This year promises to be a good year for the liver and liver patients. Each of the most common liver conditions should see significant advances in their treatment during the coming year. Here are some specifics:
The treatments for chronic hepatitis C therapies will continue to improve and to become more easily available. Over the past two years, more than half a million patients have been treated and cured with the new direct-acting, oral anti-viral therapies. These therapies cure more than 95 percent of all comers, including those with advanced liver disease, kidney disease and genotype 3. So what improvements can we expect in 2017? Despite the cure rates that vary from 95-99 percent for all genotypes, there are still about 5 percent of patients who are not cured with current therapies.
Two new regimens should be approved in 2017, and each has shown a 99-100 percent cure rate in those patients who did not respond to previous therapies. Access to these therapies should also improve, as the costs of the new medications continue to decrease and the restrictions placed on access to these treatments by insurance companies appear to be easing. The challenge for 2017 is to identify the more than 3-4 million people in the U.S. with hepatitis C that have not yet been diagnosed.
Hepatitis B is treatable but not curable. The current treatments have changed the course of the disease, with improvement in fibrosis levels and fewer patients progressing to cirrhosis and liver cancer. But these are lifelong therapies that can be costly. New treatments, which will be tested in clinical trials in 2017, aim to cure hepatitis B.
These new therapies, both oral and injectable, will be added to the current treatments so that the excellent therapeutic effects of standard of care treatments are not lost. Although these therapies will not be widely available in 2017, they are available in our area and are exciting as medical science moves to cure hepatitis B once and for all.
Primary biliary cholangitis
Primary biliary cholangitis is a common autoimmune condition that has been treated with ursodeoxycholic acid (Urso) for the past 20 years. Urso treatments have resulted in a dramatic decease in the number of patients developing cirrhosis and requiring a liver transplantation.
Still, some patients do not respond to Urso. Obetacholic acid was approved in 2016 for use in patients without a complete response to Urso or those who are intolerant of Urso. Obetacholic acid works well and has been shown to normalize liver chemistries. While approved in mid-2016, access to this treatment has been complicated and difficult. 2017 promises to be a good year for improved access to this treatment. The increased availability should lead to even greater success in preventing disease progression.
Non-alcoholic fatty liver/non-alcoholic steatohepatitis (NAFLD/NASH) is the most common liver condition in the U.S. affecting approximately 60-80 million Americans. This condition leads to cirrhosis and liver cancer and is rapidly becoming the leading indication for liver transplantation. Currently, the only treatments for NAFLD/NASH are diet and exercise and vitamin E.
While these therapies are used, their long-term effectiveness are not dramatic and patients continue to progress. New therapies are being developed to treat NAFLD/NASH that are based upon counteracting presumed mechanisms of fat deposition in the liver. This is the first time that direct-acting therapies are being used in this condition. Numerous clinical trials with these advanced therapies are now available to patients.
There are many other advances in the diagnosis and treatment of liver disease ahead in 2017: new diagnostic tests for hereditary liver diseases, better diagnostic imaging and improved liver cancer treatments, to name a few. I look forward to the upcoming year and seeing how these advances will change the lives of people with liver conditions for the better.
David Bernstein, MD, is chief of gastroenterology, hepatology and nutrition at Northwell Health.