July 2009 Issues

American Society for Metabolic and Bariatric Surgery (ASMBS)

Summary: Bariatric procedure volume is down slightly but expected to remain flat for the next 12 months, though self-pay patients have declined, and doctors are holding their breath about what healthcare reform will mean for bariatric surgery. ♦ Laparoscopic bands are losing a little market share due to some disillusionment with the results and to the increased popularity of the gastric sleeve procedure. Johnson & Johnson’s Realize is also taking share from Allergan’s Lap-Band. ♦ All types of bariatric surgery resolve Type 2 diabetes in a large percentage of patients, and the benefit appears to precede weight loss, but the durability of the effect is still unknown. ♦ Bariatric surgeons are trying to make a case for bariatric surgery in all Type 2 diabetics, regardless of BMI – to offer the procedure to normal weight diabetics. So far, no insurance will cover this, but they are gathering data in an effort to get it covered. ♦ Interest in one-incision and endoscopic procedures is increasing, driven by patient demand, not superior clinical benefits.

The International Liver Congress of the European Association for the Study of the Liver (EASL)

Summary: Vertex’s telaprevir for HCV appears to have a better overall profile than Schering- Plough’s boceprevir now that doctors have learned to manage the rash. Yet, experts are not ruling boceprevir out despite a high rate of anemia and longer duration of therapy. The anemia is manageable with EPO and may be a marker for efficacy. ♦ The first positive data were presented on the combination of a protease inhibitor and a polymerase inhibitor for HCV, and numerous companies are investigating this area. ♦ There was disappointing news on several HCV drugs, including Anadys’ ANA-598, Debiopharm’s Debio-025, and Human Genome Sciences’ Albuferon. ♦ There is still a big unmet need for HCV genotype 3. ♦ Two new therapies for hepatic encephalopathy look promising: Salex’s Xifaxan and Ocera’s AST-120.