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A revolution in Hepatitis C treatment --now cured in no time in some patients 

MD-FM Thursday April 17, 2014

  

SARAH:

MD FM, the latest medical news from around the world, here’s Peter Goodwin.

 

SEGMENT 1: HEPATITIS C: Combination of direct acting antivirals can cure patients

 

PETER:

Hello, and to begin with, patients infected with hepatitis-C type-1 –by far the most common form of HCV globally –can now be cured! And the virus isn’t just being ‘suppressed,’ like it is in treatments for HIV or hepatitis-B infection –It’s actually being eradicated! Here’s Sarah Maxwell with the details…

 

SARAH:

Yes, over 95 per cent of patients with HCV-1, who were treated with a combination of two direct acting antivirals (DAAs), sofosbuvir and ledipasvir, were cured! And that was without using interferon or ribavirin so avoiding their toxicities. These are the findings of three phase-III studies, presented at the International Liver congress of the European Association for the Study of the Liver, held last weekend in London and published in the New England Journal of Medicine. Co-author Dr. Nezam Afdhal, from Beth Israel Deaconess Medical Center in Boston gave us the details:

 

AFDHAL:

We call this rescue therapy. So with 8 weeks of treatment, 95 percent of people get cured. With 12 weeks of treatment, between 97 and 99 percent of people get cured. And there’s a very small group of difficult to treat patients, who have advanced liver disease with cirrhosis, who might require up to 24 weeks. And so it would be the best choice because of its simplicity for all patients with HCV genotype 1. I mean: it’s just one tablet once a day and there are no drug-drug interactions and there are no major side effects.

 

SARAH:

Previously, you had to take a course of treatment with interferon and the first generation DAAs for a minimum of 24 weeks –and more than half of all patients needed 48 weeks of this toxic therapy. But you can now cut treatment duration drastically with an eight to 12-week regimen. However: with 12-weeks of sofosbuvir alone costing around 80,000 dollars, Dr. Afdhal said that the only barrier remaining was going to be access to treatment:

 

AFDHAL:

If every person in the world could get access to this treatment, we would essentially be able to globally cure HCV genotype 1 because, with cure rates above 95 percent, you’re not just curing the people that have it but reducing the ability for it to spread to other people… But the reality is that, globally, it is a cost issue and it’s about access. Everybody wants to be treated with this medication, you know you’re talking about worldwide 170 million people with hepatitis C, and that’s a lot of people!

 

SARAH:

Dr. Nezam Afdhal from Boston.

 

 

SEGMENT 2: New findings question benefits of neuraminidase inhibitors for preventing and treating influenza 

 

PETER:

There’s no solid evidence to support the use of neuraminidase inhibitors like Tamiflu as effective treatment or prevention for flu. These are the conclusions of a Cochrane Review, published in the British Medical Journal, which was much more comprehensive than previous meta-analyses since it included non-published data. There’s a small get-out for governments who spent millions on them however: experts point out that while the authors’ data are solid regarding the lack of benefit for these drugs on seasonal influenza, very few studies have focused on pandemic ‘flu. So their efficacy in this specific context needs more investigation.

 

 

SEGMENT 3: First genetic variant discovered increasing the risk of colorectal cancer from eating processed meat

 

PETER:

The first genetic co-factor that increases the risk of colorectal cancer caused by eating processed meat has been identified: supporting the idea that our genetic background can modify the effects of our diet…

 

SARAH:

Yes, that’s the finding of a study, reported in PLoS Genetics, that showed this factor is a common genetic variant found in one in three people. Whilst eating processed meat was already associated with an increased risk of colorectal cancer in the general population, having this particular genetic mutation apparently makes it worse, especially if you carry two copies of the mutation. MDFM spoke with lead study author, Jane Figueiredo, who speculated on the mechanism at play:

 

FIGUEIREDO:

We know that our diet affects the gut microbiota but the microbiota can influence the immune system and maybe that’s one process why some individuals may be more susceptible and this particular gene is important in the immune system so there are a lot of implications for doing these kinds of statistical analyses.

 

SARAH:

That was Dr. Jane Figueiredo, from the University of South California, who said this was the first large-scale, genome-wide analysis of genetic variants in the context of dietary patterns. So, more studies are needed to: confirm these findings, understand the biology and to look for more similar interactions…

 

FIGUEIREDO:

If it is true, we can profile people and identify from their genetic profile people who are more susceptible to meat but we’re not at that point. People would like to believe that that is something that would be coming along, and certainly this study, and many other studies that will come down will identify different changes and different interactions that, I think, eventually, may lead us to coming up with some recommendations.

