Transcript 5th Paris Hepatitis Congress Workshop 30/1/2012 Managing

5th Paris Hepatitis Congress
Workshop 30/1/2012
Managing complications of DAAs:
Case 1
Dr Samuel S. Lee
University of Calgary
Case 1
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51 year old Caucasian man
HCV discovered 2009 on routine examination
Remote history of injection drug use age 19
No symptoms
Alcohol: 8-10 beers/week, mostly on
weekends
• Smokes 3-4 cigarettes/d; occasional marijuana
• asymptomatic
Case 1
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Physical exam: weight 81kg, BMI 28
few spider nevi, but no other abnormalities
Labs:
ALT 2 x N
Bilirubin, PT-INR, albumin, N
Hb 151 g/L, WBC 7.1, ANC 2.9, plts 145
Ultrasound: coarse liver echotexture – fatty
liver? Borderline splenomegaly. No ascites
Case 1: further investigations and
course
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HCV genotype 1a
1.1 million IU/mL HCV RNA (2009)
Fibroscan: 10.2 kP (stage 3?)
Liver biopsy (from 2009): moderate activity,
grade 1, bridging fibrosis, stage F3
• No previous treatment – patient did not wish
to suffer side effects
• Had heard of ‘new treatment’ and wished to
proceed with triple-Rx
Case 1: treatment
• Started triple-Rx with PEG a-2a + RBV
1200mg/d + boceprevir 800mg tid (after 4-wk
lead-in)
• Qual HCV RNA detectable at wk 4 lead-in (no
RVR)
• Wk 8 and 12 RNA undetectable
• Hb 118, ANC 1.2, plts 101 after lead-in
• Moderate fatigue, flu-like symptoms
Case 1: course
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Wk 6: Hb 101, ANC 0.9
RBV decreased to 800mg/d
Wk 8: Hb 93; fatigue worsening
ANC 0.7
RBV decreased to 600mg/d; PEG decreased to
135ug
• Wk 10: Hb 94, ANC 0,8
• Wk 12: Hb 92, ANC 0.7
• Wk 16: Hb 89, ANC 0.9; patient working at 60%
Case 1: further course
• Wk 7: metallic taste in mouth. Pt advised to
take plenty of water, small frequent meals
• Wk 10: still slight dysgeusia but improved
• Weight loss 5kg by wk 16
• Currently at wk 24, stable at PEG 135, RBV
600mg, boceprevir.
• In view of suspected cirrhosis and drug
reductions, plan to continue Rx for 48wk
AE summary
Flamm et al. AASLD 2011
Anemia AEs
Flamm et al. AASLD 2011
Flamm et al. AASLD 2011
Neutropenia AEs