HCV Advocate DDW 2009 Coverage
Health outcomes explored at DDW 2009
"The research being
presented during DDW shows how widespread our efforts are in understanding and
treating liver disease," said Brent Tetri, MD,
DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Text Messaging Reduces Rejection in Pediatric Liver Transplant Recipients (Abstract #175)
Text messaging may improve compliance rates in pediatric liver transplant recipients, reduce organ rejection and provide significant cost savings with medications and hospitalizations, according to a new study. Children and adolescents who receive liver transplants often have trouble remembering to take their medication regularly; in addition to being less vigilant than adults, liver patients also suffer memory problems. Missing medication is especially dangerous since their bodies can reject the transplanted liver after only two missed doses of medication. But because young people are generally technologically savvy, researchers sought to determine whether sending text messages would result in improved adherence.
The study looked at 41 young
people who were on average 15 years old and at various stages after receiving a
liver transplant. The MediM AS system from CareSpeak Communications, which
funded the study, was used to decide which time of day patients/or caregivers
preferred to receive a medication reminder via text message, which were then
sent accordingly. To ensure that patients not only received the message but
also took their medication, patients had 15 minutes to send a reply text
confirming intake. If they did not,
To determine the effectiveness of the text reminders, researchers looked at two factors: the level of medication in the patient's blood and whether their bodies rejected the liver transplant. Patients who took medication erratically had a higher deviation of medication in their blood, compared to patients who took their medication regularly. In the year prior to the study, 12 of 41 patients experienced rejection that required hospitalization and treatment because the patient's body rejected the transplant due to improper medication dosage. But one year into this study, just two patients suffered rejection of the liver.
Lead investigator Tamir
Miloh, MD, assistant professor in pediatric hepatology and surgery at
Previous studies have looked at the effectiveness of text reminders, but not on liver patients and not on a scale of this size.
Dr. Miloh will present these
data on Sunday, May 31 at in South Hall,
The Point of Care 13C Methacetin Breath Test Accurately Predicts Long Term Prognosis with Chronic Liver Disease: A Non-Invasive Liver Function Test (Abstract #S1837)
Researchers at the
Previously, prognosis in patients with chronic liver disease has been determined by using a combination of blood tests. However, this method is limited to predicting prognosis for up to three months and may only change after a life threatening complication has occurred.
Using a test called the 13C-Methacetin breath test, a rapid, non-invasive procedure, investigators were able to accurately predict the survival of liver disease patients for a period of up to two years. The test is conducted with the patient drinking a cup of water containing a dissolved substrate. The device then measures the appearance of tagged CO2 (the product of the hepatic metabolism of the 13C-Methacetin) in the exhaled breath; the patient does not do anything except sitting and breathing normally.
Studying 575 patients with varying types and degree of liver disease, investigators showed that the breath test can predict which patients will develop complications that will affect their prognosis.
"The potential for this
test is tremendous," said
Researchers believe that the accuracy of the test, and its capacity to assess liver function, makes the breath test a potentially powerful new tool in predicting prognosis of liver related complications, prioritizing patients for organ transplantation, and predicting their ability to survive surgery.
Dr. Lalazar will present
these data on Sunday, May 31 at in South Hall,
Cumulative Incidence and Risk Factors of
Hepatocellular Carcinoma (
There is a significant risk of developing of liver cancer in patients with nonalcoholic steatohepatitis, or NASH, according to a study from the Cleveland Clinic. The study also found that mild alcohol consumption may significantly increase the risk of developing liver cancer in patients with end stage liver disease.
NASH is one of two stages of
non-alcoholic fatty liver disease, the most common liver disease in the
In a retrospective study of more than 500 patients with either HCV-cirrhosis (hepatitis C) or NASH-cirrhosis over a three year period, researchers found that 20 percent of patients with HCV-cirrhosis and 12.8 percent of patients with NASH-cirrhosis developed hepatocellular carcinoma (liver cancer). The annual risk for developing liver cancer in HCV patients is 4 percent per year and that of NASH patients is 2.6 percent per year. The annual risk for NASH patients was previously unknown. While the rates are higher for patients with HCV, the risk of developing liver cancer for NASH patients is significant.
