Retreatment Strategies for Patients Failing First-Line Therapy
Source: Advanced Topics in Hepatitis C Management: Tools for Nurse Practitioners and Physician Assistants

Module

HoChong Gilles, RN, MS, FNP, reviews clinical management options for patients with chronic HCV infection who fail interferon-based therapy.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Identify causes of nonresponse and relapse to hepatitis C virus (HCV) therapy
  • Describe definitions of response during HCV therapy and key time points for monitoring response to treatment
  • Discuss diagnosis and management of common adverse effects of HCV therapy and strategies for monitoring patient adherence
  • Recall strategies for selecting optimal treatment for patients based on their baseline factors and previous course of therapy

Topics covered include:

  • Introduction
  • Treatment Response Patterns
  • Factors Contributing to Treatment Failure
  • Comorbidities as Predictors of Nonresponse
  • Other Factors Associated With Nonresponse
  • Assessing Factors Related to Nonresponse Before Retreatment
  • Retreatment Options in Nonresponders and Relapsers
  • Summary: Implications for Clinical Practice
 

Program Directors

  • Michael W. Fried
    MD

Faculty

  • HoChong Gilles
    RN, MS, FNP

Credit Information

  • Release Date:
    June 28, 2007
  • Expiration Date:
    June 27, 2008
  • Physicians:
    maximum of 1.5 AMA PRA Category 1 Credits
  • Registered Nurses:
    1.5 Nursing contact hours
  • Physician Assistants:
    maximum of 1.5 hours of AAPA Category I (Preapproved) credits

Information on this Educational Activity

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty and CCO staff reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity.

 

Program Directors

Michael W. Fried, MD
Professor of Medicine
Director of Hepatology
Associate Director, General Clinical Research Center
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina

Michael W. Fried, MD, has disclosed that he has received grant or research support from Human Genome Sciences, Idenix, Roche, Valeant, and Vertex and is on the advisory board for Human Genome Sciences, Idenix, Roche, and Valeant.

 

Faculty

HoChong Gilles, RN, MS, FNP


GI/Hepatology Department
Liver Transplant Program
Richmond Veterans Affairs Medical Center
Richmond, Virginia

HoChong Gilles, RN, MS, FNP, has disclosed that she is on the speakers bureau for Roche.
 

Staff

Jenny Schulz, PhD


Senior Managing Editor

Jenny Schulz, PhD, has no significant financial relationships to disclose.
 

Kara Nyberg, PhD


Editorial Contributor

Kara Nyberg, PhD, has no significant financial relationships to disclose.
 

Gordon Kelley, 


Clinical Editor
Clinical Care Options, LLC

Gordon Kelley has no significant financial relationships to disclose.
 

Edward King, MA


Vice President, Editorial
Clinical Care Options, LLC

Edward King, MA, has no significant financial relationships to disclose.
 

The following PIM clinical content reviewers, Linda Graham, RN; Jan Hixon, RN; and Trace Hutchison, PharmD, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interests related to the content of this CME activity of any amount during the past 12 months.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute of Medicine (PIM) and Clinical Care Options, LLC do not recommend the use of any agent outside of the labeled indications.

In this activity, the faculty member discusses unlabeled doses of peginterferon and ribavirin for treatment of hepatitis C, maintenance therapy and induction therapy for hepatitis C, and unlabeled retreatment strategies for patients failing initial HCV therapy. They also discuss the use of antidepressants for treatment of depression associated with HCV therapy, and prophylactic use of antidepressants for patients facing HCV therapy. They also discuss the use of orlistat or sibutramine for weight loss in HCV patients, and biguanides and thiazolidinediones for management of insulin resistance in HCV, filgrastin for neutropenia associated with hepatitis C therapy, and epoetin for treatment of anemia in HCV. They also discuss the experimental agents valopicitabine, telaprevir, R1626, HCV-796, SCH 503034, albumin interferon, omega interferon, and taribavirin for treatment of HCV infection.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM and Clinical Care Options, LLC. Please refer to the official prescribing information for each product for discussion of approved indication, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

 

Target Audience

This activity is intended for physicians, physician assistants, registered nurses, and nurse practitioners who provide frontline clinical care for patients with chronic hepatitis C.


