Tag Archives: Liver Specialists of Texas

New Hepatitis C Cure FDA Approved: Daclatasvir for Genotype 3 Patients

This past week, the FDA gave approval to Bristol-Myers Squibb and their first drug in the hepatitis C market. Daclatasvir was given FDA approval for patients with the genotype 3 variety of chronic hepatitis C. Daclatasvir, commercially available as Daklinza, is approved to be taken with previously approved sofosbuvir (Sovaldi)-manufactured by Gilead-in this two-drug combination. Of note, Ribavirin nor interferon are required in the combination.

Published cure rates, also know as sustained virologic response (SVR) range from 86-90%. If you are non-cirrhotic, and naive to therapy, one can expect a 96% SVR. Unfortunately, prior treatment failures with past combinations, plus the presence of cirrhosis, carries a poor response rate of 63% in this most difficult group of patients.

For more information on hepatitis C and current therapies available, visit our website at Liver Specialists of Texas .

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Dr. Rashid Khan Joins the Liver Specialists of Texas Team

Dr. Rashid Khan Joins the Liver Specialists of Texas Team

Dr. Rashid Khan will be joining Dr. Galati and Liver Specialists of Texas.

Dr. Rashid Khan will be joining Dr. Galati and Liver Specialists of Texas.

Dr. Rashid Khan will be joining Liver Specialists of Texas in July 2015.

Originally from Karachi, Pakistan, he completed his medical school education at Dow Medical College, Karachi, the second oldest medical school in the country. Following medical school, Dr. Khan was an Intern and Resident in Internal Medicine at the University of Texas Health Science Center-Houston. He completed his Gastroenterology training at the University of Texas Medical Branch in Galveston, Texas, under the direction of Dr. Don Powell and Dr. Roger Soloway. Wanting to further his education in liver disease, he completed his training in Transplant Hepatology at the Baylor College of Medicine in Houston, under the direct mentorship of Dr. John Vierling.

During Dr. Khan’s training, he participated in a number of research studies related to liver disease and the complications of cirrhosis. Dr. Khan also has two years of prior experience of working as a Transplant Hepatologist at the Liver Transplant program at the University of Texas Medical Branch, Galveston.

When not practicing medicine, Dr. Khan enjoys spending time with his young family. His hobbies include travelling, and playing and watching basketball and soccer. He is excited about joining Dr. Galati and the Liver Specialists of Texas team. He shares in Dr. Galati’s vision in providing exceptional and compassionate patient care, and in providing the highest level of care to patients with all facets of liver disease and digestive disorders.

To make an appointment with Dr. Khan, call 713-794-0700.

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Alcoholic Liver Disease: What You Need to Know-The Basics

Our latest video covers the basic aspects of alcohol related liver disease, and the complications of excessive alcohol intake. In general, there are three areas of concern:

1. The development of alcoholic fatty liver disease

2. The development of acute alcoholic hepatitis

3. Alcoholic cirrhosis

The major point to understanding is that all alcoholic drinks (servings) have about the same amount of alcohol in them. Thus, 1-beer, 1-glass of wine, and 1-serving of spirit (i.e. vodka, rum, gin, etc) all have approximately 10-12 grams of alcohol in them. Alcohol is alcohol, regardless of the volume, color, or taste.

The other key point to remember, is that the amount of alcohol daily is different for men and women. For women, one serving/day is the limit; two for men. Period. Above this, you run the risk of complications.

View our latest video.

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New Hepatitis C Drug Approved: Janssen’s Hepatitis C Drug Simeprevir Now Available

This past week, the FDA gave approval to Janssen’s new drug to treat hepatitis C. Simeprevir, commercially know as OLYSIO, is the first new hepatitis C drug since the release of telapravir (Incevik) and boceprevir (Victrelis) in 2011. Simeprevir is a  NS3/4A protease inhibitor, used in combination with interferon and ribavirin.

The release of simeprevir marks the beginning of a new wave of direct acting antiviral agents against the hepatitis C virus. Additional drugs are set for FDA approval, including the Gilead drug sofosbuvir in early December 2013.

Most of the new hepatitis C drugs will have a number of features in common. These include:

  • Very high cure rate, in the 80-90% range – lower in null and non-responders
  • Less side effects
  • Shorter duration of treatment
  • Less pills to take each day
  • Cirrhosis reduces response rates
  • Less drug-drug interactions
  • Genotype 1 subtype differences exist

Looking at the dosing of simeprevir, I have attached the official product insert that describes how the drug will be doses. Several points to consider:

  • This is an interferon/ribavirin based therapy
  • Patients with genotype 1 need additional screening for the NS3 Q80K polymorphism
  • Those with this variant have a decreased response rate to the therapy, and should be considered for an alternative therapy
  • The initial dosing is 12 weeks of simeprevir with interferon and ribavirin, followed by an additional 12 or 36 weeks of interferon and ribavirin combination therapy.
  • There are drug-drug interaction which have to be monitored closely
  • FDA approval is for genotype 1 patients only

While the release of simeprevir is welcomed, it has not provided the proverbial “home-run” we have been looking for in our quest to cure hepatitis C. In well selected patients, achieving a better than 80% cure rate is available. The concerns I have relate to the Q80K polymorphism noted above. This will be an additional step required in screening our patients. Additionally, in patients with prior non-response or null responders, as well as those with cirrhosis, these patients will still require a full 48 week of interferon and ribavirin. One of the goals of the next generation of hepatitis C therapies is reduced interferon exposure, or complete elimination. Simeprevir does not fully meet this goal.

