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ANSWER TO QUESTION OF THE WEEK: (1/22/06)
Yes. African Americans have consistently responded poorer to antiviral therapy for hepatitis C compared with Caucasians. Although African Americans (AA) have been significantly underrepresented until recently in large clinical trials studying the effectiveness of antiviral therapy, a lower overall sustained virological response rate (SVR) has been noted. Studies in the past suggested that the high prevalence of genotype 1 in AA’s was responsible for their poor response to antiviral therapy. Another theory eluded that possibly poor adherence to treatment regimens by AA patients could explain the lack of overall response to antiviral treatment.
The first large trial specifically addressing response to therapy based on race was published in 2004 in the New England Journal of Medicine. Unfortunately, this study revealed that AA's with genotype 1 have only a 19% chance of achieving a sustained virological response (SVR) compared to a 52 % chance of SVR seen in Caucasians with genotype 1 when treated with 48 weeks of pegylated interferon and ribavirin. The preponderance of genotype 1 found in AA patients did not account for the difference in response rates, since all patients studied had genotype 1. Adherence to therapy and side effect profile were similar among AA and Caucasians. Furthermore other factors such as age, sex, body weight, or education level had no significant effect on response rates. Thus, the only predictor of SVR in this study was race.
Other studies have revealed more promising SVR rates to pegylated interferon and ribavirin- 26%,28%, and 31% in AA patients. AA patients who did not respond to pegylated interferon and ribavirin who were treated with Infergen and ribavirin, or Infergen and gamma interferon, acheived a SVR of 27% and 35% respectively.
Other studies such as the VIRAHEP-C trial are currently analyzing both viral and host factors, including immunologic and genetic variables that may influence treatment outcomes.
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Dr. Palmer is an internationally renowned hepatologist who has been practicing medicine since 1985. She maintains perhaps the largest private medical practice devoted to liver disease in the United States. Dr. Palmer graduated from Columbia University with a B.A. and was trained in hepatology (as well as medical school) at the Mount Sinai School of Medicine in New York City. She has authored numerous scientific publications in the field of hepatology in such peer-reviewed journals as Hepatology, Gastroenterology, Seminars of Liver Disease, Transplantation and Archives of Internal Medicine.
She is frequently called upon by the media for her opinion on various topics related to liver disease. Dr. Palmer has appeared many times on television as a liver disease expert and has been quoted in such publications as TIME magazine, Cosmopolitan magazine, Prevention magazine, the Los Angeles Times, and Newsday. She also has appeared in numerous videos and CD-Roms aimed at educating doctors and the public about hepatitis C and other liver diseases, such as primary biliary cirrhosis.Dr. Palmer lectures to the medical and general public on liver disease-related topics on a regular basis. She also serves as a liver consultant to five major pharmaceutical companies.
Dr. Palmer is a board member of the New York chapter of the American Liver Foundation, and she sits on the nutrition subcommittee of the national chapter of the American Liver Foundation, the medical advisory board of the Latino Organization for Liver Awareness (LOLA) and the medical advisory board of the Primary Biliary Cirrhosis Organization (PBCers). She has also been a member of the practice guidelines committee of the American Association for the Study of Liver Disease(AASLD) and currently sits on the enduring educational materials committee of AASLD.
Dr. Palmer has performed trials on various experimental medication for the treatment of hepatitis. She is currently conducting research on new therapies for liver disease, specifically in the area of hepatitis C.
Her practice is located on Long Island, New York. (Main office located at: 1097 Old Country Road, Suite 104, Plainview, N.Y. 11803.
Satellite office located at 500 Portion Rd. Lake Ronkonkoma, N.Y. 11779)
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If you are interested in arranging an appointment with Melissa Palmer, M.D., please call (516) 939-2626.
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