Investigators also sought to identify modifiable risk factors in effort to potentially reduce the burden of liver cancer in this patient population. They found that even mild alcohol consumption may significantly increase the liver cancer risk in patients with end-stage liver disease.
"This study offers valuable insight into the care of patients with NASH," said Nizar N. Zein, MD, chief of hepatology and medical director of liver transplantation at the Cleveland Clinic. "Not only do we need to adjust the way we follow these patients, including tracking and preparing for the potential development of liver cancer, but we may also need to counsel this patient population against any alcohol intake given its risk."
Dr. Zein will present these
data on Monday, June 1 at in S105,
Public Awareness and Attitudes towards Non Alcoholic Fatty Liver Disease (NAFLD) (Abstract #T1006)
Patient awareness of
non-alcoholic fatty liver disease (NAFLD) and its complications is poor and
must be improved to ensure prevention, detection and treatment of the
condition. NAFLD is the most common cause of abnormal liver enzymes and one of
the most common causes of cirrhosis of the liver in the
Researchers conducted a survey of 5,000 outpatient adults asking about awareness levels of NAFLD and its risk factors. Ninety-eight percent of the patients said their physicians had never talked about NAFLD with them. By contrast, a previous study on colorectal cancer found that 40 percent were aware of that disease and its risk factors.
"It is both disturbing
and significant that a surprisingly high number of respondents were uninformed
about this silent but deadly disease," said Sury Anand, MD, chief of
The survey also found that 95 percent did not realize that fat in the liver could cause serious health problems and 80 percent had never heard of cirrhosis. Dr. Anand said prevention is especially critical since treatment options for NAFLD are limited. Public awareness of NAFLD must rise to the level of other chronic diseases and conditions, which can best be achieved with the active participation of primary care physicians, pediatricians and other providers in counseling their patients to adopt preventive lifestyle modifications.
He recommends that doctors
encourage patients to maintain healthy weight by having a good balanced diet
and regular exercise to fend off NAFLD in the similar way that patients need to
limit their carbohydrate intake in order to prevent prediabets and diabetes.
The study subjects were all from
Dr. Nan Sandar will present
these data on Tuesday, June 2 at in South Hall,
Health outcomes explored at DDW 2009
CHICAGO, IL (June 2, 2009) – Researchers are making great strides in the development of new treatments for hepatitis and in confirming the effectiveness of current treatments, according to several studies being presented at Digestive Disease Week® 2009 (DDW®).
"Only about half of the
patients infected with hepatitis B and C respond to currently used
treatments," said Nicholas J. Shaheen, MD,
Hepatitis is an inflammation of the liver that usually produces swelling, tenderness and sometimes permanent damage. Hepatitis B can be spread from mother to child at birth or soon after and through sexual contact, contaminated blood transfusions and needles. Hepatitis C, the most common form of viral hepatitis, can be spread through blood transfusions and contaminated needles, but for a substantial number of patients, the cause is unknown. Both forms of viral hepatitis may lead to cirrhosis, or scarring, of the liver.
DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Tenofovir Disoproxil Fumarate (TDF) Versus
Emtricitabine Plus TDF (FTC/TDF) for Treatment of Chronic Hepatitis B (
Two year follow-up data from
this ongoing trial demonstrate that hepatitis B (HBV) patients with persistent
viremia (presence of virus of blood) while receiving adefovir dipivoxil (
At week 96, HBV
"These data expand upon the safety and efficacy findings from the TDF hepatitis B pivotal trials," said David Oldach, MD, director of clinical research at Gilead Sciences, Inc. "Tenofovir disoproxil fumarate has demonstrated consistent efficacy across a broad range of chronic hepatitis B patients, including patients with preexisting resistance mutations or prior suboptimal response to adefovir dipivoxil, patients with cirrhosis, and patients with any of the major HBV genotypes. An additional very promising finding in the registrational trial among HBeAg positive patients has been hepatitis B surface antigen loss, occurring in 3 percent of TDF recipients in one year and 6 percent in two years time."
Continued Dr. Oldach, "The data to be presented review outcomes from the first two years of a three and a half year study. While we cannot predict future treatment outcomes, we hope and expect that the participants will continue to receive durable benefit from this therapy."
