The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that ...evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking.
A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment.
Overall SVR was 98.8% (95% CI 97.35-100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported.
Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.
Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core ...antibody anti-HBc-positive), and of those, 300,000 active carriers (hepatitis B surface antigen HBsAg-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.
The sofosbuvir-velpatasvir (SOF/VEL) combination is a direct-acting antiviral therapy that is authorized and available in Mexico, making the performance of a real-world multicenter study that ...evaluates the sustained virologic response at 12 weeks post-treatment a relevant undertaking.
A retrospective review of the case records of 241 patients seen at 20 hospitals in Mexico was conducted to assess hepatitis C treatment with the SOF/VEL combination (n = 231) and the sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) combination (n = 10). The primary efficacy endpoint was the percentage of patients that achieved SVR at 12 weeks after the end of treatment.
Overall SVR was 98.8% (95% CI 97.35–100%). Only three patients did not achieve SVR, two of whom had cirrhosis and a history of previous treatment with peg-IFN. Of the subgroups analyzed, all the patients with HIV coinfection, three patients with genotype 3, and the patients treated with the SOF/VEL/RBV combination achieved SVR. The subgroups with the lower success rates were patients that were treatment-experienced (96.8%) and patients with F1 fibrosis (95.5%). The most frequent adverse events were fatigue, headache, and insomnia. No serious adverse events were reported.
Treatments with SOF/VEL and SOF/VEL/RBV were highly safe and effective, results coinciding with those of other international real-world studies.
La combinación de sofosbuvir-velpatasvir (SOF/VEL) es una terapia antiviral de acción directa que está autorizada y disponible en México. Esto hace que la evaluación de la respuesta virológica sostenida (RVS) 12 semanas después del tratamiento, por medio de la realización de una revisión multicentro en el mundo real, sea una tarea relevante.
Se efectuó una revisión retrospectiva de los registros de 241 casos de pacientes atendidos en 20 hospitales en México para evaluar el tratamiento contra la hepatitis C con la combinación SOF/VEL (n = 231) y sofosbuvir/velpatasvir/ribavirin (SOF/VEL/RBV) (n = 10). El objetivo de eficacia primario fue el porcentaje de pacientes que lograron la RVS 12 semanas posterior a la finalización del tratamiento.
En general, la RVS fue de 98.8% (IC 95% 97.35 a 100%). Solo tres pacientes no lograron la RVS, de los cuales dos padecían cirrosis y una tenía historia previa de tratamiento con interferón pegilado (peg-IFN). De los subgrupos analizados, todos los casos con infección de virus de la inmunodeficiencia humana (VIH), tres con genotipo 3 y aquellos tratados con la combinación SOF/VEL/RBV, lograron RVS. Los subgrupos con tasas menores de éxito fueron los pacientes que tenían experiencia con tratamiento (96.8%) y pacientes con fibrosis F1 (95.5%). Los eventos adversos más frecuentes fueron fatiga, cefalea e insomnio. No se reportaron eventos adversos graves.
Los tratamientos con SOF/VEL y SOF/VEL/RBV fueron altamente seguros y efectivos y los resultados coinciden con los de otros estudios internacionales realizados en el mundo real.
Characterization of hepatocellular carcinoma in Mexico Cisneros-Garza, L E; González-Huezo, M S; López-Cossio, J A ...
Revista de Gastroenterología de México (English Edition),
2018 Jul - Sep, 20180701, Letnik:
83, Številka:
3
Journal Article
Recenzirano
Odprti dostop
In Mexico, complications of cirrhosis are the third leading cause of death in adult males. In recent decades, the incidence of hepatocellular carcinoma has increased worldwide. The aim of this study ...was to determine the characteristics of patients with hepatocellular carcinoma at two Mexican tertiary care hospitals.
An observational, cross-sectional, retrospective study was conducted between January 2008 and April 2014. We described the clinical features, epidemiologic characteristics, diagnosis, and treatment of patients with hepatocellular carcinoma.
