49th Annual Meeting of the European Association for the Study of the Liver (EASL 2014), 9-13 April 2014, London

EASL logo 3 webThis year the European International Liver Conference was held from 9-13 April at the ExCell Centre in east London.

This was a five day meeting and the programme included 170 oral abstract presentations and over 1320 poster presentations.

Although this is primarily a liver conference, HIV/HCV coinfection featured in several sessions including an overview lecture by Dr Sanjay Bhagani from the Royal Free Hospital.

Most of the news focused on new oral drugs for hepatitis C (called Directly Active Agents or DAAs) – and there are a lot of new drugs. Some companies have several compounds that are only being studied together as in-house combinations (including Gilead, Abbott and Merck).

Dramatic results were seen in efficacy and safety of these drugs – with cure rates approaching 100% for treatment naive patients. Many presenters commented that 2014 for hepatitis C is perhaps comparable to the first years of combination therapy for HIV in 1996. The meeting also included promising results in advanced and difficult to treat patients including people with cirrhosis and who did not respond to previous HCV treatment.

Although most of the DAA studies focus on HCV mono infection, some HIV/HCV coinfection studies are included. Importantly though, DAAs appear to have similar success rates irrespective of HIV status, so the monoinfection studies are highly relevant for HIV positive people. Regulatory decisions on approving new DAAs are likely to recommend broad use, irrespective of HIV status.

Highlights of the DAAs with new data at EASL 2014 included:

  • ABT-450/r/ABT-267, ABT-333 (AbbVie combination)
  • sofosbuvir – already approved in Europe and the US – but with new data from different genotypes and populations
  • sofosbuvir plus ledipasvir (Gilead combination)
  • sofosbuvir plus GS-5816 (another Gilead combination)
  • MK-5172 and MK-8742 (Merck combination) – including date from HIV positive people with genotype 1.
  • daclatasvir (from BMS) – including its use with sofosbuvir (in research not supported by Gilead)
  • simeprevir (Janssen) – already licensed in the US and available on early access in the EU.

The details are as important as the headline news. Some studies, especially in sub-groups, have small study numbers. A surprising number of abstracts promised “SVR results will be presented” which is a convention that HIV conferences restricted years ago. If the data is not in the abstract when submitted, it doesn’t get in.

This excitement is also tempered by issues of cost and access. this is an issue both for developed countries (based on the launch price of sofosbuvir) and in middle and low income countries where most HCV positive people live (where dramatically reduced pricing will be needed).

The programme, abstract books (published as a supplement to Journal of Hepatology) and related Apps are already available as open access online from the conference website.

The meeting doesn’t seem to webcast sessions, but a series of 26 press conferences and interviews are available on YouTube:

Reports in this issue of HTB are:

Links to other websites are current at date of posting but not maintained.