 

SARAH:

Jane Figueiredo, from Los Angeles.

 

SEGMENT 4: Brain imaging techniques improve diagnosis of patients who might recover consciousness from an apparent vegetative coma

 

PETER:

Functional brain imaging could become very useful for predicting whether patients who appear to be in a vegetative coma have any potential to recover consciousness…

 

SARAH:

Yes, that’s according to the largest trial to date, reported in The Lancet, assessing positron emission tomography and functional MRI in 126 patients with severe brain damage. PET scanning seemed particularly helpful, and Professor Jamie Sleigh, from New Zealand, wrote a comment on the study:

 

SLEIGH:

Positron emission tomography looks at the metabolism that’s going on in parts of the brain and so... They essentially found that those patients who had a very low level of metabolism --particularly in certain areas of the brain that seem associated with consciousness -- none of them seemed to recover consciousness. Other patients who seemed to be in a vegetative state, because clinically they weren’t responding much, but had quite a lot of good metabolism going on in their brain --three quarter of those recovered some form of consciousness later.

PETER:

This sounds very exciting because it’s very difficult, in practice, to discriminate between patients in a minimally conscious state and those in a vegetative state isn’t it?

 

SARAH:

Well, exactly, so functional brain imaging could complement standard clinical examination greatly:

 

SLEIGH:

I think the interesting thing in this study was that some patients who were classified as being vegetative, who would generally be thought to have a very poor prognosis, if those patients had a good metabolism, then the prognosis was probably quite a lot better, and you couldn’t really detect that clinically.

SARAH:

That was Jamie Sleigh from the University of Auckland, who said there’s still a lot of work to be done to sort out the best way of going about these tests.  

 

SEGMENT 5: Reduction in salt-intake likely to have contributed to England’s drop in heart attacks and strokes

 

PETER:

An overall reduction in salt intake over the past decade in England, is likely to have contributed greatly to the major drop in heart attacks and strokes seen between 2003 and 2011…

 

SARAH:

Yes, according to a study published in the British Medical Journal Open, dietary salt consumption had dropped by 15 percent since 2003, which is great news for England because salt can increase blood pressure, and this in part leads to heart disease and stroke. And the study found indeed that blood pressure also dropped during that decade, as did cardiovascular mortality, which fell by 40 percent!  

 

MACGREGOR:

When we looked at the blood pressure fall, we took out people with high blood pressure who were on treatment and we then corrected for the other factors so: weight has gone up, fruit and vegetable consumption went up by a very small amount, alcohol has gone up.. and yet it still fell and, you can’t prove it but it is extremely likely that that fall in blood pressure is due to the fall in salt intake.

 

SARAH:

That was Professor Graham MacGregor, from the Wolfson Institute of Preventive Medicine in London, who assessed salt intake in the population by collecting 24 hour-urine samples. He said the drop was due to decreased salt in processed foods:

 

MACGREGOR:

Bread has come down by 25-30 percent, ready-prepared meals have gone down by 40 percent, so you can see: if you do it slowly, no one notices and this is the beauty of it. It affects everybody and you don’t have to change what you’re buying. Whereas telling people to buy foods with less salt in doesn’t work.

 

SARAH:

And Professor MacGregor added that most people around the world eat way more salt than the recommended 6g a day so clearly, there’s a role that industry and legislation can play.

 

MACGREGOR:

First of all, it encourages the UK to keep going and particularly to get the food industry on board because they have to be persuaded to do this in a voluntary policy, it is voluntary. Some countries have regulated so… some are much more advanced than others.

 

SARAH:

Professor Graham MacGregor from London.


IN BRIEF 1: Mothers with higher BMI have increased risk of stillbirth and infant death

 

PETER:

Finally, in brief: a high maternal body mass index, before or during early pregnancy, was associated with an increased risk of stillbirth and infant death. A meta-analysis, published in JAMA, showed the risk was two to three-fold higher in women with a BMI over 40, that’s “severely obese,” compared to women with a BMI of 20. But apparently, even modest increases in BMI were associated with a higher risk for the baby.

 

IN BRIEF 2: Traditional Chinese herbal remedy as effective as methotrexate for treating rheumatoid arthritis

 

PETER:

A traditional Chinese herbal remedy, used to relieve joint pain and inflammation, worked as well as low dose methotrexate for treating rheumatoid arthritis. That’s according to a randomized study, the first head to head comparison, published in the Annals of Rheumatic Diseases. More than that: combining this herbal remedy, called Triptergium wilfordii Hook F, with methotrexate was more effective than either treatment used alone.

 

PETER:

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week. So until then, from me Peter Goodwin, goodbye!

 

 

 

 

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