肝脏会议聚焦脂肪肝病

StephenW

Fatty Liver Disease in the Spotlight at The Liver Meeting

Laird Harrison

November 02, 2018

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SAN FRANCISCO — Research on treatments for patients with fatty liver disease and nonalcoholic steatohepatitis, in particular, will be highlighted at The Liver Meeting 2018: American Association for the Study of Liver Diseases (AASLD).

"Because NASH is by far the most prevalent liver disease in the United States, most of the drug development has centered on that," said Nancy Reau, MD, from Rush University Medical Center in Chicago.

Multiple drugs for the disease are making their way through the pipeline, she told Medscape Medical News. "We really do expect therapy for this. Will it be good therapy? Will we want to use it? That's different. But we will get drugs."

Results from phase 2 studies of drugs for nonalcoholic steatohepatitis — Mgl-3196 (Madrigal Pharmaceuticals), obeticholic acid (Ocaliva/Intercept Pharmaceuticals), GS-9674 (Gilead Sciences), NGM282 (NGM Bio), arachidyl amido cholanoic acid (Aramchol, Galmed Pharmaceuticals), and tropifexor (Novartis) — will be presented.

Also presented will be phase 2 results for VK2809 (Viking Therapeutics), a treatment for nonalcoholic steatohepatitis and other nonalcoholic fatty liver diseases, and results for myrcludex B (MYR Pharma), a treatment for hepatitis B and D.

But no less important than the development of new drugs is precision in the use of existing therapies.

Researchers are figuring out how to make better use of the treatments they have on hand, particularly for hepatitis C and hepatocellular carcinoma, said Kimberly Brown, MD, from the Henry Ford Health System in Detroit, who is cochair of the scientific programming committee for the meeting.

A study from Cleveland Clinic researchers examines what happens when solid organs from donors infected with hepatitis C are transplanted into patients without the virus. Results could determine whether such donations are safe and expand the pool of organs available for transplant.

"This is a very big deal," Brown told Medscape Medical News.

Another issue of concern in the transplant community is the obesity of donors and recipients. A study of fatty liver and normal liver transplantations into obese and normal-weight recipients will be presented by a group from the University of Virginia.
Hepatocellular Carcinoma

Hepatocellular carcinoma is "one of the only cancers where mortality continues to increase," said Reau. But researchers are working toward solutions.

The combination of entecavir plus tenofovir has helped reduce the incidence of this cancer in patients with chronic hepatitis B, but it has not been eliminated.

An international team of researchers will present findings on the surveillance needed in these patients. "It would be great if we could figure out a group of patients that we didn't have to screen for cancer," Brown said.

The question of whether the PD-1 inhibitor nivolumab is as safe and effective for patients with a class B Child-Pugh score as it is for patients with a class A score will also be addressed. This is of particular interest because most patients with advanced hepatocellular carcinoma have a class B Child-Pugh score.

Drugs for hepatitis C are now saving lives that would have been lost only a decade ago. But not everyone with this virus has access to these powerful treatments.

Researchers from the National Institutes of Health and the University of Maryland will discuss the effectiveness of therapy for hepatitis C in people who inject drugs and policies for treatment.

"This is important to us because the majority of patients who have new hepatitis C are using intravenous drugs," said Brown. "There has been a long-standing opposition on the part of insurers to treat this population of patients. Things that are cited are the risk of nonadherence and ongoing drug use."

Adherence in this population and the benefits of the combination of sofosbuvir and velpatasvir will be explored.

In a related project, findings from a study of glecaprevir and pibrentasvir in treatment-naïve patients with hepatitis C and compensated cirrhosis will reveal whether the standard 12-week regimen can be shortened to 8 weeks.

