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Salisbury VAMC hepatitis C cure rates among best in VA

By Michael Maddox

W.G. (Bill) Hefner VA Medical Center Public Affairs

There have been many advances in the treatment of hepatitis C over the last decade, and the Salisbury VA Medical Center has been a leader in treating and curing the disease, thanks to staying on the cutting edge of treatments available over the years.

Hepatitis C damages the liver directly. The level of damage it can do depends on how long a person has had it and if they have other health issues. It can cause scarring of the liver and can eventually develop into cirrhosis.

Salisbury’s Infectious Disease clinic has been providing care to hepatitis C patients in a comprehensive multidisciplinary environment since 2007, and has been above national averages for cure rates in recent years, said Dr. Charles de Comarmond, chief of the Infectious Disease clinic.

“If you look at the past few years from 2010 to now, we have been one of the leaders, probably in the top five in the country based on the number of patients who have received hepatitis C treatment here,” he said. “We have a very high success rate despite the fact that over 50 percent of our patients fall into the “difficult to treat” category; our rates have surpassed the national VA benchmark for every year that we’ve had the program in Salisbury.”

De Comarmond said there are several reasons his team has been so effective at treating hepatitis C patients.

“We’re successful because we use a team approach. We have clinical pharmacists in the clinics looking at the patient’s medication adherence. We also have a mental health provider in the clinic so that the patients who really need the support don’t have to go to another clinic,” he said. “The whole concept of a Patient-Aligned Care Team (PACT) was happening right here in our clinic even before it was born as a concept.”

Another reason for the high rates of success is that the clinic has been able to provide the most recent treatments available on the market as they became available.

“For many years, the only choices that we had in terms of drugs to treat hepatitis C was interferon and ribavirin. Interferon was like chemotherapy and it had a lot of side effects. Patients receiving these drugs felt like they were experiencing the flu every week for 48 weeks,” he said. “Imagine having to take injections every week for 48 weeks and having flu-like symptoms; and the cure rate was only 30 to 40 percent.”

Then, about three years ago there was an emergence of new drugs starting to hit the market.

“The next two drugs, telaprevir and boceprevir, were revolutionary in terms of cure rates – moving them from 30 to 60 percent based on clinical trials. They also cut the treatment time down to six months,” he explained. “But they still required us to use interferon and ribavirin, so we were just adding more medication to the existing regimen.”

The cure rates changed tremendously as two new drugs were approved for use last year — sofosbuvir and simeprivir.

“These really changed the landscape as the treatment time has been cut to 12 weeks, and they have moved the cure rate to more than 80 percent nationally,” said de Comarmond. “The only issue that we have seen here is that a lot of our patients have already been exposed to multiple other treatments, causing them to have a response rate of less than 80 percent.”

“Because of these most recent drugs, the cure rate in our clinic moved from 30 to 40 percent, to a 60 percent cure rate, which is fantastic because we almost doubled our cure rate,” he added. “This has allowed Salisbury to become the number one center across the country in VA for treating patients with this type of medication.”

De Comarmond said he hopes to see cure rates continue to rise thanks to release of the most recent hepatitis C medications.

“As of about a month ago, we now have a combination of new pills, sofosbuvir and ledipasvir, and the treatment with these drugs is anywhere between eight to 12 weeks with an expected cure rate of 80 to 95 percent,” he said. “We have really seen an evolution of the duration of treatments getting shorter and shorter, and the cure rates are much higher.”

A new combination therapy, Viekira Pak was also approved in the past month — offering high cure rates.

Along with advancements in medications, the clinic also provides the latest technological screening equipment available.

“We were among the first in the country to perform noninvasive staging of liver disease. We have a device that is called a fibroscan that allows us to use an ultrasonic probe that measures the liver’s stiffness, compared to doing liver biopsies to see what stage of liver disease” a patient is in, he explained. “So now, instead of a patient having to come in and fast, get a biopsy, wait two or three hours before they go home, the patients can come here, get a completely painless procedure done in 10 minutes.”

“We also have the ability to do bedside ultrasonography in our clinic. If a patient comes in and they are complaining of pain or a change in their health condition has developed, we are able to immediately scan the liver and see if it’s inflamed or if there are any other causes for the discomfort,” he said. “This is extremely unusual because most clinics do not have this amount of technology directly in the clinic to do rapid diagnostics and staging. All of this has helped with the success of the program.”

De Comarmond said the current target is to be able to treat 30 to 40 new patients each month.

“We are treating patients with the more advanced liver disease first. Then, eventually, we will bring in the patients who have earlier stages of liver disease,” he said.

The first step to treatment is early detection.

“Hepatitis is a silent disease – you won’t know you have it unless you get tested for it. The classic risk factors for hepatitis C include if you have used intravenous drugs or cocaine, if you have received a blood transfusion before 1991, and if you have tattoos or piercings because of the possibility that it was done with equipment that wasn’t sterilized properly,” said de Comarmond. “Most people, when they acquire hepatitis C, have only mild flu-like symptoms, so they really don’t know they have it because there are no special signs or symptoms for it.”

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