Purpose

The purpose of this activity is for participants to acquire knowledge regarding the optimal clinical management of patients with chronic hepatitis C who do not respond to therapy or who relapse.


Learning Objectives

Upon completion of this activity, participants should be able to:

  • Identify causes of nonresponse and relapse to hepatitis C virus (HCV) therapy
  • Describe definitions of response during HCV therapy and key time points for monitoring response to treatment
  • Discuss diagnosis and management of common adverse effects of HCV therapy and strategies for monitoring patient adherence
  • Recall strategies for selecting optimal treatment for patients based on their baseline factors and previous course of therapy
 

Physician Continuing Medical Education

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine and Clinical Care Options, LLC. Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

 

Nursing Continuing Education

Accreditation Statement

CNA/ANCC

This educational activity for 1.5 contact hour(s) is provided by Postgraduate Institute for Medicine (PIM).

PIM is an approved provider of continuing education by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

California Board of Registered Nursing

Postgraduate Institute for Medicine is approved by the California Board of Registered Nursing, Provider Number 13485 for 1.8 contact hours.

 

Physician Assistant Continuing Education

This program has been reviewed and is approved for a maximum of 1.5 hours of AAPA Category I CME credit by the Physician Assistant Review Panel. Approval is valid for one year from the issue date of June 28, 2007. Participants may submit the self-assessment at any time during that period.

This program was planned in accordance with AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.

 

Commercial Support


This program is supported by an educational grant from Roche.

 

Program Medium


This program has been made available online, and in print.

 

Site Requirements


  • Internet Explorer 7+, Firefox 3+, Safari 3+, or Chrome
  • JavaScript enabled
  • 1024x768+ screen resolution
  • Adobe Flash Player
 

Instructions for Credit

Participation in this self-study activity should be completed in approximately 1.5 hours. To successfully complete this activity and receive credit, participants must follow these steps during the period from June 28, 2007, through June 27, 2008:

1. Register online at http://www.clinicaloptions.com.
2. Read the target audience, learning objectives, and faculty disclosures.
3. Study the educational activity online or printed out.
4. Submit answers to the posttest questions and evaluation questions online.

You must receive a test score of at least 70% and respond to all evaluation questions to receive a certificate. After submitting the evaluation, you may access your online certificate by selecting the certificate link on the posttest confirmation page. Records of all CME activities completed can be found on the "CME Manager" page. There are no costs/fees for this activity.

  • How Recent Guideline Updates on HBV Screening in HCV-Infected DAA Recipients Affect Clinical Practice

    Norah Terrault MD, MPH - 11/23/2016    1 comment / Last Comment: 11/29/2016
    How do recent AASLD/IDSA updates on HBV screening change nonspecialist and specialist management of HCV patients? Here’s my take.
  • Weighing the Treatment Options for Genotype 3 HCV Infection in Cirrhotics

    Mark S. Sulkowski MD - 2/25/2016    3 comments / Last Comment: 4/11/2016
    In my practice, it is the patient with cirrhosis and genotype 3 HCV infection who causes me to pause and carefully consider the patient’s treatment options.
  • Decompensated Cirrhosis: My Take on New Treatment Strategies Following AASLD 2015

    Ira M. Jacobson MD - 12/24/2015    2 comments / Last Comment: 1/4/2016
    Despite the variety of highly effective, highly tolerable regimens available for treating HCV, strategies for patients with decompensated liver disease remain challenging.
  • My Evolving Strategy for Treating Patients With Genotype 3 HCV Infection

    Norah Terrault MD, MPH - 9/10/2015    10 comments / Last Comment: 6/25/2016
    Following the recent FDA approval of daclatasvir and the presentation of key data at the 2015 EASL meeting, our team has made several changes to our approach in managing patients with genotype 3 HCV infection.
  • Patients With Renal Disease: One of the Remaining Challenges in HCV Therapy

    Nancy Reau MD - 8/25/2015    31 comments / Last Comment: 6/25/2016
    A recent patient discussion highlighted important questions about how to approach HCV infection in renal disease.