12
n = 12
IFN-naive patients
IFN-experienced patients
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STEALTH C-1: NTZ + PegIFN ± RBV in G4 HCV Patients
• 77 patients completed NTZ lead in – Week-12 HCV RNA
reduction: 0.26 log10 IU/mL (P = .0032)
• RVR (IFN-naive patients)– PegIFN + RBV: 38% – PegIFN + RBV + NTZ:
64% (P = .048)*
• No increase in AEs noted in NTZ arms vs SOC
Rossignol JF, et al. EASL 2008. Abstract 68.
0
20
40
60
80
100
SV
R (
%)
P = .023
10
30
50
70
90
50
61
79
PegIFN + RBVPegIFN + NTZPegIFN + RBV + NTZ
P = NS
IFN-Experienced Patients
8
25
N = 40 28 28 12 12 IFN-Naive Patients
* 16 wks total therapy (12 weeks NTZ + 4 weeks PegIFN + RBV + NTZ)
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Target DrugTelaprevir (Vertex/JJ)Boceprevir (Schering)ITMN-191 (Intermune/Roche)TMC435350 (Tibotec/Medivir)
Balapiravir* (Roche)R7128 (Pharmassett/Roche)MK-0608 (Merck) BILB 1941(Boehringer-Ingelheim)GS 9190 (Gilead)A-837093 (Abbott)PF868554 (Pfizer)
DEBIO-025 (DebioPharm) NIM 811 (Novartis)
Stage (Phase)III
II/IIIII
IIIIaIIIIII
III
Protease
Polymerase
Cyclophilin B inhibitors
STAT-C: Specifically Targeted Antiviral Therapy for Hepatitis C
Slide Courtesy of Nelson D. Adapted from 2007 Roche HCV Symposium, AASLD 2007. Boston, MA.
*Generic name of R1626
Back Up
Data have not been reviewed or approved by FDA.
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HCV-796 (Polymerase)
ISIS 14803(Antisense)
BILN 2061(Protease)
Heptazyme (Ribozyme)
NM-283 (Polymerase)
ACH-806/GS-9132 (NS4a)
ANA975(TLR agonist)
UT-231B(Imino sugar)
VX-497(IMPDH inhibitor)
JTK-003(Polymerase)
CPG 10101(TLR agonist)
R803(Polymerase)
Graveyard for HCV Compounds is Filling Up Quickly!
R7025(Interferon-alpha )
Back UpBack Up
Data have not been reviewed or approved by FDA.
Courtesy of Nelson D. Adapted from 2008 Roche HCV Symposium.
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Communication and Education
Research and Treatment
State and Local Prevention Programs
Surveillance & Screening High Risk population
HCV
Hepatitis C Future
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HCV Prevention and Detection
• Prevention
– Community Education
– Awareness
• Risk Factors • Complications
• Detection
– Testing high risk populations