In the days to come, I will post additional information on sofosbuvir. For now, these are the highlights to consider (refer to this FDA document for additional details):

  • Sofosbuvir will likely receive FDA approval for Genotype 1,2,3, and 4 patients with hepatitis C
  • Interferon-free treatment in genotype 2 and 3 for 12 weeks
  • Sofosbuvir combined with interferon and ribavirin in genotype 1 and 4 for 12 to 16 weeks

This treatment strategy is far different than the simeprevir treatment noted above.

Looking further, we will eventually have all interferon-free protocols. It is anticipated that as additional new drugs are approved, they will be combined (example sofosbuvir and simeprevir), allowing us to treat a wide range of patients, safely, and with a cure rate many of us may have never envisioned 20 years ago.

For a consultation to see if you are a candidate for these new drugs, contact Lexa at our office at 713-794-0700 and visit our webpage for additional information.

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Dr. Joe Galati and the Liver Specialists of Texas Staff: Supporting Local Charities

Our practice, Liver Specialists of Texas and staff, have been supporters of the First Colony Dream League. The Dream League roster is approximately 60 physically- and/or mentally- challenged players. In addition, the league has an “Angels in the Outfield” program, where approximately 150 teenage boys and girls from Ft. Bend area schools volunteer to assist Dream League players during the game, becoming a loyal buddy in the process.

On this particular Saturday morning in May, our staff came out to support the players and their families, and also provided educational material on liver disease, increasing public awareness.

This video is a brief summary of the day, and the BBQ cookout that followed.

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Lentils: A Super Food to Love

Lentils: A Super Food to Love

LentilsDay 20.

Hard to believe we are almost finished with the 31 Days of Wellness. Don’t fear, there are 334 days in the year left afterwards.

There is a very nice entry from the New York Times Recipe for Health section, that features an assortment of healthful recipes you should all bookmark and check in with from time to time. Today I chose the entry on Lentils.

If you have lentils, you have dinner. This high-fiber, protein-rich legume cooks in 20 to 40 minutes, depending on the dish, and requires no soaking. Lentils are the basis for many starters and salads, soups and stews, side dishes and Middle Eastern pastas. The distinctive flavor has been adapted to a variety of classic cuisines, from France to the Mediterranean, from India to Mexico and North America.

The usual supermarket offerings are brown lentils, but there are other varieties and they’re all worth looking out for. Chefs prefer the pricier small black “beluga” lentils (in their raw state they glisten like caviar, but the resemblance stops there) and the firm green Le Puy lentils from France, because when cooked both types stay intact and maintain a firmer texture. But the flavors of all three are similar enough to make them interchangeable in this week’s recipes.

Red lentils, available in Indian and Mediterranean markets, have a different taste, more akin to dried favas or split peas, and a very different texture when cooked, so do not attempt to substitute these for the brown, black or green varieties.

One fact worth noting: unlike other beans, lentils do not contain sulfur, the gas-producing element in legumes. And in addition to being an excellent source of soluble fiber and a good source of protein, manganese, iron, phosphorous, copper, vitamin B1 and potassium, lentils are an excellent source of molybdenum, a mineral important in the metabolism of fats, carbohydrates and iron. — Martha Rose Shulman

Like so many foods, the key message all of us are stressing is the need to experiment, and leave your comfort zone of what you are used to. Discuss it over with your family, and each week select one new vegetable to try. If you don’t like it, try another.

Send me your feedback, and share your experience. Keep trying.

Dr. Joe Galati

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Dr. Joe Galati Discusses Colonoscopy: Instructions for our Patients

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Dr. Galati and Liver Specialists of Texas: What We Do

We have produced a brief introductory video describing the staff and activities of Liver Specialists of Texas.  Let us know what you think. Your feedback is valued.

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Dr. Saira Khaderi Discusses Hepatology

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Boceprevir is FDA Approved:Now What?

Boceprevir is FDA Approved:Now What?

Now that Boceprevir is FDA approved, it seems that a big sigh of relief has been let out by both patients and physicians. Despite this great news and FDA success, the work now starts, evaluating and screening the thousands of patients that have been waiting for this day.

Here is my advice to all concerned patients:

  • I cannot stress the need to get your old records related to past HCV therapies. This will help assist us in how to best manage you on the three-drug combination.
  • Get the report from your most recent liver biopsy. The degree of damage, or lack of it, will be of great value when we discuss how to best treat you.
  • Have an up to date list of all your other medical condition, if this applies to you. Other conditions such as diabetes, heart disease, kidney disease, depression, or cancer will allow us to modify treatment as needed-taylored specifically to you.
  • Have the names and phone numbers of all your treating physicians and health care providers. Communication with them is vital.

This is an exciting time for all of us. Call us if you have questions and concerns. We will be updating the blog and website daily. Stay tuned to these new development.

Now What Do We Do?

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