Hepatitis C: Dilemmas in Treatment

GENERAL INFORMATION

Target Audience
The target audience for this program includes hepatologists, gastroenterologists and other physicians with an interest or specialty in treatment of Hepatitis C.

Educational Objectives
At the conclusion of the course, the participant should be better able to:
– Identify the dilemmas faced in the treatment of patients with hepatitis C, including various patient types
– Discuss techniques for identifying sustained response to treatments for hepatitis C.
– Review pharmacoeconomic and ethical considerations in managing hepatitis C.
– Describe the latest developments in treatment of hepatitis C.

Faculty Disclosure

This symposium is supported by an educational grant from F. Hoffmann-La Roche, Ltd. The Institute for Medical Studies relies on its faculty to provide CME content that is free from bias. In accordance with ACCME standards, all CME faculty are expected to disclose to the program audience any commercial relationships germane to program content. Faculty disclosure for this program is as follows:

Mitchell Shiffman, MD: research support Hoffman-La Roche, Ltd., National Institutes of Health, Schering, Amgen Inc. Glaxo-Wellcome, Gilead Sciences.

Donald Jensen, MD: clinical investigator for sponsored clinical trials, consultant for F. Hoffman-La Roche, Ltd. and Amgen, Inc. lecturer for Amgen, Schering, and Hoffman-La Roche, Ltd.

David Gretch, PhD: consultant for Hoffman-La Roche, Ltd. and Chiron.

Raymond Koff, MD: research support, F. Hoffman-La Roche, Ltd., Schering, Amgen Inc. and Interferon Sciences, speakers bureau and consultant for F. Hoffman-La Roche, Ltd. Amgen Inc. and Schering.

Disclosure of Unapproved Use
CME faculty must disclose to the audience whenever an unapproved use of a drug is being discussed. The most commonly discussed drugs in this program are the recombinant alfa interferons, ribavirin and pegylated interferons.

Recombinant alfa interferons are indicated for the treatment of patients with chronic hepatitis C diagnosed by HCV antibody and/or a history of exposure to hepatitis C who have compensated liver disease and are 18 years of age or older.

The combination of interferon alfa-2b with ribavirin is indicated for the treatment of hepatitis C in patients with compensated liver disease who have relapsed following alfa interferon therapy.

Pegylated interferon has not been approved by the FDA for any indication. It is an investigational drug about which no claims of safety can be made.

Co-Chairs

William M. Lee, MD
Director, Clinical Center of Liver Disease
University of Texas, Dallas, Texas

E. Jenny Heathcote, MD
Professor of Medicine
University of Toronto, Toronto, Ontario, Canada

William M. Lee, MD
Professor of Internal Medicine and Director, Clinical Center for Liver Disease, University of Texas Southwestern Medical School, Dallas, Texas.

Dr. Lee was educated at Amherst College and received his medical degree from Columbia University College of Physicians and Surgeons, completing his training in Internal Medicine at the Presbyterian Hospital, New York City (Columbia-Presyterian Medical Center). He served as Honorary Registrar and Research Fellow to Dr. Roger Williams at the Liver Unit, Kings College Hospital, London from 1973 ­ 74, then was on the faculty of Columbia ­ Presbyterian until 1980; he became an Associate Professor and later Professor and Chief of the Division of Gastroenterology at the Medical University of South Carolina, Charleston, SC between 1980 and 1990. Since his arrival at UT Southwestern in 1990, he has continued to devote 50% of his time to practice and the rest to clinical and basic research. Four review articles in the New England Journal of medicine (The Extra-Cellular Actin-Scavenger System, 1992, Acute Liver Failure 1993, Drug-Induced Hepatotoxicity 1995, Hepatitis B Virus Infection 1997), define his main areas of research and clinical interest.

In addition, Dr. Lee has the largest site in Texas performing viral hepatitis clinical trials (9 on payroll, 22 active protocols), and has begun an N1H-sponsored Multi-Center Acute Liver Failure Study Group comprising 15 sites around the US, and is Secretary-Treasurer of the American Association for the Study of Liver Diseases.

E. Jenny Heathcote MB, BS, MD, FRCP, FRCP ©
Dr. Heathcote graduated from the Royal Free Hospital School of Medicine at the University of London, UK with an MB BS in 1968. Following internship and residency in internal medicine she returned to the Royal Free Hospital where she conducted studies on the transmission of hepatitis B. She was the first to report that sexual transmission particularly among male homosexuals was a common route of transmission of this virus. These epidemiological studies were supported by the Medical Research Council and were the basis for her MD thesis. Dr. Heathcote was appointed lecturer at the University of London in 1974, and she was awarded an N1H fellowship in gastroenterology in 1976 to study at Stanford University in California. In 1979 she moved to Canada where she was appointed Assistant Professor at the University of Toronto and staff gastroenterologist at the Toronto Western Hospital. Her research on the epidemiology and therapy of viral hepatitis continues. In addition she maintains an active clinical research program in cholestatic/autoimmune liver disease. Dr. Heathcote was made a full Professor in 1995, the same year she was awarded the University of Toronto, Department of Medicine Clinician Teacher Award.

Hepatitis C: Dilemmas in Treatment

SYMPOSIUM FACULTY

David Gretch, MD
Assistant Professor of Laboratory, Medicine, Viral Hepatitis Laboratory, University of Washington, Seattle, Washington

Donald Jensen, MD
Director, Section of Hepatology, Rush Presbyterian-St. Luke’s Medical Center, Chicago, Illinois

Raymond Koff, MD
Chairman, Department of medicine, Metro West Medical Center, Framingham, Massachusetts

Mitchell Shiffman, MD
Associate Professor of Medicine, Chief, Hepatology Section, Medical College of Virginia, Richmond, Virginia

Program CME Director
Stanley Golanty, MD
Medical Director, The Institute for Medical Studies, Laguna Niguel, California

SCIENTIFIC AGENDA

Welcome and Introductions
Stanley Golanty, MD

Opening Remarks
William Lee, MD

Hepatitis C: Dilemmas in Treatment
Mitchell Shiffman, MD

Identifying the Sustained Responder
David Gretch, MD

Pharmacoeconomic and Ethical Concerns in Managing the Disease
Raymond Koff, MD

Update on Treatment Options
Donald Jensen, MD

Questions and Answers
E. Jenny Heathcote, MD, Moderator

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