Reau reports financial relationships with AbbVie, Abbott Laboratories, GENFIT, Gilead Sciences, Merck, Bristol-Myers Squibb, and Shire. Brown reports financial relationships with Gilead, Merck, and Pfizer.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Laird Harrison @LairdH

StephenW

肝脏会议聚焦脂肪肝病

莱尔德哈里森

2018年11月2日

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旧金山 - 特别是在肝脏会议2018：美国肝病研究协会（AASLD）上将重点介绍对脂肪肝和非酒精性脂肪性肝炎患者的治疗方法。

芝加哥拉什大学医学中心的Nancy Reau博士说：“因为NASH是迄今为止美国最常见的肝脏疾病，大多数药物开发都集中于此。”

她告诉Medscape医学新闻，这种疾病的多种药物正在通过管道。 “我们确实期待这方面的治疗。这会是一种很好的治疗方法吗？我们想用它吗？那是不同的。但我们会得到毒品。”

非酒精性脂肪性肝炎药物的第2阶段研究结果 - Mgl-3196（Madrigal Pharmaceuticals），obeticholic acid（Ocaliva / Intercept Pharmaceuticals），GS-9674（Gilead Sciences），NGM282（NGM Bio），arachidyl amido cholanoic acid（Aramchol，Galmed）药品）和tropifexor（诺华） - 将出席。

同时展示的还有VK2809（Viking Therapeutics）的第2阶段结果，非酒精性脂肪性肝炎和其他非酒精性脂肪性肝病的治疗，以及myrcludex B（MYR Pharma）的治疗结果，这是一种治疗乙型和乙型肝炎的方法。

但与开发新药同样重要的是使用现有疗法的精确性。

研究人员正在研究如何更好地利用他们现有的治疗方法，特别是对于丙型肝炎和肝细胞癌，来自底特律亨利福特健康系统的医学博士Kimberly Brown说，他是科学计划委员会的联合主席。会议。

克利夫兰诊所的一项研究人员研究了当感染丙型肝炎的捐赠者的实体器官被移植到没有病毒的患者身上时会发生什么。结果可以确定这些捐赠是否安全并扩大可用于移植的器官库。

“这是一个非常重要的事情，”布朗告诉Medscape医学新闻。

移植社区关注的另一个问题是捐赠者和接受者的肥胖。弗吉尼亚大学的一组研究人员将对脂肪肝和正常肝移植进行肥胖和体重正常接受者的研究。
肝细胞癌

Reau说，肝细胞癌是“死亡率持续上升的唯一癌症之一”。但研究人员正致力于解决方案。

恩替卡韦加替诺福韦的组合有助于降低慢性乙型肝炎患者中这种癌症的发病率，但尚未消除。

一个国际研究小组将介绍这些患者所需监测的结果。 “如果我们能够找出一组我们没有筛查癌症的患者，那将是很好的，”布朗说。

PD-1抑制剂nivolumab对于B级Child-Pugh评分和A级评分患者是否安全有效的问题也将得到解决。这是特别令人感兴趣的，因为大多数患有晚期肝细胞癌的患者具有B级Child-Pugh评分。

丙型肝炎药物现在挽救了仅在十年前就已经丧失的生命。但并非每个患有此病毒的人都可以使用这些强大的治疗方法

美国国立卫生研究院和马里兰大学的研究人员将讨论注射吸毒者和治疗政策对丙型肝炎治疗的有效性。

“这对我们很重要，因为大多数患有新丙型肝炎的患者都在使用静脉注射药物，”布朗说。 “保险公司长期以来一直反对对待这一群患者。所引用的是不依从和持续吸毒的风险。”

将探索这一人群的坚持以及sofosbuvir和velpatasvir相结合的好处。

在一个相关项目中，glecaprevir和pibrentasvir对未接受过治疗的丙型肝炎和代偿性肝硬化患者的研究结果将揭示标准的12周治疗方案是否可以缩短到8周。

Reau报告了与AbbVie，Abbott Laboratories，GENFIT，Gilead Sciences，Merck，Bristol-Myers Squibb和Shire的财务关系。布朗报告与吉利德，默克和辉瑞的财务关系。

在Twitter @MedscapeGastro和Laird Harrison @LairdH上关注Medscape Gastroenterology