Research & Treatment News
May 24, 2010
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Although eltrombopag may help some people complete Hepatitis C therapy and thus beat the virus, learn why the FDA is warning physicians that this platelet-boosting drug poses a risk to those with chronic liver disease.
by Nicole Cutler, L.Ac.
Following the latest news updates on medications that you have been or could be prescribed is a monumental and often frustrating task. This is especially true for those living with chronic Hepatitis C, since new developments related to this illness seem to emerge on a daily basis. A recent report from the U.S. Food and Drug Administration (FDA) has delivered news that ranks high on the priority list of things those with Hepatitis C should be aware of. In collaboration with the FDA, GlaxoSmithKline unveiled important information about the platelet-boosting drug eltrombopag (Promacta), specific to individuals with liver disease.
What Is Eltrombopag?
To help those with a blood-clotting problem, eltrombopag is a medication that increases the production of platelets. Other drugs that can restore normal platelet functions are infusions or injections, while eltrombopag has the advantage of being a pill taken just once a day.
Irregularly-shaped, colorless cells that are present in blood, platelets have a sticky surface that helps them form clots to stop bleeding. This function is necessary, because the human body does not handle excessive blood loss well. Thus, individuals who have low levels of platelets in their blood run a substantial risk of a dangerous bleed. There are a handful of conditions that could lead to low platelet levels. Because it is one of the most severe side effects of ribavirin, a low platelet count is the most prominent reason for discontinuing Hepatitis C combination therapy (pegylated interferon and ribavirin).
Eltrombopag Used for Hepatitis C
Following a 2007 study by Duke University Medical Center researchers, eltrombopag has been a medication preferred by some hepatologists for certain individuals with Hepatitis C. According to the study involving Duke and other centers worldwide, eltrombopag was found to boost platelet levels of a majority of patients with low platelet counts and cirrhosis of the liver due to Hepatitis C infection.
Completing the fully prescribed course of Hepatitis C combination therapy offers those with this liver disease the most hope for recovery. Unfortunately, many must discontinue Hepatitis C treatment because of its severe side effects. By capitalizing on the platelet-boosting action of eltrombopag, patients with low platelet counts were deemed eligible for beginning or continuing Hepatitis C combination therapy - giving them a better chance of eliminating the virus.
The Eltrombopag Warning
Despite the appearance of eltrombopag being a savior for many people trying to complete Hepatitis C treatment, a new safety finding reveals just the opposite. Upon this discovery, the FDA has begun notifying healthcare professionals to be aware of eltrombopag increasing the likelihood of a venous thrombus in those with chronic liver disease. Also known as a blood clot in a vein, a venous thrombus located in deep veins is a major risk for a pulmonary embolism - a potentially fatal event. Although the study revealing this trend was small, there was a clear tendency to forming venous blood clots in participants who took eltrombopag compared to those taking a placebo. While GlaxoSmithKline is working with regulatory agencies to include more specific safety information on eltrombopag's label, here is what you should know:
· Eltrombopag should be aimed at increasing the platelet count to a level that reduces the risk of bleeding - not for bringing the platelet count up to normal.
· Additional caution should be exercised when administering eltrombopag to those with Hepatitis C, including lower dosages and monitoring the patient closely.
Any course of therapy must carefully weigh potential risks with the possible benefits. When it comes to fighting Hepatitis C, this analysis gets complicated, especially if managing low platelet counts during antiviral therapy. Your healthcare provider should be aware of this new warning by the FDA. However, we are always our own best advocates, so make sure you know about the potential risk of using eltrombopag during Hepatitis C therapy.
