New Interventional procedures guidance [IPG614] Endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer

New Interventional procedures guidance [IPG614] Endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer
Published date: May 2018  Next review: May 2021


Evidence-based recommendations on endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer in adults. This involves using heat energy both to clear blockage in the bile ducts before inserting stents and to clear blocked stents.


For full guidance https://www.nice.org.uk/guidance/ipg614

Pembrolizumab for Advanced Hepatocellular Carcinoma – second line onwards

Hepatocellular Carcinoma (HCC) is the most common type of liver cancer. This type of cancer develops from the main liver cells, called hepatocytes. Treatment and survival depends on the stage at which the cancer is diagnosed. HCC is more common in people who have long‐term damage to the liver (cirrhosis) due to a viral infection or excessive alcohol intake.


http://www.io.nihr.ac.uk/report/pembrolizumab-for-advanced-hepatocellular-carcinoma-second-line-onwards/


From the NIHR Innovation Centre

HPV vaccination programme for men who have sex with men

The government has confirmed that it will introduce a nationwide HPV vaccination programme for men aged 45 or younger who have sex with other men.

NHS England and Public Health England (PHE) will work to start the programme from April 2018, for those attending sexual health (GUM) clinics and HIV clinics in England.

Hepatitis E: symptoms, transmission, prevention, treatment

Details

This document explains hepatitis E, describing the:

• symptoms
• means of transmission
• best means of prevention and treatment

From Public Health England

Glecaprevir–pibrentasvir for treating chronic hepatitis C [TA 499]

New:  Technology appraisal guidance


Glecaprevir–pibrentasvir is recommended, within its marketing authorisation, as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.


It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need.




Why the committee made these recommendations
  
Current treatment options for chronic hepatitis C depend on genotype, cirrhosis status and treatment history. Glecaprevir–pibrentasvir is suitable for all genotypes and has a shorter treatment duration than most other direct-acting antiviral treatments.

Hepatic amyloidosis: a cause of rapidly progressive jaundice

BMJ Case Reports 2018; doi:10.1136/bcr-2017-222942

An 83-year-old man presented with an acute history of weight loss and jaundice. He had a history of type 2 diabetes mellitus and hypertension. He consumed 30 units of alcohol per week. 

UHCW Research: Benjamin Disney and Veena Shinde

NIHR Signal Harm reduction approaches predicted to reduce rates of new hepatitis C infection for people who inject drugs

A combination of providing clean needles and syringes and offering safer oral therapy, such as methadone, reduced the predicted risk of becoming infected with hepatitis C virus by 71%. Providing both services to people who inject drugs was likely to be cost-effective and has the potential to be cost-saving in some parts of the UK, depending on the size of the local population of people who inject drugs and underlying rates of infection.

Current services are estimated to save up to £54 million in costs of treating hepatitis C infection. This is in addition to the savings made from reducing the incidence of HIV infections. This study suggests that if such programmes are decommissioned, the number of new hepatitis C infections would at least double.

From the NIHR Dissemination Centre

Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis

Clinical Nutrition ESPEN. DOI: http://dx.doi.org/10.1016/j.clnesp.2017.10.009

Undernutrition in cirrhotic patients is often poorly recognised until late-stages. The current UK screening tool, the Malnutrition Universal Screening Tool, can miss undernutrition in patients with ascites/fluid retention. A 6-question Liver Disease Undernutrition Screening Tool (LDUST) has been developed in America.

We sought to compare LDUST with MUST in the detection of undernutrition in 50 inpatients and 50 outpatients with liver cirrhosis in a secondary care setting. This was then validated by a dietitian assessment.

UHCW Research: M. McFarlane, C. Hammond, T. Roper, J. Mukarati, R. Ford, J. Burrell, V. Gordon

and N. Burch

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N. Burch

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Affiliations

Volixibat for non-alcoholic steatohepatitis (NASH)

Currently, there are no approved therapies for the treatment of NASH, but doctors recommend dietary changes and exercise to prevent or slow disease progression. Volixibat is a new experimental once-daily oral tablet that may improve NASH by targeting and blocking a protein (apical sodium-dependent bile acid transporter) found in the liver. This is thought to improve liver function by reducing the amount of cholesterol (fatty substance) in this organ. If licensed, volixibat has the potential to establish itself as a single-agent and the first treatment specifically for NASH.


From the NIHR Innovation Observatory

A4250 for progressive familial intrahepatic cholestasis

Progressive familial intrahepatic cholestasis (PFIC) is a rare, inherited condition that usually begins in infancy. The condition affects the liver, hindering or stopping the flow of bile from the liver. Bile flow is needed for fats, nutrients and vitamins to be absorbed into the body, and also to help the body get rid of toxins. Problems absorbing fats and nutrients can lead to poor weight gain and slower growth, and excess toxins in the body can lead to jaundice and itching, which can have a large impact on the quality of life of the patient and their family. There is no cure for this condition, and current treatments can only reduce the symptoms and slow down damage to the liver. It is not known how many people have this condition, but around 35 genetic tests are carried out each year for this condition.
The drug A4250 works in a new way that directly targets the part of the gut that allows bile to flow into the liver. By stopping bile from coming into the liver, bile levels are reduced, slowing down damage to the liver and reducing the symptoms of jaundice and itching. Because the drug acts directly on the gut, it has the potential to reduce the side-effects that occur with current medicines, such as problems with vitamin absorption. The drug is taken by mouth as a capsule.


