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Michael Fried, MD

Despite treatment success rates of 95 percent and better, hepatitis C (HCV) therapy can still improve. Finding a universal cure is the goal, according to Michael Fried, MD, professor of medicine and director of the UNC Liver Center at the University of North Carolina, Chapel Hill.

“We are really at the point of curing all patients of hepatitis C, of leaving no SVR [sustained viral response] behind,” Dr. Fried said. “Even though the regimens we have today are incredibly effective, there are certain populations that may benefit from longer duration of therapy, addition of ribavirin under certain circumstances or other tweaks so that we are approaching universal cure.”

Dr. Fried will moderate the AASLD Clinical Symposium, Prospects for New HCV Treatments, Monday afternoon. The session’s expert presenters will review the latest thinking on special populations that may need more intensive treatment, the prospects for curing patients with decompensated liver disease, dealing with patients who fail to respond to treatment and the prospects for new therapeutic agents in the near term.

“These are topics no one would have believed 10 years ago, even five years ago,” Dr. Fried said. “The world has changed in dramatic ways when we start talking about ways to improve on 95 percent treatment success. Patients with hepatitis C should be incredibly hopeful, as they already are.”

In the early days of HCV treatment, success rates fell between 7 and 20 percent. Today, overall response rates routinely top 95 percent. And while there are no longer problem populations, there are populations that are more challenging than most. For these patients, the goal is to optimize treatment from a growing armamentarium of direct-acting antiviral agents and combination regimens.

Patients with decompensated liver disease can be treated for HCV and even cured, Dr. Fried noted. However, these patients are excluded from certain treatment regimens because of potential toxicity. Additionally, the question remains whether curing these patients will bring significant long-term advantages, such as avoiding liver transplantation.

Patients who fail treatment are another challenging group. Fortunately only a relatively small number of patients do not respond to treatment even when they are 100 percent adherent.

“We think treatment failure for these patients may have to do with resistant variants of the virus that need to be managed,” Dr. Fried said. “When you truly fail therapy, you usually fail with a selection of resistant variants. Knowing what to do for these patients with some of the newer generations of medications will be very important for that minority who fail despite their best efforts.”

Several new agents and new combinations within existing treatment categories will likely be approved over the next 18 months, Dr. Fried added.

“I want to stress that the current regimens are incredibly effective,” he said. “But when people do fail therapy, we will have regimens that have non-overlapping resistance profiles with which to treat them. We are looking at the very real possibility of new dual- and triple-agent regimens that will treat more patients more effectively.”
Access to treatment is also improving, he said, noting that increased competition is bringing prices down and payors are beginning to recognize the advantage of curative treatment.

“We have an outstanding panel of speakers for this symposium who will present new and key information in a very concise way,” Dr. Fried said. “This symposium will immediately change clinical practice for those who currently manage or plan to manage patients with hepatitis C.”

Please refer to the DDW Mobile App or the schedule-at-a-glance in Monday’s issue for the time and location of this and other DDW® events.