Dr. Oldach will present these
data on Monday, June 1 at in Room S105,
The Long Term Effects of Interferon Based (IFNTx) Therapy on Hepatic Histology in Patients with Chronic Hepatitis C Virus. Results of a Five Year Prospective Evaluation on Fibrosis Progression and Fibrosis Regression (Abstract #7)
Interferon or peginterferon
with or without ribavirin (IFNTx) should be the standard treatment for patients
with hepatitis C (HCV), according to a study presented by researchers from the
"The use of interferon
or peginterferon for the treatment of patients with hepatitis C can have a
dramatic improvement on the histology of the disease, including the
disappearance of cirrhosis," summarized Richard Sterling, MD, MSc,
Professor of Medicine,
Researchers conducted a
longitudinal cohort study to evaluate the use of IFNTx on liver histology in
patients with chronic HCV. Seven hundred and fifty five patients underwent
liver biopsy and received a single course of IFNTx or no treatment. Of these
patients, 230 were followed for five years without additional treatment (41
patients declined treatment and 189 received IFNTx without obtaining sustained
virologic response) before undergoing a repeat liver biopsy. An additional 102
patients who received IFNTx and obtained sustained virologic response (
There were no significant
differences in worsening of inflammation or fibrosis scores between those who
did not undergo treatment or did not have an
Dr. Mitchell Shiffman will
present these data on Sunday, May 31 at in Room 9B-16,
For the first time, researchers have shown that patients with hepatitis C (HCV) genotype 1 who do not respond to standard treatment can obtain a sustained virologic response using a combination regimen of telaprevir (T) plus peginterferon-alfa-2a (P) ± ribavirin (R). About 70 percent of patients who had relapsed on previous HCV treatment experienced sustained virologic response and about 40 percent of patients who previously had not responded to treatments experienced sustained virologic response. Patients who had not responded to previous treatments needed to undergo 48 weeks of treatment with T/PR. The sustained virologic response rate was significantly higher in all treatment groups receiving T/PR regimens compared with those receiving placebo plus PR48.
"This is a very important and unique trial," said Adrian M. Di Bisceglie MD, FACP, chairman of the department of internal medicine and chief of hepatology at the Saint Louis University School of Medicine, and lead investigator of the study. "Since a large majority of hepatitis C patients do not experience a sustained response to current treatments, it is necessary to identify new drugs and treatment regimens to help better the chances of patients clearing the disease from their systems. The results of this trial bring us closer to understanding how to do that."
In the PROVE3 study, 453 patients were randomized to receive T/PR for12 weeks followed by PR for 12 weeks (T12/PR24); T/PR for 24 weeks followed by PR for 24 weeks (T24/PR48); T/P for 24 weeks (T24/P24); or placebo/PR for 24 weeks, then PR for 24 weeks. Of the participants, 235 (52 percent) completed their assigned treatments. Many of the patients included in the intent-to-treat analysis had baseline characteristics know to be associated with poor response to treatment, including 196 (43 percent) with cirrhosis or bridging fibrosis, 418 (92 percent) with baseline serum HCV RNA ≥ 800,000 IU/mL, and 40 (9 percent) were African American.
The general safety profile of T12/PR24 compared with T24/PR28 was similar to that observed in treatment naïve patients. Patients in the T12/PR24 or T24/PR48 group experienced greater frequency of fatigue, nausea, headache, rash, pruritus, diarrhea, anemia, insomnia, fever, hair loss and chills thank those treated with placebo followed by PR48. Of those patients discontinuing treatment due to adverse events, 11 (10 percent) were in the T12/PR24 group, 29 (25 percent) were in the T24/PR48 group, 10 (9 percent) were in the T24/P24 and five (4 percent) were in the placebo plus RP48 group.
"We are continuing to
study these treatment combinations in a phase
Approximately 80 percent of
HCV patients in the
This study was funded by Vertex Pharmaceuticals.
Dr. Di Bisceglie will present
these data on Tuesday, June 2 at in Room E451B,
Digestive Disease Week® 2009 (DDW®) is the largest
international gathering of physicians, researchers and academics in the fields
of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Jointly sponsored by the American Association for the Study of Liver Diseases
(AASLD), the American Gastroenterological Association (
Angela Townsend/Plain Dealer Reporter
People who suffer from the most serious form of nonalcoholic fatty liver disease have a significant risk of developing liver cancer, researchers at the Cleveland Clinic have found.