From the NIHR Innovation Observatory

Seladelpar for primary biliary cirrhosis – second or subsequent line

Primary biliary cirrhosis (PBC), is a long-term liver disease in which the pipes (ducts) that transports bile in the liver become damaged. PBC causes the build-up of bile in the liver and eventually may lead to scarring. Nine out of ten people with PBC are women. The exact cause of PBC is not known, although family history, when combined with lifestyle may increase the risk of getting PBC. The most common symptoms of PBC are itchy skin and fatigue, however, up to half of people with PBC do not have any symptoms until extensive liver damage occurs.
Seladelpar is a new drug currently being developed and tested to treat PBC. It acts by promoting the natural transportation and storage of bile within the liver. It is currently taken as a capsule in doses of 2 mg, 5mg, 10mg, or 20mg once a day. If licensed in the UK, seladelpar could provide an additional treatment option for people with PBC


From the NIHR Innovation Observatory

Pexastimogene devacirepvec (pexa-vec) for hepatocellular carcinoma – first line

Pexastimogene devacirepvec is under development for the first line treatment of advanced hepatocellular carcinoma. The drug is an engineered virus with a gene that promotes the body’s natural response to cancerous cells in the liver. This treatment is administered by injection directly into the cancerous cells in the liver or through the veins. It is designed to selectively target and destroy cancer cells through three different ways: direct destruction of the cancer cells, reduction of the blood supply to tumours and the stimulation of the body’s defense against cancer cells. If licensed, pexastimogene devacirepvec may offer an additional treatment option for patients. Currently, there are few treatment options for advanced hepatocellular carcinoma patients, with only one drug, sorafenib, approved for the first line treatment of advanced hepatocellular carcinoma.


From the NIHR Innovation Observatory

New hexavalent vaccine including Hepatitis B for primary immunisations

From 1 October 2017, all babies born on or after 1 August 2017 will become eligible for a hexavalent vaccine which includes Hepatitis B (HepB) for their primary immunisations.

This vaccine, called Infanrix hexa, will replace those used before. Infanrix hexa is a combination vaccine used to protect against diphtheria, tetanus, whooping cough, HepB, polio and disease caused by Haemophilus influenzae type b. 

Guidance for health professionals and suppliers, regarding implementation of the vaccine is available.

Quality Standards for Paediatric Gastroenterology, Hepatology & Nutrition

The Royal College of Paediatrics and Child Health and the British Society of Paediatric Gastroenterology, Hepatology and Nutrition have worked together to develop these new standards.

The standards apply to children receiving gastroenterology, hepatology and nutrition care in the secondary and tertiary care settings across the UK.

New liver disease atlas shows major variation across England

New data published by Public Health England (PHE) shows a wide variation of premature mortality rates from liver disease across England.

The atlas shows premature mortality rates – dying before the age of 75 – ranged from 3.9 per 100,000 in South Norfolk clinical commissioning group (CCG) to 30.1 per 100,000 in Blackpool CCG, a 7.7 fold difference.

The atlas paints a mixed picture, with 10 indicators showing improvements including a reduction of premature deaths and fewer alcohol-specific hospital admissions for under 18s. Nine of the indicators have become worse over time, including a doubling of hospital admission rates for cirrhosis from 54.8 per 100,000 to 108.4 per 100,000 people over the past decade.

Sorafenib for treating advanced hepatocellular carcinoma

New Evidence-based recommendations on sorafenib (Nexavar) for treating advanced hepatocellular carcinoma in adults.

This guidance is a Cancer Drugs Fund reconsideration of sorafenib for the treatment of advanced hepatocellular carcinoma (TA189).

Sorafenib is recommended as an option for treating advanced hepatocellular carcinoma only for people with Child-Pugh grade A liver impairment, only if the company provides sorafenib within the agreed commercial access arrangement.

Liver cancer drug, sorafenib has been approved for routine NHS use

Liver cancer drug, sorafenib has been approved by NICE, as part of the Cancer Drugs Fund, for routine NHS use for Hepatocellular carcinoma (advanced and metastatic) - sorafenib (first line).

Hexavalent 6-in-1 vaccine to be made available to newborn babies

All babies born on or after 1 August 2017 will be offered protection against hepatitis B as part of our universal childhood immunisation programme, Public Health England has announced. This is in addition to continued protection against diphtheria, tetanus, pertussis, polio and Hib.

Liver Disease quality standard

This quality standard from NICE covers the identification, assessment and management of chronic liver disease in adults, young people and children, and cirrhosis in adults and young people. It describes high-quality care in priority areas for improvement. It does not cover treatment for liver cancer.

This has now been published.

WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cance

New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the WHO Model list of essential medicines for 2017. Other additions include medicines for HIV, hepatitis C, tuberculosis and leukaemia.