CC January 2015 Advances in hepatitis treatment

echoecho's version from 2015-05-20 13:23


Question Answer
Patients infected with the HCV genotype 1 represent ____ % to ____% of HCV infections in the United States?60%; 75%
Hepatitis C virus genotype ____ is more difficult to cure (HCV RNA negative during long-term follow-up) than genotype 2 or genotype 3?1
What 3 genotypes are uncommon?4, 5, 6
What is the goal when treating hepatitis C?eradication of the virus
State the end point of successful therapy?sustained virologic response defined as undetectable HCV RNA in the serum 24 weeks after treatment has been stopped
A tectonic shift has occurred in the treatment of hepatitis C. Previously, the combination of peginterferon and ribavirin (Copegus) was the standard of care for patients with chronic hepatitis C, no matter the virus genotype. This regimen is effective as 70-80% for genotypes ____ and ____ and rates of 45-70% among patients with other genotypes?2; 3
What was the most common side effects of the combination of peginterferon and ribavirin (Copegus)?flu-like symptoms, irritablity, depression
What made the regiment of peginterferon and ribavirin (Copegus) difficult for patients to tolerate?the length of the treatment (48 weeks)
The subsequent combination of what with peginterferon-ribavirin increased viral response rates from 75% to 90% while reducing treatment duration, adverse effects and the number of pills?second-generation protease inhibitors
*** Patients with HCV genotype 1 should receive what treatment regimen? Why?1)sofosbuvir (Sovaldi) + pegylated interferon + ribavirin 2) because of the shorter duration of therapy (8-12 weeks) and high rates of SVR (sustained viral response) of 89-90%
*** Patients with HCV genotype 1 could receive what as an alternate treatment regimen? SVR (sustained viral response)?1) simeprevir (Olysio) + pegylated interferon + ribavirin 2) 79-86%
*** Patients with HCV genotype 2 and 3 (20-29% of HCV infections in the US) should receive what treatment regimen? SVR (sustained viral response)?1) sofosbuvir + ribaviron alone) 2) genotype 2, 12 weeks duration, 82%-93% 3) genotype 3, 24 weeks duration, 80-95%
*** Pts with HIV-HCV coinfection and pts w/ compensated cirrhosis (cirrhosis but preserved synthetic liver functions) should receive what treatment regimen?the same treatment as patients with HCV alone
While beneficial due to improved efficacy and shorter duration of therapy, several of the regimens still contain ______, thos not mitigating the adverse effects, which made the original therapy intolerable for many patients?interferon
In october 2014, the introduction of the combination of ____-_____ for the treatment of hepatitis C in adults was a huge turning point in hepatitis C genotype 1 therapy?ledipasvir-sofosbuvir (Harvoni)
What are the advantages of using ledipasivir-sofosbuvir (Harvoni)? 1) shorter treatment duration 2)single dailly pill
***What is the treatment duration of ledipasivir-sofobuvir (Harvoni)?treatment duration is generally 12 weeks (24 weeks for previously treated patients with cirrhosis), although studies in rx naive pts w/o cirrhosis demonstrate excellent results with an 8-week treatment regimen
***Initial response to ledipasivir-sofobuvir (Harvoni) is nearly ____% with sustained viral response of ___% to ___%?100%; 95-99%
The above answer with rates of response to therapy is held true regardless of what 2 things?1) race 2) presence of cirrhosis
The ledipasivir-sofosbuvir (Harvoni) can be given to patients with Pugh ___, ____, or ____ hepatic impairment, although safety and efficacy in pts in decompensated cirrhosis has not been demonstrated?A, B, or C
What is the dosage adjustment needed for mild to moderate renal impairment? Safety and efficacy have not been demonstrated with GFR < ___?no dosage adjustment needed; 30
What is the pregnancy category? Are dose adjustments needed?B; no
The medication is well tolerated, with complaints of what being the most common side effects?fatigue, headache
What is the cost of this treatment?$64,300 x 8 weeks; $94,500 x 12 weeks and $189,000 x 24 weeks
The increased cost of the med to the healthcare system must be balanced against the benefits of therapy. List the benefits of this therapy?prevention of the progression to cirrhosis; mitigating need for liver trasplant; decreasing infectivity
List the factors that affect the decision regarding optimal therapy for the patient?1) genotype 2) previous treatment (if any) 3) presence of cirrhosis 4) cost
*** What is the first-line treatment for patients with genotype 1 hepatitis C?ledipasvir / sofosbuvir (Harvoni)