BSG supported STOPAH study shows a lack of evidence for drug treatments
Wednesday, 29 April 2015 08:22
The survival of patients with alcohol-related hepatitis is not being significantly improved by the main drugs currently widely used in treatment of this condition, according to a major new National Institute for Health Research sponsored study supported by members of the British Society of Gastroenterology.
Senior health professionals are highlighting an 'urgent need' for investment into research for the prevention and treatment of alcohol-related liver disease. Documented in the New England Journal of Medicine¸ a trial of over 1,000 patients using prednisolone and pentoxifylline did not achieve a statistically significant reduction in mortality after 28 days, 90 days, or a year.
The alarming findings come at a time when the incidence of alcohol-related liver disease is rapidly increasing, however the report does also show that the overall mortality has fallen compared to studies done in the past which suggests that specialist in hospital care of these very sick people can improve outcomes, and what could be achieved more widely contrasting with the 2013 NCEPOD report on the care of cirrhosis where care was often found to be lacking.
Commenting, British Society of Gastroenterology Vice President (Hepatology), Dr Stephen Ryder, said:
"STOPAH has answered some key questions in the treatment of alcohol-related hepatitis and highlighted the urgent need for research into the prevention and treatment of alcohol-related liver disease, which is on the rise.
Whilst the study does suggest that patients are receiving better care than reported in previous reviews, unfortunately it also shows that neither steroids or pentoxifylline are effective treatments and there is no real indication now for their use.
The stark finding in STOPAH remains the high late mortality related to resumption of alcohol intake and emphasises the need for universal implementation of the BSG recommendations on alcohol care teams, that seems likely to be a far more effective intervention than any medical therapy for the acute episode.
One of the great successes of this study was to show that UK hepatologists and gastroenterologists from over 50 UK centres can collaborate to deliver important large scale clinical studies aimed at improving outcomes for patients with liver disease."
UEG is calling on all EU countries to evaluate advanced CRC screening techniques to help increase survival rates
Tuesday, 17 March 2015 10:14
The Colorectal Cancer Awareness month kicks off UEG's latest campaign "Screening Saves Lives (CRC) 2015". Colorectal cancer accounts for about half of all gastrointestinal malignancies in Europe and the annual incidence is predicted to rise by 12% by 2020. UEG is calling on everyone over 50 to 'Step Up, Take the Test'. Read full press release and follow this campaign on Twitter #ScreeningSavesLives.
Nice Quality Standards for IBD
Friday, 27 February 2015 10:42
Professor Chris Probert, Chair BSG IBD Section Committee
"The BSG welcomes the release of Quality Standards for IBD by NICE. The four statements are necessarily succinct and members should read the more detailed version on the NICE website. This document sets a standard that should be recognised by CCGs and Trusts and should enable us to raise the quality of our services. These standards should form the basis of the forthcoming IBD Accreditation, along with the IBD Audit and Registry."
Changes in HCV therapy - approval of Sofosbuvir
Friday, 30 January 2015 13:55
Dr Stephen Ryder, BSG Vice-President Hepatology & Dr Andrew Austin, Chair BSG Liver Section
There are two major changes in HCV therapy which now have NICE and/or NHSE approval for use. The first is that commissioning guidance for the use of Simiprevir is published (http://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a02/). This allows G1 patients without Q80K to access triple therapy now using Simiprevir instead of Boceprevir or Telaprevir.
The second and probably more significant development is the approval of Sofosbuvir. The approval can be summarised as below:
Sofosbuvir in combination with pegylated interferon + ribavirin (Peg-IFN+RBV)
|HCV genotype||Adult patient population|
|Genotype 3||Treatment-naïve with cirrhosisa|
|Genotype 4, 5, or 6||Treatment-naïve & experienced with cirrhosisa|
Sofosbuvir in combination with RBV
|HCV genotype||Adult patient population|
|Genotype 3||Treatment-naïve with cirrhosisb|
|Treatment-experienced with cirrhosisb|
The NHSE approval is for cirrhotic patients to access treatment in April with non-cirrhotic patients from July.
There is a meeting at Barts on 3rd March 2015 (advertised by BVHG) to establish clinical guidelines as to who to treat with what when. It is highly likely that by July other agents approvals will make the interferon component of the regimen outdated. NHSE will establish a process by which the drugs will be distributed shortly but it would seem prudent for centres to enter local negotiations now in order all are ready to prescribe when we are given the approvals. It is pretty certain that similar data gathering will be required as for EAP.
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