Tuesday, October 22, 2013

FDA Reviews 2 Promising New Drugs for Hepatitis C

Hepatitis C

Doctors may soon have two new drug options for patients with hepatitis C, just as the liver-destroying virus becomes a major public health concern for millions of baby boomers.
The Food and Drug Administration holds a public meeting this week to review two experimental medications from Johnson & Johnson and Gilead Sciences. The new drugs, if approved, could offer a quicker, more effective approach to eliminating hepatitis C, a blood-borne disease blamed for 15,000 deaths in the U.S. this year.
In a review posted online Tuesday, the FDA reported that J&J's drug simeprevir has a slightly higher cure rate than currently available treatments, though it also caused rashes and sunburn in some patients.
On Thursday the FDA will ask a panel of outside experts whether the drug should carry warnings about rashes and sunburn on its label. The agency is not required to follow the panel's advice, though it often does.
The meeting comes at a time when federal health officials are urging baby boomers to get tested for the virus, which can go unnoticed for decades before causing symptoms.
Between 3 million and 4 million Americans are infected with hepatitis C, and people born between 1945 and 1965 are five times more likely to have it than people of other age groups, according to the Centers for Disease Control and Prevention.
Many baby boomers contracted the virus by sharing needles or having sex with an infected person in their youth. The disease was also spread by blood transfusions before 1992, when blood banks began testing for the virus.
"If something is not done soon, all these people who were infected in the 60s and 70s are going to start experiencing the long-term consequences of liver disease," said Gaston Picchio, head of hepatitis drug development for J&J's Janssen Therapeutics unit.
Most people with hepatitis C do not even know they have the virus until after liver damage has occurred, causing abdominal pain, fatigue, itching and dark urine.
For most of the last 20 years, the standard treatment involved a grueling one-year regimen of pills and injections that caused flu-like symptoms and cured less than half of patients. Many patients failed to complete the full treatment cycle. Others delayed starting treatment at all in the hopes that more effective treatments would come along.
Two drugs approved in 2011 kicked off a new effort to treat the disease. Research shows that adding the two new drugs — Vertex Pharmaceuticals' Incivek and Merck & Co.'s Victrelis — to the older drug cocktail can boost cure rates to between 65 and 75 percent.
And the drugs the FDA is reviewing this week have the potential to push cure rates even higher.
J&J's simeprevir cured 80 percent of patients who had not previously been treated for the disease, according to the FDA's review. Additionally, the vast majority of patients were able to cut their treatment time in half to 24 weeks, compared with the usual 52 weeks. The New Brunswick, N.J., company is seeking approval to combine the daily pill with the older treatment regimen for patients with the most common form of the virus. J&J developed the drug with Swedish drugmaker Medivir.    
On Friday, the same FDA panel will review another hepatitis C drug from Gilead Sciences Inc. that some analysts say will become the first-choice for treating the disease. The pill, known as sofosbuvir, has been shown to cure up to 90 percent of patients after just 12 weeks of therapy, according to one company study. Additionally, analysts believe the drug will eventually be used without interferon, the injectable medication used in the current drug cocktail that causes nausea, diarrhea and other unpleasant side effects.
Gilead is racing against other drugmakers to develop the first all-pill approach to treating hepatitis C, long viewed as the holy grail by drugmakers. Similar efforts are underway from Abbott Laboratories, Bristol-Myers Squibb Co., Vertex Pharmaceuticals and others.
Pharmaceutical industry consulting firm Decision Resources estimates the market for hepatitis C drugs will grow to more than $23 billion by 2018. Sales of the drugs are expected to decline to $17.5 billion by 2021 as more patients are cured of the virus.
Source                                                                                                                                                     ABC News

Hepatitis A


Hepatitis A

Viral hepatitisInfectious hepatitis
Last reviewed: October 16, 2011.
Hepatitis A is inflammation (irritation and swelling) of the liver from the hepatitis A virus.

Causes, incidence, and risk factors

The hepatitis A virus is found mostly in the stools and blood of an infected person about 15 - 45 days before symptoms occur and during the first week of illness.
You can catch hepatitis A if:
  • You eat or drink food or water that has been contaminated by stools (feces) containing the hepatitis A virus (fruits, vegetables, shellfish, ice, and water are common sources of the hepatitis A virus)
  • You come in contact with the stool or blood of a person who currently has the disease
  • A person with hepatitis A does not wash his or her hands properly after going to the bathroom and touches other objects or food
  • You participate in sexual practices that involve oral-anal contact
About 3,600 cases of hepatitis A are reported each year. Because not everyone has symptoms with hepatitis A infection, many more people are infected than are diagnosed or reported.
Risk factors include:
  • International travel, especially to Asia or South or Central America
  • IV drug use
  • Living in a nursing home or rehabilitation center
  • Working in a health care, food, or sewage industry
Hepatitis A
Other common hepatitis virus infections include hepatitis B and hepatitis C. Hepatitis A is the least serious and mildest of these diseases. The other hepatitis infections may become chronic illnesses, but hepatitis A does not become chronic.