References:
http://www.docguide.com/news/content.nsf/news/852576140048867C8525772100737C12, FDA Warns Against Eltrombopag Use in Patients With Chronic Liver Disease, Retrieved May 17, 2010, Doctor's Guide Publishing Limited, 2010.
http://www.drugs.com/mtm/eltrombopag.html, eltrombopag, Retrieved May 19, 2010, drugs.com, 2010.
http://www.fi.edu/learn/heart/blood/platelet.html, Platelets: Sticky Situations, Retrieved May 19, 2010, The Franklin Institute, 2010.
http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2010;volume=16;issue=1;spage=51;epage=56;aulast=Danish, Considerations in the management of hepatitis C virus-related thrombocytopenia with eltrombopag, Fazal A Danish, et al, Retrieved May 17, 2010, The Saudi Journal of Gastroenterology, January 2010.
http://www.sciencedaily.com/releases/2007/11/071128172408.htm, Pill Boosts Platelets In Hepatitis C Patients, Retrieved May 17, 2010, ScienceDaily LLC, 2010.
Posted by Editors at 12:52 PM --- Printer-friendly version
May 13, 2010
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May is Hepatitis Awareness Month, and there is no better time to participate in the much-needed improvement of viral hepatitis prevention, control and surveillance programs.
by Nicole Cutler, L.Ac.
The medical accomplishments of today are often a result of the hard work and dedication of the previous generation. For those who enjoy pristine health, it is easy to take the evolution of modern medicine for granted. But when it comes to medical issues that combine healthcare and politics, those with chronic viral hepatitis don't have the luxury of taking medical progress for granted. Marking the 15th anniversary of Hepatitis Awareness Month in the United States, May 2010 is a prime opportunity to demonstrate political solidarity in an effort to raise viral hepatitis awareness.
There is no question that the primary culprits of chronic viral hepatitis, the Hepatitis B and Hepatitis C viruses, are major health problems worldwide. Even though those with either viral strain have a better chance of eliminating the virus with early detection and treatment, chronic viral hepatitis often goes undetected until it has progressed to advanced liver disease. Unfortunately, chronic viral hepatitis is the most common reason for a liver transplant in the United States, and frequently leads to cirrhosis, liver failure or liver cancer.
A division of the National Academy of Sciences, the Institute of Medicine announced study results in 2010 proving that chronic viral hepatitis is in need of resources to match its toll on the public health system. The researchers concluded that more funds are required to boost knowledge and awareness, surveillance and healthcare services for chronic viral hepatitis. Upon realizing these specific needs as outlined by the Institute of Medicine, most who understand the prevalence and severity of viral hepatitis are ready to demonstrate a political stance in favor of funding for this disease.
Below are two opportunities to get involved in the union of healthcare and politics - with the overarching goal to endorse viral hepatitis prevention, control and surveillance programs.
1. March in Washington - On May 19, 2010, which also happens to be World Hepatitis Day, a rally in Washington D.C. will be held at the United States Capitol. Sponsored by the National Viral Hepatitis Roundtable, the goal of this march is to demand that Congress fully funds hepatitis programs in the U.S.
2. Support Bill H.R. 3974 - Otherwise known as the Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009, bill H.R. 3974 was written to amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish, promote, and support a comprehensive prevention, education, research, and medical management referral program for viral hepatitis infection. This program will lead to a marked reduction in the disease burden associated with chronic viral hepatitis and liver cancer.
Since this important bill is currently in the first step of the legislative process, public support counts. By letting your U.S. House of Representative know (via phone call or email) that you support this bill, you are making your desire to enhance hepatitis awareness known. You can reach your Representative by calling the Capitol Switchboard at (202) 224-3121, or email Representatives directly from writerep.house.gov.
Because there are so many worthy causes and limited resources, government-sponsored programs to improve prevention, education and access to medical care always involves dedicated advocates. When it comes to the tremendous burden of viral hepatitis on America's health and well-being, there are few worthier causes. With this in mind, there is no better time than now to get political by joining the March 19, 2010 rally or conveying your support of H.R. 3974 - because the efforts we make today will make a difference in hepatitis awareness tomorrow.