The findings were presented
Monday at Digestive Disease Week in
Nonalcoholic fatty liver
disease is the most common liver disease in the
The disease is so named because of the accumulation of fat in the liver -- without an excessive amount of alcohol as the cause. The liver also becomes inflamed and scarred.
Researchers looked at patients with the most serious form of the disease, nonalcoholic steatohepatitis, or NASH. About 20 percent of patients with NASH go on to develop cirrhosis of the liver. (Cirrhosis of the liver is also caused by alcohol abuse -- which accounts for most cirrhosis cases -- and other conditions such as hepatitis B and C.)
"We suspected that having cirrhosis from fatty liver disease would lead to liver cancer, but that wasn't defined before," said Dr. Nizar Zein, the Clinic's chief of hepatology and medical director of liver transplantation.
The research was conducted by Mustafa Ascha, a student at Case Western Reserve University for whom Zein serves as a mentor.
It wasn't until the 1980s that much was known about fatty liver disease. And until recently, alcohol was blamed as the sole cause.
Cirrhosis of the liver causes hepatocellular carcinoma, the most common form of liver cancer and the fifth most common cancer worldwide.
The Clinic study followed 510 patients with liver cirrhosis from 2003 to 2006. About 38 percent (195) suffered from NASH. The other 62 percent had hepatitis C.
The two goals were to see if patients would develop liver cancer, and if that risk could be quantified.
The answers were "yes" and "yes."
Nearly 13 percent of the NASH patients developed cancer over the course of the study.
Per year, 2.6 percent of the patients developed liver cancer. If that pattern holds true, more than one-fourth (27 percent) will develop liver cancer after 10 years, Zein said.
In comparison, about 20 percent of the hepatitis patients developed liver cancer, at an annual rate of 4 percent per year.
But a diagnosis of liver cancer isn't necessarily an automatic death sentence. Found early, it can be treated, Zein said.
Those at highest risk for liver cancer are older people and people who drink alcohol, even in small quantities.
Zein said he counsels fatty liver disease patients to avoid alcohol completely, but added the opinion is not "universal."
The Clinic is one of only a few institutions that have followed a large population of people with the disease. To date, the Clinic's study is the largest, Zein said.
Measuring the cancer risk not only will raise awareness about the dangers of nonalcoholic fatty liver disease, but also will help physicians decide how often people with the disease should be screened for cancer, Zein said.
By Todd Neale, Staff Writer, MedPage Today
Reviewed by Dori F. Zaleznik, MD; Associate Clinical
Professor of Medicine,
Dorothy Caputo, MA, RN, BC-
CHICAGO, June 3 -- The investigational protease inhibitor telaprevir, added to standard hepatitis C (HCV) treatment, produced a sustained virologic response in about half of patients who had previously failed with conventional therapy, a phase IIb trial showed.
Patients who received
telaprevir, peginterferon, and ribavirin had higher response rates than those
who received peginterferon and ribavirin alone, the current standard treatment,
according to Adrian Di Bisceglie, M.D., of
The group of patients who received telaprevir and peginterferon, but not ribavirin had less of a benefit than those who received all three drugs, he reported at Digestive Disease Week here.
Because there is no existing standard of care for patients who fail to respond to standard treatment for HCV, he said, "I personally believe this . . . represents a new paradigm for how we will treat nonresponders in the future."
About three million
people in the
Conducted at 53 centers, the PROVE3 (Protease Inhibition for Viral Evaluation) study follows the PROVE1 and PROVE2 studies, which evaluated the effect of telaprevir in treatment-naive patients. (See EASL: Telaprevir Shows Promise of Shortened Hepatitis C Therapy and AASLD: Telaprevir Yields Good Response in Combo Therapy for HCV)
PROVE3 involved 453
patients with HCV genotype 1, the most common in the
The patients were randomized to four treatment arms with varying duration of treatment with telaprevir, peginterferon, and ribavirin:
· 12 weeks of all three drugs followed by 12 weeks of standard treatment
· 24 weeks of all three drugs followed by 24 weeks of standard treatment
· 24 weeks of telaprevir and peginterferon, but no ribavirin
· 24 weeks of placebo plus standard treatment followed by 24 weeks of standard treatment (control)
The median age of the patients was 51 and about two-thirds were male. All four groups were well-matched according to baseline characteristics.