One hundred and forty-eight patients were included. There was a predominance in males and disease manifestation in the sixth decade of life. Liver disease was associated in 87% of subjects and was mainly attributed to alcohol abuse, hepatitis C infection, and nonalcoholic steatohepatitis. Sixty percent (60%) of cases were classified as Child-Pugh stage A cirrhosis, 75.5% harbored a single tumor at diagnosis, 27.7% had normal alpha-fetoprotein values, and only 39.2% of patients with known liver disease were under a surveillance program. Tumors were larger than 5cm at diagnosis in 64.3% of patients, and well-differentiated lesions were most frequently detected. Over 70% of patients were diagnosed at a non-curative stage. By the 2014 study cutoff point, 77.7% of patients had died. Treatment was determined by the means available at each center and followed the therapeutic recommendations in international guidelines in 45.3% of cases, clearly impacting survival.
Better surveillance methods are required to diagnose the disease at its early stages, but treatment still requires individual adaptation to each center's available resources.
The Mexican consensus on alcoholic hepatitis Velarde-Ruiz Velasco, J A; Higuera-de la Tijera, M F; Castro-Narro, G E ...
Revista de gastroenterologia de Mexico (English),
07/2020, Letnik:
85, Številka:
3
Conference Proceeding
Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core ...antibody anti-HBc-positive), and of those, 300,000 active carriers (hepatitis B surface antigen HBsAg-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.
La infección por el virus de hepatitis B (VHB) continúa siendo un problema de salud pública mundial, en México se estima que podría haber por lo menos tres millones de personas adultas que han adquirido hepatitis B (anticuerpo anti-antígeno central del VHB anti-HBc positivo), de ellos cerca de 300,000 portadores activos (antígeno de superficie del VHB HBsAg positivo) podrían requerir tratamiento. Al ser prevenible por vacunación, debe enfatizarse la vacunación universal. Esta infección es un factor de riesgo mayor para el desarrollo de carcinoma hepatocelular, el estudio semestral con ultrasonido hepático y alfafetoproteína sérica favorece la detección temprana de esta neoplasia y debe realizarse en todo paciente con infección crónica por VHB, independientemente de la presencia de fibrosis avanzada o cirrosis. En la actualidad, la terapia de primera línea, son análogos nucleós(t)idos con alta barrera a la resistencia.
Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and ...anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients.
These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.
El manejo de la coagulación en el paciente con cirrosis ha sufrido una transformación significativa a partir de principios de este siglo, con el concepto de un rebalanceo entre factores procoagulantes y anticoagulantes. Esto ha cambiado el paradigma de que los pacientes con cirrosis tienen una mayor tendencia a la hemorragia, ya que existe un rebalanceo entre factores procoagulantes y anticoagulantes. Además, ha traído a la luz la presencia de complicaciones relacionadas a eventos trombóticos en este grupo de pacientes.
En estas guías se detallan aspectos relacionados con los mecanismos fisiopatológicos que intervienen en el mantenimiento de la hemostasia en el paciente con cirrosis, la relevancia de la hipertensión portal, factores mecánicos para el desarrollo de sangrado, modificaciones en la síntesis hepática de factores de coagulación, y los cambios en el sistema reticuloendotelial en la descompensación hepática aguda e insuficiencia hepática aguda sobre crónica (IHAC). Se abordan nuevos aspectos relacionados a las complicaciones hemorrágicas en pacientes con cirrosis, considerando el riesgo de hemorragia durante procedimientos diagnósticos o terapéuticos, así como la utilidad de diferentes herramientas diagnósticas de la coagulación y recomendaciones en el tratamiento farmacológico y transfusión de hemoderivados en el contexto de hemorragia. En estas guías se actualiza el conocimiento respecto al diagnóstico y abordaje de complicaciones relacionadas a hipercoagulabilidad en el paciente con cirrosis, así como la eficacia y seguridad del tratamiento con diferentes esquemas de anticoagulación. Finalmente, se mencionarán recomendaciones en el manejo de la coagulación en el contexto de IHAC, descompensación hepática aguda y aspectos específicos relacionados al paciente en protocolo de trasplante hepático.
Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence ...over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented. Resumen: El Carcinoma Hepatocelular (CHC) se presenta cada vez más frecuentemente como una de las principales complicaciones de cirrosis, su principal factor de riesgo. La última década ha presentado modificaciones en su incidencia, relacionadas con una transición epidemiológica en la etiología de la cirrosis, con disminución en la prevalencia de hepatitis C y aumento en la etiología relacionada con la enfermedad por hígado graso no alcohólico (EHNA), además del desarrollo del CHC en hígado no cirrótico por EHNA. Se han identificado marcadores genéticos asociados a la enfermedad, así como avances en vigilancia y diagnóstico. En relación al tratamiento, el perfeccionamiento de técnicas quirúrgicas, tanto relacionadas con resección como trasplante; y radiológicas en estadios curativos permite mejorar la supervivencia de los pacientes candidatos a este abordaje; y finalmente, hay cambios radicales en el abordaje sistémico con expectativas mucho más optimistas cuando se comparan con lo disponible hace una década. Es por eso que la Asociación Mexicana de Hepatología decidió realizar el II Consenso Mexicano de Carcinoma Hepatocelular, en el cual se hizo una revisión actualizada de la evidencia disponible nacional e internacional sobre la epidemiología, factores de riesgo, vigilancia, diagnóstico y tratamiento de la enfermedad; con el objetivo de ofrecer al médico mexicano una revisión actualizada sobre los diferentes tópicos de esta enfermedad. En esta segunda parte del documento se presenta los tópicos relacionados con el tratamiento del CHC.
Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence ...over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago.
Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma.
In this first part of the document, the topics related to epidemiology and diagnosis are presented.
El carcinoma hepatocelular (CHC) se presenta cada vez más frecuentemente como una de las principales complicaciones de cirrosis, su principal factor de riesgo. La última década ha presentado modificaciones en su incidencia, relacionadas con una transición epidemiológica en la etiología de la cirrosis, con disminución en la prevalencia de hepatitis C y aumento en la etiología relacionada con la enfermedad por hígado graso no alcohólico (EHNA), además del desarrollo del CHC en hígado no cirrótico por EHNA. Se han identificado marcadores genéticos asociados a la enfermedad, así como avances en vigilancia y diagnóstico. En relación al tratamiento, el perfeccionamiento de técnicas quirúrgicas, tanto relacionadas con resección como trasplante, y radiológicas en estadios curativos permite mejorar la supervivencia de los pacientes candidatos a este abordaje; finalmente, hay cambios radicales en el abordaje sistémico con expectativas mucho más optimistas cuando se comparan con lo disponible hace una década.
Es por eso que la Asociación Mexicana de Hepatología decidió realizar el II Consenso Mexicano de Carcinoma Hepatocelular, en el cual se hizo una revisión actualizada de la evidencia disponible nacional e internacional sobre la epidemiología, los factores de riesgo, la vigilancia, el diagnóstico y el tratamiento de la enfermedad, con el objetivo de ofrecer al médico mexicano una revisión actualizada sobre los diferentes tópicos de esta enfermedad.
En esta primera parte del documento se presentan los tópicos relacionados con la epidemiología y el diagnóstico.
The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for ...treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.
La Asociación Mexicana de Hepatología A.C. llevo a cabo el Consenso del manejo de las complicaciones de la cirrosis hepática en población pediátrica con el fin de proveer a los médicos de información útil para su tratamiento. Participaron un grupo de gastroenterólogos pediatras y expertos en nutrición, nefrología y enfermedades infecciosas, quienes revisaron la literatura médica. El método Delphi fue aplicado para obtener el nivel de acuerdo de los enunciados emitidos; estos fueron enviados a los participantes para ser analizados, votados y en sesiones virtuales fueron discutidos, obteniendo así, las declaraciones finales. Los resultados del consenso fueron emitir las indicaciones para el manejo de un niño con cirrosis hepática, con el fin de prevenir o controlar las complicaciones.
PDF
