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Dr Patrick Marcellin, Beaujon Hospital

New Strategies to Manage Patients With Viral Hepatitis

Paris (ots/PRNewswire)

- World Experts Meet in Paris for the First International
Conference on  the Management of Patients With Viral Hepatitis
The world's leading hepatitis experts, along with more than 850
physicians, will be meeting in Paris on September 10 and 11 for the
first International Conference on the Management of Patients with
Viral Hepatitis. The conference will review the most current
information about viral hepatitis B and C, among the most frequent
viral infections in the world, which have seen major advances in
their treatment in recent years.
"Today, hepatitis B can be brought under control and hepatitis C
can actually be cured. Therefore, these results should be applied in
day-to-day clinical practice without further delay," says Professor
Patrick Marcellin of the Liver Unit, hôpital Beaujon in Clichy,
France.
Over the past few years, medical research has made it possible to
develop effective treatments for viral hepatitis at a rapid pace, and
clinicians are not always able to apply the latest findings to their
clinical practice. "The objective of this international meeting,"
says Prof. Marcellin, "is to give leading international specialists
an opportunity to explain today's level of clinical knowledge in
clear terms that physicians can apply directly to their practice and
therefore benefit patients."
Hepatitis C: current knowledge and new developments
Worldwide prevalence of hepatitis C varies between 0.1 and 5%,
depending on the country. Some 170 million people are infected by the
hepatitis C virus across the globe, including 4 million in the United
States and 5 million in Western Europe. In France, it is estimated
that between 400,000 and 500,000 persons are infected, which
represents 1.1 to 1.2% of the adult population. This figure reaches
60% for intravenous drug users, 25% for prisoners, and 25% for
patients living with HIV. Hepatitis C is the cause of 60% of primary
liver cancers and 30% of liver transplants. As a result, hepatitis C
is the number one cause of liver transplants in the world.
"Management of patients with hepatitis C is probably the area
where the most significant strides have been made. Today, doctors
have more effective and better adapted treatments for patients. The
virus was identified in 1989, and every year new studies make it
possible to improve therapy and increase efficacy for both patients
who were never treated and for patients who did not previously
respond to treatment," says Prof. Christian Trépo of the Hôpital
Hôtel-Dieu in Lyon, France.
A combination of pegylated interferon and ribavirin has been shown
to have the greatest efficacy and is currently the standard of care.
Clinical studies conducted in the last few years have demonstrated a
sustained virological response in more than 80% of patients with
genotype 2 and 3, and more than 50% of patients with the more
difficult-to-treat genotype 1[1]. Studies have also been conducted
using different treatment durations (6 months versus one year) and
lower doses of ribavirin, according to the infecting genotype[2]. The
ability to predict the patient's response after 12 weeks of treatment
is a decisive factor in the management of treatment and encourages
better patient adherence, which is essential for a cure. New evidence
has paved the way to treat patients with either the most benign form
of the disease (chronic hepatitis C with 'normal' transaminase
levels[3]) or with the most severe form of the disease (cirrhosis).
Among cirrhosis patients who clear the virus, a regression of hepatic
lesions appears to be also possible[4],[5].
A number of studies of individuals co-infected with both hepatitis
C virus (HCV) and HIV have made it possible to better define
treatment for these patients, doctors heard. The recent publication
in the New England Journal of Medicine (July 29, 2004)[6] of the
results of the APRICOT study (AIDS PEGASYS(R) Ribavirin International
CO-infection Trial) should lead to far-reaching changes in the
treatment of HIV/HCV co-infection. This international study has shown
that the combination of pegylated interferon alfa-2a and ribavirin
achieved a sustained virological response in 40% of patients - the
highest rate ever reported in a clinical trial of co-infected
patients.
"Even though significant progress has been made, nearly half of
patients still do not respond to the treatments that are currently
available. These treatments often have side effects and can be poorly
tolerated. It is important to continue research," says Prof. Levrero
of Policlinico Umberto I in Rome, Italy. "Research is being pursued
in several directions. The most promising paths are enzyme inhibitors
such as protease inhibitors, which are currently in early clinical
trials[7]."
Hepatitis B: current knowledge and new developments
"Hepatitis B is the 'poor relation' among the different types of
hepatitis, even though one third of the world's population is
infected and 350 million people are chronic carriers of the hepatitis
B virus and can potentially transmit it," explains Prof. Patrick
Marcellin. The hepatitis B virus is mainly prevalent in developing
countries, and especially so in Southeast Asia and sub-Saharan
Africa, where more than 8% of the population are chronic carriers of
the hepatitis B surface antigen. In recent years there has been an
increase in the prevalence of hepatitis B in the West due to
immigration from Africa and Asia. This viral disease is the cause of
more than one million deaths worldwide each year.
Acute hepatitis B is often asymptomatic, but nearly one in 10 of
those infected develops a chronic infection with a risk of spreading
it to others. Due to the asymptomatic nature of the disease and a
lack of routine screening among high-risk populations, diagnosis
often comes too late. Safe, effective vaccines have been developed
for hepatitis B and immunisation programs make it possible to control
the spread of the disease and have resulted in clear benefits for the
prevention of cirrhosis and cancer.
With further research, it may be possible to develop new therapies
that do not bring the disadvantages of current treatments, such as
poor tolerance and diminished long-term efficacy due to viral
resistance. Three drugs are currently available for the treatment of
chronic hepatitis B. Conventional non-pegylated interferon-alpha
induces a sustained response in only 10 to 30% of patients.
Nucleoside (lamivudine) and nucleotide (adefovir dipivoxil) analogues
are well tolerated, but their efficacy is impaired by viral
resistance (especially high for lamivudine). Treatment with
nucleoside or nucleotide analogues need to be indefinitely
administered in the majority of patients which increases the risk of
occurrence of viral resistance.
Recent studies have revealed markedly improved efficacy with
pegylated interferon compared with conventional non-pegylated
interferon[8], providing inhibition of viral replication in nearly
50% of patients[9]. Combination therapies using various drugs are
currently under evaluation, although the optimal therapeutic approach
remains to be determined. A number of nucleoside analogues currently
under development are likely to play an important role in treatment.
For the future, it appears likely that therapeutic combinations will
be needed to reduce the risk of resistance.
The international hepatitis community is aware of the need to
share the latest information about the progress made in the field of
both hepatitis B and C. This will improve the management of all
affected patients who will benefit from the optimal currently
available treatments.
Note to the editor:
This conference was organised by Professor Patrick Marcellin and
runs September 10th and 11th 2004 at the Palais des Congrès, Paris,
France.
References
[1] Fried MW et al, N Engl J Med. 2002 ; Sep 26 ; 347(13) : 975-85
[2] Hadziyannis et al, Ann Intern Med. 2004 ; Mar 2 ; 140(5) :
346-55
[3] Marcellin et al, Gastroenterol Clin Biol. 2004 ; 28:A18.
[4] Pol et al, Hum Pathol. 2004 Jan;35(1):107-12.
[5] Marcellin, Ann Intern Med. 1997 Ann Intern Med. 1997 Nov
15;127(10):875-81.
[6] Torriani FJ et al, N Engl J Med. 2004 Jul 29 ; 351(5 ):
438-50.
[7] Lamarre D et al, Nature. 2003 Nov 13;426(6963):186-9
[8] Cooksley WG, J Viral Hepat. 2003 Jul ; 10(4) : 298-305.
[9] Marcellin et al, Gastroenterol Clin Biol. 2004 ; 28:A60.

Contact:

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(Fgaudry@ruderfinn.fr), Ruder Finn, Tél:
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