The primary endpoint was sustained virologic response 24 weeks after the end of each treatment regimen.
All three telaprevir groups were superior to placebo in the percentage of patients who had a sustained virologic response at follow-up:
· 51% in patients who received 12 weeks of telaprevir (P<0.001)
· 52% in those who received telaprevir for 24 weeks along with standard treatment (P<0.001)
· 23% in those who did not receive ribavirin (P=0.035)
· 14% in the controls
Similar benefits were seen at four weeks, indicating a rapid virologic response, and immediately at the end of treatment.
Some patients relapsed between the end of treatment and the follow-up, 24 weeks later. The relapse rates were 30% and 13% in the two groups that received telaprevir plus standard treatment and 53% in both the group that did not receive ribavirin and the controls.
Notably, almost 40% of patients who had not responded to treatment at all before the study showed a sustained virologic response at follow-up in the two groups that received all three drugs (P<0.001 for both). That compared with only 9% of the controls.
Response rates of 69% and 76% were seen among prior relapsers (P<0.001 for both), with the higher rate occurring in those who received 48 weeks of standard treatment in addition to 24 weeks of telaprevir.
There was no difference in response rates between patients with and without cirrhosis.
"It appears that telaprevir is able to overcome this and other traditional poor response factors," Dr. Di Bisceglie said.
The most common adverse events in groups receiving telaprevir were fatigue, nausea, headache, rash, itching, anemia, and gastrointestinal side effects, only some of which were severe enough to result in discontinuation.
The dosing regimen
involving 24 weeks of all three drugs, followed by 24 weeks of peginterferon
and ribavirin, is currently being evaluated in a phase
Dr. Di Bisceglie said FDA approval for telaprevir is about two years away. Telaprevir and a similar drug, boceprevir, appear to be the closest to approval.
Patients with significant liver disease should receive treatment with peginterferon and ribavirin right away, he said, but patients who have previously failed a course of treatment might think about waiting for these drugs to hit the market.
"These drugs are coming and not that far away, and it may be better to be waiting with our nonresponders for better treatment," he said.
The study was supported by Tibotec and Vertex Pharmaceuticals, co-developers of telaprevir.
Dr. Di Bisceglie reported no conflicts of interest.
Primary source: Digestive Disease Week
Di Bisceglie A, et al
Standard therapy for chronic hepatitis C virus (HCV) infection in HIV negative people is 24 weeks of pegylated interferon plus weight-adjusted ribavirin for those with HCV genotypes 2 or 3, and 48 weeks for those with harder-to-treat genotypes 1 or 4.
Current guidelines indicate
that HIV positive patients should receive combination anti-HCV therapy for 48
weeks regardless of HCV genotype. But coinfected individuals with genotypes 2
or 3 can achieve good outcomes with the shorter 24-week course, according to
data presented at the annual Digestive Disease Week (DDW 2009) meeting this
and colleagues from
The study included 85 HCV monoinfected participants (38 with genotypes 1, 4, or 5; 47 with genotypes 2 or 3) and 47 HIV-HCV coinfected patients (23 with genotypes 1, 4, or 5; 24 with genotypes 2 or 3). About 60% of the coinfected participants were on HAART.
Patients with genotypes 1, 4, or 5 were treated for 48 weeks with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day ribavirin, with doses adjusted according to body weight. Patients with genotypes 2 or 3 received the same dose of Pegasys plus 800 mg/day ribavirin (regardless of weight) for 24 weeks.
intention-to-treat analysis of participants with genotypes 1, 4, or 5, the
patients with genotypes 2 or 3, 70% of HCV monoinfected patients and 67% of
HIV-HCV coinfected patients achieved
RNA at week 4 -- known as rapid virological response (RVR) -- had a positive
predictive value (PPV) for
o .78 for HCV monoinfected patients with genotypes 1, 4, or 5;
o .81 for HCV monoinfected patients with genotypes 2 or 3;
o .76 for HIV-HCV coinfected patients with genotypes 2 or 3.
· 22 patients (36%) with genotypes 1, 4, or 5 did not complete the study for various reasons (lack of response at week 12, withdrawal of consent, adverse events, death) compared with 12 patients (17%) with genotypes 2 or 3.
