We need Sarah Henderson on the case.

So passionately said .

Hi Em, here's the latest info...
"It’s time for action on Hepatitis C in New Zealand
Thursday, 30 July 2015, 5:01 pm
Press Release: Joint Media Statement

“It’s time for action on Hepatitis C in New Zealand”– Hepatitis C can be eliminated.

Chronic Hepatitis C is a significant viral infectious disease which carries serious long-term implications for health. 50,000 people in New Zealand are living with chronic Hepatitis C, [1] of whom up to 30,000 may not know that they have it. [2] Symptoms are often non-specific, and many people are not tested until they develop serious consequences. [2] For those who live with chronic Hepatitis C infection, there is reduced quality of life and ongoing stigma for them and their families/whanau.

Every year in New Zealand, 1000 people contract Hepatitis C.[2] Since 2000, the numbers of people with severe liver scarring (cirrhosis) caused by Hepatitis C have doubled. This is because people with Hepatitis C are an ageing group, with low rates of diagnosis and very low treatment uptake (<1% per annum).[2] Hepatitis C is now New Zealand’s leading cause of liver transplants, due to liver cancer or complications of cirrhosis,[3] and one driver of the projected increase in deaths from liver cancer.[4] In 2014, approximately 140 New Zealanders died prematurely from consequences of the Hepatitis C virus, and by 2030 this number is expected to climb to 350.[2]

If the current low rates of diagnosis, assessment, and treatment are not dramatically improved, three times as many people are predicted to present with life-threatening complications of liver failure and liver cancer caused by Hepatitis C over the next two decades. [2] This increase would continue to reduce people’s quality and length of life, and also increase costs to New Zealand’s health system. Recent advances in treatments, diagnostic technologies, and methods for assessing the stage of disease, together with lessons learnt from recent pilot projects, suggest that an opportunity now exists to eliminate Hepatitis C in New Zealand by 2030.[2] Modeling shows that changing treatment strategies as soon as new treatments are available could substantially reduce morbidity and mortality, and that Hepatitis C could even be eliminated from New Zealand.[2] These strategies could also result in significant savings to the New Zealand health system, by avoiding direct and indirect costs. Delay in access to new therapies would have a tangible impact, resulting in more than 200 preventable deaths every year.[2]

There is a late breaker from the AASLD conference. It shows that SOF Dac and Simeprevir are the ultimate weapons. Very soon it will be apparent that three way combos of drugs already available will do the job in as little as one month.

It's late breaker number 23 if you want to read the full story.

A third weapon is the answer to replacing Ribavirin not prolonging the course to six months,

They cured some easy to treat patients in THREE weeks. Surely we should be looking at adding Simeprevir instead doubling the time frame of treatment.

From my Hepmag post:
We are suffering an injustice at the hands of Gilead and, by extension, our government.
The US was founded on the principle of equal justice. Gilead is basically a hedge fund. They snapped up the company that developed sofosbuvir because they saw the profit potential. See below:

The cognoscenti were there to hear Gane. An unshowy, respected doctor, he had been working on hepatitis C since the early 1990s, and for the past year, had been carrying out a clinical trial of a particularly promising new drug developed by a small American pharmaceutical company called Pharmasset. The drug was known by its laboratory name, “PSI-7977”, and today, Gane was to give an update on the trial, called ELECTRON.
Sofosbuvir, for all intents and purposes. Gilead bought them out for $11 billion. Check their latest earning reports....

Well, that is fine, because, it too, is the American way-at least until they start telling people "We will sell you your life for your life savings."

The Founders broke a few English laws to start this great country.

We owe it to them and ourselves to bend a few today in the name of fairness and justice for all. This should not be a rich person's cure.

Globalization has set the price for a 12 week treatment of pure generic harvoni at just less than $2000.

Buyer beware.
Buyer be informed.
Buyer get well.

Mike

Q

James-Freeman-facebook wrote: The side effects people got on PEG/Riba may have been more PEG and less Riba than we thought. I have a good dozen patients who are relapses telling me it's much easier than they expected and their numbers look good.

Then again I just took one patient off Riba because after 18 weeks he was getting sick both on the numbers and in spirit. He's feeling much better now and we are getting some blood cells back.

These two comments are much in line with the discussion I had with my hepatologist about suitable treatment for myself.

For the first one, I always thought the sides seemed to cycle around the weekly injection, not all directly afterwards but still cyclic rather than constant as you would expect with daily Riba.

