Recent dramatic changes in the treatment of hepatitis C has prompted the Canadian Association for the Study of the Liver (CASL) to issue updated clinical guidelines for managing hepatitis C, a serious liver disease. Thanks to new direct-acting antivirals that are significantly more effective for patients with the most common form of the disease (genotype 1) and new options for predicting treatment outcome, the treatment prospects for patients have never been brighter. The new guidelines published in the June issue of the Canadian Journal of Gastroenterology recommend that it is now time to consider treating all willing hepatitis C patients who do not have liver failure.
According to modeling data, the incidence of advanced hepatitis C complications will continue to rise over the next decade putting a severe burden on Canada’s health care resources and driving up the demand for liver transplants. Liver cancer is one of the few forms of cancers on the rise in this country and this trend is expected to continue due in part to hepatitis C. Although chronic hepatitis C affects an estimated one per cent of the population, a significant proportion remains undiagnosed and of those who have been diagnosed, many have not been treated.
“The low efficacy rates of the standard pegylated interferon and ribavirin treatment led many treating physicians to hold off on recommending treatment to their genotype 1 patients,” says Dr. Kevork Peltekian, President of the Canadian Association for the Study of the Liver and hepatologist at the Queen Elizabeth II Health Centre in Halifax. “Thanks to newly approved triple combination therapies, the odds of achieving complete viral eradication in these patients have improved substantially. We believe that treatment should be considered for all hepatitis C patients regardless of fibrosis stage or normal ALT levels.”
Physicians in Canada that care for patients with hepatitis C genotype 1 now have access to a comprehensive document which outlines current recommendations for treatment protocols and offers additional alternatives for assessing fibrosis beyond what is considered the ‘gold standard’, a liver biopsy.
“The reality is that biopsies are not available in all parts of the country and it is an invasive procedure that carries a certain degree of risk,” says Dr. Robert Myers, Associate Professor and Director of the Viral Hepatitis Clinic, University of Calgary and lead author of the guidelines. “CASL members agree that elastography (for example Fibroscan®) and serum biomarker panels (including FibroTest) used alone or in combination can be just as effective in assessing fibrosis.”
In addition to the direct-acting antivirals, another major advance offers physicians a method for predicting treatment response. “We have identified several single nucleotide polymorphisms (SNPs) – or variations in a patient’s genetic sequence – that correlate with their likelihood of clearing the virus,” says Dr. Myers. “These indicators should not be used to rule out therapy but are another source of information that may help guide decisions regarding treatment.”
Recognizing the importance of giving physicians the tools to treat, the CLF was pleased to be able to fund the CASL Consensus Conference on Viral Hepatitis and the development of the new clinical guidelines for the management of chronic hepatitis C. “The consensus guidelines comprise the opinions of this country’s experts on the best methods and strategies for treating hepatitis C,” says Dr. Morris Sherman, Chairman of the Canadian Liver Foundation. “This will be a crucial document to share with provincial and federal governments as part of our advocacy efforts for more attention to and investment in patient care and research in hepatitis C. We encourage all physicians to join us in these efforts on behalf of their patients.”
In conjunction with the new clinical guidelines, the Canadian Liver Foundation (CLF) has launched a new awareness campaign to encourage Canadians to learn about the risk factors for hepatitis C and to get tested. The campaign features public service announcements by Gemini-nominated comedian Mike MacDonald who has hepatitis C. The radio and TV spots entitled ‘No Laughing Matter’, highlight the fact that it only takes “one incident or one moment in time” to contract hepatitis C and urges people to visit www.liver.ca to learn more.
To view the new Consensus Guidelines on the Management of Hepatitis C, visit the Canadian Journal of Gastroenterology website at www.pulsus.com/gastro. For more information on hepatitis C and to find out how to get involved in the CLF’s advocacy initiatives, visit www.liver.ca