These findings led the
researchers to conclude, "Genotypes 2 and 3 predict the likelihood of
"In coinfected patients
with genotypes 2 and 3, a 6-month treatment has the same efficacy as in
monoinfected patients," they continued. "Undetectable HCV RNA at week
4 has a good positive predictive value of
Finally, they recommended, "Aggressive treatment of adverse effects to avoid withdrawal or treatment stop is crucial."
Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; University of Basle, Basle, Switzerland; University of Zurich, Zurich, Switzerland; Hospital of La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland; Hospital of Lugano, Lugano, Switzerland; Private Practice, Winthertur, Switzerland.
JJ Gonvers, MH Heim, M
Cavassini, and others. In HIV-HCV Co-Infected Patients with HCV Genotype 2 or 3
Infection a 6-Month Treatment with Peginterferon Alpha Plus Ribavirin Has the
Same Efficacy As in Mono-Infected Patients. Digestive Disease Week (DDW 2009).
By Todd Neale, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
Patients divided into
high, medium, and low-risk groups according to the breath test had two-year
survival rates of 98.9%, 89.7%, and 73%, respectively, Gadi Lalazar, M.D., of
The test might be able to add predictive value to the Model for End-Stage Liver Disease (MELD), he said.
Among patients with relatively high MELD scores of 17 and 18, a one-point increase in the breath test score was associated with a 30% higher risk of death.
The new test could be used to assess prognosis from the earliest stages of liver disease to cirrhosis, to help doctors determine whether a cirrhotic patient has enough liver function to undergo a surgical procedure, to prioritize patients for liver transplantation, and perhaps to decide when patients need to start therapy for chronic viral hepatitis, Dr. Lalazar said.
Brent Tetri, M.D., of Saint Louis University, a moderator at the press briefing where the findings were presented, said, "The liver does so many hundreds of different things, it would be very nice to have a good, simple test where we can just assign a number to how a liver's functioning."
Although MELD is able to predict prognosis in chronic liver disease, it is based on several blood tests and only estimates three-month risk.
In addition, patients with similar MELD scores will sometimes have different disease courses -- some will decompensate and die and others will not, according to Dr. Lalazar.
And often, the MELD score will only rise after a complication has occurred, at which point it's too late to prepare the patient for transplantation, he said.
So Dr. Lalazar and his colleagues assessed the predictive ability of the 13C-methacetin breath test.
Here's how it works: The patient drinks a solution containing methacetin, which is exclusively metabolized by the liver. He then sits and breathes normally. A nasal cannula measures exhaled carbon dioxide tagged with 13C for 15 minutes.
The changes in the amount of 13C exhaled allow the researchers to assess liver function.
The researchers gave the test to 575 patients with chronic liver disease of different etiologies. About two-thirds were the result of hepatitis C. More than a third (36.3%) were cirrhotic.
After two years, 25 patients had died from both liver-related and non-liver-related causes.
A survival model was
constructed containing age, percent dose of methacetin recovered at 15 minutes
The model significantly predicted survival (P<0.0001) such that those with high scores had a two-year survival rate of 98.9%. Those with medium scores had a survival rate of 90%, and those with low scores had a survival rate of 73%.
In cirrhotic patients the test was also discriminatory with survival rates of 97%, 85% and 70% at 24 months respectively (P=0.0171).
Dr. Lalazar and colleagues found that the addition of the scores from the breath test helped predict mortality risk even within MELD categories.
Further research is needed, however, before determining whether patients flagged for increased risk by breath test should be get priority in treatment.
That the variability between breath tests in a single patient was about 11%, a consistency rate which Dr. Tetri called "pretty good."
There were no tolerability issues, according to Dr. Lalazar.
The study was supported in part by Exalenz Bioscience, which developed the breath test. One of the study authors is the medical director for the company.
Dr. Lalazar reported no conflicts of interest.
Dr. Tetri reported serving on advisory committees or review panels for Amylin Pharmaceuticals, Gilead Sciences, and Vertex Pharmaceuticals.
Lalazar G, et al "The point of care 13C methacetin breath test accurately predicts long-term prognosis in patients with chronic liver disease: a non-invasive liver function test" DDW 2009; Abstract S1837.