References:
http://cdc.gov/mmwr/preview/mmwrhtml/mm5917a1.htm, Hepatitis Awareness Month --- May 2010, Retrieved May 7, 2010, Centers for Disease Control and Prevention, 2010.
http://www.experiencefestival.com/a/1960s_-_Events_and_trends/id/4726438, 1960s Events and Trends, Retrieved May 6, 2010, Global Oneness, 2010.
http://www.govtrack.us/congress/bill.xpd?bill=h111-3974, H.R. 3974: Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009, Retrieved May 7, 2010, govtrack.us, 2010.
http://www.hepb.org/advocacy/awareness_month.htm, May is National Hepatitis Awareness Month, Retrieved May 7, 2010, Hepatitis B Foundation, 2010.
http://www.iom.edu/Reports/2010/Hepatitis-and-Liver-Cancer-A-National-Strategy-for-Prevention-and-Control-of-Hepatitis-B-and-C.aspx, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C, Retrieved May 7, 2010, Institute of Medicine, 2010.
http://www.natap.org/2010/HCV/032610_03.htm, The Institute of Medicine report on viral hepatitis: A call to action, Retrieved May 7, 2010, Hepatology, March 2010.
http://www.nvhr.org/calltoaction.htm, A Call To Action!, Retrieved May 6, 2010, National Virus Hepatitis Roundtable, 2010.
Posted by Editors at 11:56 AM --- Printer-friendly version
May 12, 2010
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Denial is a logical response to a new Hepatitis C diagnosis. While being in denial has some practical uses, refusing to accept this liver disease can be harmful to you and your loved ones.
by Nicole Cutler, L.Ac.
Regardless of how long Hepatitis C has inhabited a liver, receiving a diagnosis of this illness is far greater than many people can immediately handle. As is the case for many chronic, potentially terminal diseases, the psyche cycles through a variety of emotions before settling down. Denial represents one of the most commonly encountered stages of coming to terms with a new Hepatitis C diagnosis. While refusing to accept your illness is an initial protective mechanism, getting stuck in this phase could pose a serious risk to the person with the disease and those in close proximity to him or her.
As described in the book The First Year: Hepatitis C: An Essential Guide for the Newly Diagnosed, many newly diagnosed with Hepatitis C find themselves experiencing the following five stages of grief:
1. Denial and isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance
These stages represent the feelings and coping mechanisms endured in the grieving process of accepting any kind of unwanted change. Experts recognize that these stages can occur sequentially, cyclically or simultaneously. Regardless of how these emotions are experienced by someone coming to terms with his or her Hepatitis C diagnosis, each individual goes through this process at his or her own pace.
Denial's Usefulness
When it comes to this common first reaction to discovering a positive Hepatitis C status, denial can be a valuable coping mechanism. Willfully ignoring facts helps some people maintain sanity in insane situations; for others, it postpones the need to deal with them. Thus, initially refusing to acknowledge the reality of a chronic illness acts as a shock absorber, so that a person can slowly accept his or her prognosis.
When it happens on his or her own time schedule, someone in this position will be more prepared to deal with the realities of living with Hepatitis C, such as:
· How he or she may have acquired Hepatitis C
· How he or she can prevent transmitting his or her illness to others
· Learn about his or her degree of liver disease and corresponding treatment options
· How to disclose his or her health status to family, friends and coworkers
· What lifestyle changes he or she has to make
· How to finance his or her battle against Hepatitis C
When Denial Is Not So Useful
Despite the important preparatory role denial can play in learning you have a chronic, progressive liver disease with no guaranteed cure, ignoring a Hepatitis C status for too long can be detrimental. For people who are overwhelmed by self-blame, depression and feelings of hopelessness, there is a risk of inflicting self-harm. In this situation, professional help should be sought immediately.
Additionally, denying a Hepatitis C diagnosis for an extended period of time can be harmful, because:
· Treatment Is Delayed - Some people live with Hepatitis C for decades without any indication of illness. Nonetheless, several studies have demonstrated that antiviral treatment has the best chance of success when administered in the earlier stages of Hepatitis C infection. Being in denial can delay treatment to a point where the odds of beating the virus diminish.
· Others May Be Infected - Although infecting others with Hepatitis C is easiest if intravenous drug supplies are shared, there are other ways to pass on the virus. By staying in denial, those infected may not know that sexual partners or household members who share personal items are at increased risk of acquiring Hepatitis C.
