During this auspicious time for patients and practitioners alike,

During this auspicious time for patients and practitioners alike, futility rules can be applied most effectively when their basis is transparent and understood. Our recommendations are consistent with the US Food and Drug Administration position and the 2011 practice guidelines from the American Association for the Study of Liver Diseases.7 In addition to detectable HCV RNA at week 24, an earlier and robust week 12 stopping rule of an HCV RNA level ≥100 IU/mL can conveniently be incorporated

into the routine care of both treatment-naive and treatment-experienced patients treated with boceprevir combined with peginterferon/ribavirin. In particular, our findings challenge the common practice of discontinuing P/R therapy in treatment-experienced patients with Z-VAD-FMK PFT�� molecular weight detectable HCV RNA at week 12 in favor of using

a week 12 futility threshold of 100 IU/mL in all patients receiving boceprevir-containing regimens. The sequential application of stopping rules at weeks 12 and 24 appears to maximize the early discontinuation of futile therapy while minimizing premature treatment discontinuation in patients who might achieve SVR. These rules merit validation in larger and varied patient populations in the future. The authors thank all the patients, health care providers, and investigators involved in these studies. They are also indebted to Richard Barnard for providing the resistance data from SPRINT-2; to Ruiyun Jiang for quality-checking the input used for these analyses; 上海皓元 and to Jon Stek, Joann DiLullo, Kathleen Newcomb, and Karyn Davis for providing indispensable advice and support in the preparation of this article. Additional Supporting Information may be found in the online

version of this article. “
“Early recognition of recipients with rapidly evolving recurrent hepatitis C following orthotopic liver transplantation (OLT) is the only practical approach to improve outcome of these patients.1 Recently, transient elastography (TE) was shown to identify patients with rapidly progressive hepatitis C in the first year following OLT, differentiating them from patients with slowly progressive hepatitis C.2 Thirty-seven consecutive liver graft recipients with recurrent hepatitis C, who underwent transplantation from June 2005 to December 2007, were prospectively investigated with repeated TE examinations at 3, 6, 9, and 12 months after OLT and underwent a liver biopsy at month 12. Significant liver fibrosis was scored as Ishak staging (S) ≥ 3. Patients with S < 3 at month 12 were defined slow fibrosers compared to rapid fibrosers, who had S ≥ 3. Of the 33 patients who completed the follow-up (four died within month 6), 21 (64%) were slow fibrosers and 12 (36%) were rapid fibrosers, thus confirming the 63% and 37% rates of slow and rapid fibrosers previously reported.2 Slow fibrosers had significantly lower TE measurements at 3, 6, 9, and 12 months (median 7.5, 7.0, 6.

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