Symptoms

Symptoms will usually show up 2 - 6 weeks after being exposed to the hepatitis A virus. They are usually mild, but may last for up to several months, especially in adults.
Symptoms include:

Signs and tests

The doctor will perform a physical examination and may discover that you have an enlarged and tender liver.
Blood tests may show:
  • Raised IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG)
  • Elevated liver enzymes (liver function tests), especially transaminase enzyme levels

Treatment

There is no specific treatment for hepatitis A. Rest is recommended when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver, including acetaminophen (Tylenol).
Fatty foods may cause vomiting, because substances from the liver are needed to digest fats. Fatty foods are best avoided during the acute phase.

Expectations (prognosis)

The virus does not remain in the body after the infection has gone away.
Over 85% of people with hepatitis A recover within 3 months. Nearly all patients get better within 6 months.
There is a low risk of death, usually among the elderly and persons with chronic liver disease.

Complications

There are usually no complications. One in a thousand cases becomes fulminant hepatitis, which can be life threatening.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hepatitis.

Prevention

The following tips can help reduce your risk of spreading or catching the virus:
  • Always wash your hands thoroughly after using the restroom and when you come in contact with an infected person's blood, stools, or other bodily fluid.
  • Avoid unclean food and water.
The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the restroom may help prevent such outbreaks.
If you have recently been exposed to hepatitis A and have not had hepatitis A before or have not received the hepatitis A vaccine series, ask your doctor or nurse about receiving either immune globulin or the hepatitis A vaccine. Common reasons why you may need to receive one or both of these include:
  • You live with someone who has hepatitis A
  • You recently had sexual contact with someone who has hepatitis A
  • You recently shared illegal drugs, either injected or noninjected, with someone who has hepatitis A
  • You have had close personal contact over a period of time with someone who has hepatitis A
  • You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis A
Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after receiving the first dose. The 6- to 12-month booster is required for long-term protection.
Travelers should take the following precautions:
  • Avoid dairy products.
  • Avoid raw or undercooked meat and fish.
  • Beware of sliced fruit that may have been washed in contaminated water. Travelers should peel all fresh fruits and vegetables themselves.
  • Do not buy food from street vendors.
  • Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur.
  • Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.)
  • If no water is available, boiling water is the best method for eliminating hepatitis A. Bringing the water to a full boil for at least 1 minute generally makes it safe to drink.
  • Heated food should be hot to the touch and eaten right away.

References

  1. Advisory Committee for Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Recommended immunization schedules for children, adolescents, and adults -- United States, 2010 (accessed November 9, 2010).
  2. Advisory Committee for Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC) Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007;56:1080-1084. [PubMed]
  3. Hoofnagle JH. Acute viral hepatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 151.
  4. Sjogren MH, Cheatham JG. Hepatitis A. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 77.
  5. Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, Favorov MO, Margolis HS, Bell BP. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007;357:1685-1694. [PubMed]
Review Date: 10/16/2011.
Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California.
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Copyright © 2013, A.D.A.M., Inc.

What is the difference between Hepatitis A, B and C?

Question: Can you explain the difference between Hepatitis A, B and C (and other letters)? If I get a vaccination for hepatitis, which am I protected from?
Answer: “Hepatitis” means inflammation of the liver. It can have many causes, including viruses, medications and alcohol. Most commonly, however, we think of the viruses, called A, B and C.
Hepatitis A causes an acute hepatitis that almost always gets better on its own. It is easily spread from person to person, in food and water, and can infect many people at once. Hepatitis B can be both acute (short-term illness) and chronic (ongoing illness), and is spread through blood or other body fluids in various ways. Hepatitis C is almost always chronic and spreads only by blood. Hepatitis A and B can be prevented by vaccination, but not Hepatitis C. There are now many good medications available to treat chronic Hepatitis B and C.
The symptoms of acute hepatitis include yellowing of the skin and eyes, nausea, fever and fatigue. Chronic hepatitis may have no symptoms, and can last many years and lead to cirrhosis of the liver, which means the liver becomes heavily scarred and less functional. Cirrhosis can sometimes lead to cancer of the liver or liver failure, both of which may require a liver transplant.
Prevention is very important. Other than vaccination, people should be very careful about hygiene (such as hand-washing after using the restroom) to prevent Hepatitis A. Hepatitis B and C can be transmitted by sex or sharing needles, razors, or toothbrushes with someone who has the disease. In the U.S., there are about 4 million people with Hepatitis C, and 2 million with Hepatitis B. All three forms of viral hepatitis are very common around the world.
 Source                                                                                                                                                                                                       Richard Manch, MD, is the medical director of the Banner Good Samaritan Liver Disease Center in Phoenix, Ariz.

Refreshing Our Hearts

Refreshing Our Hearts