· Harmful Behaviors Are Continued - Refusal to acknowledge Hepatitis C may allow behaviors that fuel liver damage to continue. Such behaviors - like drinking alcohol, smoking cigarettes or doing illicit drugs - can cause viral load to multiply and lead to hastened liver cell death.
· Protecting the Liver Takes Longer - Once a Hepatitis C diagnosis is acknowledged and put into perspective, several approaches can help a person protect his or her liver from the constant viral assault. The longer a person stays in denial, the more time elapses before liver disease progression is stopped. Lifestyle changes such as supplementing with milk thistle, exercising regularly, prioritizing sleep and eliminating processed foods can help people live healthfully with Hepatitis C (instead of being sick from Hepatitis C).
As a whole, learning as much as you can about Hepatitis C can help ease someone from denial into acceptance. According to Beri Hull, the Global Advocacy Officer at The International Community of Women Living with HIV and AIDS, "Being in denial, and not knowing much about hepatitis C makes it more frightening."
Refusing to accept a diagnosis of Hepatitis C is a normal precursor to accepting this unwanted illness. While denial as an initial response serves a purpose, it can be dangerous to stand in this perspective for an extended period of time. Because it can delay your treatment, lead to the infection of other people, foster the continuation of harmful behaviors and prevent you from protecting your liver, being in denial about Hepatitis C can be extremely detrimental if allowed to persist for anything more than a short period of time.
References:
Bruce, Cara, Lisa Montanarelli, Teresa L. Wright, The First Year: Hepatitis C: An Essential Guide for the Newly Diagnosed, Marlowe & Company, Cambridge, MA, 2007; 4-6.
http://www.care2.com/greenliving/6-ways-to-deal-with-denial.html, 6 Ways to Deal With Denial, Paula Spencer, Retrieved October 10, 2009, Caring.com, 2009.
http://www.helium.com/items/1491419-reacting-to-hepatitis-c-diagnosis, Rachelle de Bretagne, Retrieved October 11, 2009, Helium, 2009.
http://www.hepeducation.org/supportgroups/documents/DISCLOSURE.pdf, Hepatitis C Disclosure, Alan Franciscus, Retrieved October 10, 2009, Hepatitis C Support Project, June 2002.
http://www.tpan.com/publications/pa/sep_oct_06/hiv_hepc.shtml, Living with HIV and Hepatitis C, Tracy Swan, Retrieved October 10, 2009, tpan.com, 2009.
http://74.125.93.132/search?q=cache:zKq_BmlreSwJ:www.heart-intl.net/HEART/011507/NationalHepatitisC.ppt+denial+hepatitis+c&cd=29&hl=en&ct=clnk&gl=us&client=firefox-a, National Hepatitis C Needs Assessment, Kerry Paterson, Retrieved October 10, 2009, Australian Hepatitis Council, 2009.
Posted by Editors at 12:53 PM --- Printer-friendly version
May 11, 2010
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Based on sophisticated computer and mathematical modeling, researchers predict that a combination of drugs designed to fight three or more mutated strains of Hepatitis C simultaneously is needed to better eradicate this virus.
Combination of direct antivirals may be key to curing hepatitis C
Science Centric | 6 May 2010
A combination of antiviral drugs may be needed to combat the drug resistance that rapidly develops in potentially deadly hepatitis C infections, a new study using sophisticated computer and mathematical modeling has shown.
Using probabilistic and viral dynamic models, researchers at the University of Illinois at Chicago, Oakland University and Los Alamos National Laboratory predict why rapid resistance emerges in hepatitis C virus and show that a combination of drugs that can fight three or more mutated strains may be needed to eradicate the virus from the body. They compared their model with data from a clinical trial of the new direct-acting antiviral medication telaprevir.
The findings are published in Science Translational Medicine.
Continue reading this entire article:
http://www.sciencecentric.com/news/article.php?q=10050606-combination-direct-antivirals-may-be-key-curing-hepatitis-c
Posted by Editors at 11:16 AM --- Printer-friendly version
May 10, 2010
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Even though the scope of Hepatitis B and Hepatitis C dwarfs that of HIV, our progress on viral hepatitis is lagging. Luckily, we can learn from the success of AIDS awareness campaigns on how to shift our focus onto education and funding for viral hepatitis.
by Nicole Cutler, L.Ac.
