PowerPoint Presentation

State of the Art Therapy for HCV

Last Updated: February 21, 2014Robert G. Gish MDSenior Medical Director, St Josephs Hospital and Medical Center, Liver ProgramPhoenix, ArizonaClinical Professor of MedicineUniversity of Nevada, Las VegasHepatitis Web StudyHepatitis C OnlineHepatitisweb study1DisclosuresResearch Support: BMS, Gilead, BI, Merck

Consulting board: BMS, Gilead, BI, Merck, Abbvie, Nanogen, Idenix

Honoraria for promotional talks: BMS, Gilead, MerckHepatitisweb studyProjected Timing for New Regimen LaunchesPAST 2013NOW 2014THE FUTURE 20152016Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q42013201420152016IFN-FreeTriple TherapyDaclatasvir/Asunaprevir*-----GT1b Nave/Tx-Exp/IFN Intolerant 24 weeksSofosbuvir + RBV------GT 2/3, Nave/Tx-EXP/IFN Ineligible TX-ExpABT-450/267/333/RBV8-24 weeks----GT1, Nave/Tx-EXPSofosbuvir +Ledipesvir/RBV 8-24 weeksGT1/4, Nave/TX-EXP/IFN Ineligible Sofosbuvir Triple----GT 1, 4, 5, 6, NaiveSofosbuvir Triple----GT 1, 4, 5, 6, NaveFaldaprevirAll Oral Dual or Triple? ----GT1 Nave, Tx-EXPDaclatasvir Triple-----GT1. Nave onlyMERCKPRESIDIOIDENIXACHILLIONVERTEXHepatitisweb studyMany Direct Acting Antivirals in DevelopmentProtease inhibitorsFaldaprevirAsunaprevirABT-450MK-5172SovaprevirACH-2684GS-9451 NAIAD Synergy trial

NS5A InhibitorsDaclatasvirLedipasvirABT-267GS-5816 pangenotypicACH-3102PPI-668GSK 2336805SamatasvirMK-8742

Hepatitisweb studyMany Direct Acting Antivirals in DevelopmentNS5B NucleosidesVX 135IDX 20963ACH 3422

NS5B Non-nucleosidesABT 333BMS 791325PPI 383GS 9669TMC 647055

Hepatitisweb studyCurrent standards and future directionsGenotype 1: PEG/RBV/SOF 12 weeks or Sofosbuvir + Simprevir for 12 weeksThis is the last phase of major use for Peginterferon/RBV in the USINF can shorten therapy with SOF for HIV/HCV co-infected patients and genotype 3 patients by using a 12 week triple protocol and save substantial money by cutting treatment duration by one-halfContinues to be used with genotype 4, 5, 6 for triple 12 week SOF based therapyAll oral agents is the standard of care for genotype 2 and 3 and evolving to primary treatment with all oral therapy