And as I have cirrhosis and will be retreating the recommendation was that 24 weeks looked the best option, hitting it hard from the start with the view to going full term but the possibility that Riba be cut short if I can't tolerate for numbers (or I guess spirit). I agreed this as my best option for guaranteeing success.

But I'm not sure how this translates to SShady43 without cirrhosis as I felt my specialist seemed to think Riba's effect was at least partly based on it's ability to better impact the virus in scar tissue, etc. (I hope I'm am paraphrasing him correctly here.)

That's interesting James, and I don''t doubt you are right, but some drugs are more effective with different genotypes eg Viekira Pak with 1b. Wouldn't it be better if Government negotiated the best price for a cure for each genotype.

1b is the easiest genotype to treat with DAAs and can be done in 3 weeks with 3 DAAs

news.sciencemag.org/health/2015/10/study...eek-hepatitis-c-cure

See LB-23 here....

www.aasld.org/sites/default/files/TLM-20...reakingAbstracts.pdf

Simeprevir is already listed so 1/4 of a course of Harvoni and 1/4 a course of Olysio looks like it will do the trick for RVR patients.

AbbVie and Viekira Pak are more civilized in their PBS negotiations. Better ? It just got a black box FDA warning....

www.fool.com/investing/general/2015/11/0...nd-express-scri.aspx

We, as in Australia do not need all the manufacturers products.

We, as in Australia should invite those Pharma companies who want our TAX DOLLARS to sharpen their pencils.

We, as in Australia should cure as many patients now as we can afford.

Hypothetically why not cut a deal with one?

That would be infinity percent more patients getting treatment. Currently it is a division by zero error.

berrinice wrote: I am about 68kg so the answer is yes, if I want 150% dosage. Which I do. I am hard to treat 3 non responder. I never want to go down this path ever again; its been a total nightmare. kindly

I'm a 96 kg 3a non responder with a knocked around liver but have had a great response with Sof and Dac regular dose so far. Week 2 bloods Alt Ast within range V/L 19 mill down to 16.

You would be better off doing Sof+Dac+Riba

One more point Doc, those Hep organisations should have picked this deception up.(there is enough of them spread across the country) Its wrong that we are only learning about it now. We have a right to know. The public has a right to know. This must be a new news worthy story. kindly

That info about Gilead quietly changing the product is simply breathtaking Doc. For once, I'm almost lost for words!

Disclaimer: This is outside the published guidelines but what I might do if forced to choose.

We can see experts suggest 12 weeks Riba is enough and that makes sense based on the half life.

We know things get better on treatment.

So if doing 12 weeks Riba I would consider doing the last, rather than the first 12 weeks with Riba, particularly in the difficult situation of someone F4 with low platelets.

Psychologically it would probably be easier to add Riba as an insurance having first felt the benefits of 2 strong DAA, expecially for those who have done it tough on PEG/Riba.

The side effects people got on PEG/Riba may have been more PEG and less Riba than we thought. I have a good dozen patients who are relapses telling me it's much easier than they expected and their numbers look good.

Then again I just took one patient off Riba because after 18 weeks he was getting sick both on the numbers and in spirit. He's feeling much better now and we are getting some blood cells back.

I am about 68kg so the answer is yes, if I want 150% dosage. Which I do. I am hard to treat 3 non responder. I never want to go down this path ever again; its been a total nightmare. kindly

For something to qualify as a generic it must show similar pharmacokinetic properties (in English similar blood levels at different points of time after taking it). You will find all the nitty gritty here:

www.australianprescriber.com/magazine/26/4/85/7

The Form I vs Form II argument is probably irrelevant to clinical results but it remains a fact that Form I was what was used in the Phase 3 trials everyone reads and Form II is what is used in the commercial product.

It is unlikely to make a significant difference. A 50 kg person is getting 150% of the dose an average 75 kg person gets in mg/kg terms. A 150 kg person is getting only 50% in mg/kg terms. Provided the therapeutic window is wide enough dose adjustment is not required and a one size fits all dose is fine.

That said my eyes nearly fell out of my head when I saw that Gilead had changed from using what was tested to something that was not tested in the same way (Phase 3) but rather in the same way a generic is declared bio-identical.

Hi Angus,

Yes, it is a good point. I was sent the link today and did not twig about the 2014 - I just presumed it was from a couple of weeks ago.

Given that it's still not available it remains relevant.....

I will edit the post to make it obvious it was from last year.