These days, you would be hard-pressed to find an adult who doesn't know about HIV, the virus that causes AIDS. On the other hand, those familiar with chronic viral hepatitis - including its infectivity, prevalence and severity - are in the clear minority. Despite this inequity, an estimated five times more Americans are currently living with chronic Hepatitis B or Hepatitis C than with HIV or AIDS.
· An estimated 5.3 million people currently live with chronic Hepatitis B or Hepatitis C in the U.S.
· An estimated 1.1 million people currently live with HIV or AIDS in the U.S.
HIV Awareness
HIV (human immunodeficiency virus) was first identified in the United States in 1981. Campaigns to educate the public about this disease's course and how it is transmitted, began to flourish by the late 1980s. Upon recognizing that HIV attacks the immune system and can cause devastating and/or fatal illness, this disease received unparalleled attention in the media, political, education and healthcare arenas. The attention helped change the face of HIV, by:
· Improving Funding - With so many aware of HIV's dangers, research and development funding skyrocketed. This funding eventually led to the creation of medicines that enable people with HIV to live relatively long and healthy lives.
· Many Living With HIV - The U.S. Centers for Disease Control (CDC) estimates that about 1.1 million Americans are currently living with HIV or AIDS. As the yearly rate of new HIV infections continues to decline, those who have the virus are able to live longer.
· Teaching Safe Sex - Known to be transmitted via sexual activity, the massive education campaign about HIV and safe sex has helped prevent many new viral transmissions.
HIV education has clearly resulted in fewer new infections and improved treatment options. Now, it is Hepatitis B and Hepatitis C's turn.
Hepatitis Ignorance
A new Institute of Medicine (the health branch of the National Academy of Sciences) study has found that Hepatitis B and C are not widely recognized as serious public health problems. The consequence of this lack of recognition is that viral hepatitis prevention, control and surveillance programs have inadequate resources. By acknowledging that the current approach for preventing and controlling chronic Hepatitis B and C is not working, the investigators identified the following needs:
· There is a need to increase the knowledge and awareness about chronic viral hepatitis among health care providers, social service providers and the public.
· There is a need to improve surveillance for Hepatitis B and C.
· There is a need to expand the integration of viral hepatitis services.
Both Hepatitis B and C rank among the world's leading causes of preventable deaths. If not recognized and addressed early enough, viral hepatitis can lead to chronic liver disease or liver cancer. Although both viruses can be prevented and are easier to treat if caught early, many find out about their infection only after their hepatitis virus has progressed to advanced liver disease. The cause of 15,000 deaths in the U.S. each year, and the most common reasons for a liver transplant, Hepatitis B and Hepatitis C are serious illnesses.
Evidenced by fewer new infections and dramatically improved treatments, AIDS awareness has made a dramatic impact on HIV. Even though it can be just as dangerous as HIV and infects more Americans, Hepatitis B or C is currently lacking that same level of awareness. As the Institute of Medicine suggests, it is time for our media, politicians, educators and healthcare providers to focus on viral hepatitis. By giving Hepatitis B and Hepatitis C the attention and funding they deserve, the burden of viral hepatitis will finally begin to lighten.
References:
http://www.cdc.gov/hiv/topics/basic/, Basic Information: HIV, Retrieved February 10, 2010, Centers for Disease Control and Prevention, 2010.
http://www.iom.edu/Reports/2010/Hepatitis-and-Liver-Cancer-A-National-Strategy-for-Prevention-and-Control-of-Hepatitis-B-and-C.aspx, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C, Retrieved February 10, 2010, Institute of Medicine, 2010.
http://www.time.com/time/health/article/0,8599,1956864,00.html, Study: Threat of Hepatitis Underestimated, Laura Fitzpatrick Retrieved February 8, 2010, Time Inc., January 2010.
Posted by Editors at 12:12 PM --- Printer-friendly version
