April 17, 2015

Hepatitis C Will Share Spotlight This Year at Liver Congress


Medscape Medical News > Conference News

Miriam E. Tucker

April 17, 2015

Hepatitis C will again be a hot topic at this year's European Association for the Study of the Liver (EASL) International Liver Congress, but other subjects, such as nonalcoholic fatty liver disease, hepatocellular carcinoma, and noninvasive liver function assessment, will share more of the spotlight than they did previously.

There will also be a bit of a celebration in Vienna as EASL marks the fiftieth anniversary of the organization and the Congress, and the thirtieth anniversary of the Journal of Hepatology.

Hepatitis C dominated the agenda at last year's Congress, where phase 3 data from several manufacturers of oral interferon-free treatments were rolled out. But the issue has shifted from proving that the drugs work — in fact, sustained virologic response is now achieved in more than 90% of all hepatitis C patients — to the cost of treating patients in urgent need.

"Cost is now the main issue. We know we can cure almost everyone. Now we're focusing on the most severe patients, including those with liver transplants and decompensated patients who couldn't be cured before. And we'll be getting data on real-life cohorts," EASL vice-secretary Laurent Castera, MD, told Medscape Medical News.

A session will be devoted to the revised EASL hepatitis C treatment guidelines, which will be posted on the website shortly before the meeting and subsequently published in the Journal of Hepatology, according to EASL secretary-general Markus Peck-Radosavljevic, MD.

New Hep C Guidelines

"We think we will have better discussions if people have already had a chance to go through them," Dr Peck-Radosavljevic told Medscape Medical News.

More public health sessions have been added this year. "We already had a public health track, but we re-enforced that, so there's more this year," he reported. "I think that is needed, especially in viral hepatitis, because the interest has now shifted from finding the best cure — of which there are now several — to how we can get this cure out to all the people who need it. For that reason, public health is occupying a larger part of the meeting."

Although the focus is on treating the sickest patients for now, the field is "slowly moving toward treating all patients. Of course, ultimately that's the goal. The cost is coming down everywhere, and it will come down further with the competition," he added

Several of the top studies presented will focus on nonalcoholic fatty liver disease, an increasing problem as rates of obesity continue to climb. "Now that hepatitis C will be controlled and cured, there's increasing awareness of fatty liver disease. This will be the future of hepatology," Dr Castera predicted.

"This is becoming an interesting issue, with clinical trials describing not only epidemiology and pathophysiology, but also moving into treatment," said Dr Peck-Radosavljevic. One of the trials that will be presented is a phase 2 trial of the diabetes drug liraglutide, for which "the data are good," he added.

Three of the four postgraduate courses will be devoted to fatty liver disease; the fourth is on liver transplantation. And three basic science seminars will address hepatocellular carcinoma.

Europeans are leading the way in the noninvasive assessment of liver disease, including hepatitis, cirrhosis, fatty liver disease, and hepatocellular carcinoma, according to Dr Castera, who was involved in the development of a set of guidelines on the topic that will be released in conjunction with the meeting.

Noninvasive Assessment

Despite a decade of work in the area, these will be the first-ever guidelines on noninvasive methods. They will address, among other things, ultrasound and blood tests for the diagnosis and monitoring of liver disease.

"This has really been a major revolution, particularly in Europe. It will really change the field, especially for hepatitis C patients," said Dr Castera, pointing out that there will be a recommendation to use noninvasive methods in the first line to determine the degree of fibrosis in every patient with hepatitis C.

But, he added, noninvasive diagnostic and monitoring techniques are also important in other liver diseases, such hepatocellular carcinoma, and for the characterization of fatty liver disease.

"Noninvasive assessment has generated a lot of interest for more than 10 years. It allows you to get information a lot more readily from your patients, both at diagnosis and as disease progresses," Dr Peck-Radosavljevic told Medscape Medical News. "We thought the data were good enough to write a guideline."

Anniversaries and Celebrations

In addition to a ceremony to commemorate the anniversary of EASL and the publication of an anniversary issue of the Journal of Hepatology to coincide with the meeting, there will be an acknowledgment that the journal "has reached an impact factor above 10," Dr Castera told Medscape Medical News.

Dr Peck-Radosavljevic will say a few words about the anniversary during his opening address and show some old photos, but "we won't do too much on the history," he said. "To be honest, we need the time for other things in the opening. We're doing so many things that it's important for people to know what's happening right now."

Dr Castera has served on the speaker's bureau for Echosens, which manufactures a FibroScan elastography device. Dr Peck-Radosavljevic has financial relationships with AbbVie, ArQule, Bayer, BMS, Gilead, Lilly MSD, Boehringer-Ingelheim, and Roche.