Teerha Piratvisuth - Academia.edu (original) (raw)

Papers by Teerha Piratvisuth

Alimentary Pharmacology & Therapeutics, 2018

Hepatology International, May 17, 2012

Large amounts of new data on the natural history and treatment of chronic hepatitis B virus (HBV)... more Large amounts of new data on the natural history and treatment of chronic hepatitis B virus (HBV) infection have become available since 2005. These include long-term follow-up studies in large community-based cohorts or asymptomatic subjects with chronic HBV infection, further studies on the role of HBV genotype/ naturally occurring HBV mutations, treatment of drug resistance and new therapies. In addition, Pegylated interferon a2a, entecavir and telbivudine have been approved globally. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings were discussed and debated. The earlier ''Asian-Pacific consensus statement on the management of chronic hepatitis B''

Hepatology International, Dec 11, 2014

Background There is considerable variation in reimbursement policies in Asian countries and this ... more Background There is considerable variation in reimbursement policies in Asian countries and this is likely to have an impact on treatment practice for chronic hepatitis B (CHB). Consequently a survey of leading hepatologists was performed to evaluate such policies and their impact on management of CHB in the Asia Pacific region. Methods A questionnaire was sent to key hepatologists in Asia Pacific for information on CHB reimbursement policy-its nature, coverage, funding source, duration, review strategy and impact on Asia Pacific Association for the Study of the Liver (APASL) CHB guidelines. The results were analysed and described. Results Leading hepatologists from 16 Asia Pacific countries responded. Almost all of the countries have reimbursement policies but eligibility varied from only a limited group (e.g. civil servants only) to universal access. In most instances reimbursement was from the central government (except China, Pakistan and Hong Kong). Reimbursement policies were usually created by Ministry of Health committees, who received input from medical professionals, although they may not be aware of the APASL guidelines. Policies were limited by available resources, funds and prioritization. Where there was a regular review this occurred between 1 and 5 years. The quantum of reimbursement varied from 50 % in Singapore to 100 % in the majority of other countries. The criteria for treatment reimbursement were based on doctor's opinion alone (Bangladesh, India, Pakistan, Philippines, Singapore and Vietnam) or specific clinical/laboratory criteria in rest of the countries. In general, most countries offered unlimited duration for reimbursement except Taiwan, Indonesia and Pakistan. Monitoring tests for treatment

Objectives HIV/HCV co-infection is associated with more aggressive liver than HCV mono-infection.... more Objectives HIV/HCV co-infection is associated with more aggressive liver than HCV mono-infection. However, there are limited data in Thailand. This study was done to compare demographic data, basic laboratory results and hepatic fibrosis between HIV/HCV co-infected patients and HCV mono-infected patients in a major tertiary care center in Southern Thailand. Methods This was a cross-sectional single center 2-year retrospective study of HCV-treatment-naïve HIV/HCV co-infected patients and HCV mono-infected patients in Songklanagarind Hospital in Southern Thailand. The records of demographic data, basic laboratory results and hepatic fibrosis information were noted from all eligible patients. Results Data from 151 treatment-naïve HCV infected patients during the years 2018-2019 were collected. 51(34%) patients had HIV/HCV co-infections. Genotype 3a was predominant in HCV mono-infected patients(51%), while genotype 1a was predominant in HIV/HCV co-infected patients(35%). The median BMI ...

Journal of Hepatology, 2016

Frontiers in Nutrition

BackgroundInfection is a detrimental complication among cirrhotic patients, leading to major morb... more BackgroundInfection is a detrimental complication among cirrhotic patients, leading to major morbidity and mortality. Reduction in phagocytic activation, as part of immunoparesis, is a distinctive key component of cirrhosis-associated immune dysfunction (CAID) and predicts the development of infection. However, there are limited data on immunotherapeutic approaches to restore phagocytosis.AimsWe aimed to determine the effect of branched-chain amino acid (BCAA) granules on phagocytic activity in patients with CAID.MethodsIn this double-blind randomized controlled trial, Participants were randomly assigned (1:1 ratio stratified by Child-Pugh status) to receive either BCAA granules or placebo. In the 3rd and 6th months, phagocytic activity was assessed by flow cytometry. The primary endpoint was the restoration of innate immunity at the 6th month, defined as ≥75% phagocytic activity; the secondary endpoints were the accretion of phagocytic activity and hospitalization due to infection....

Antiviral Therapy, 2019

Background Peginterferon alfa-2a (PEG-IFN) treatment stopping rules in chronic hepatitis B (CHB) ... more Background Peginterferon alfa-2a (PEG-IFN) treatment stopping rules in chronic hepatitis B (CHB) are clinically desirable. Previous studies exploring this topic contained important limitations resulting in inconsistent recommendations within the current treatment guidelines. We undertook a systematic review and individual patient data meta-analysis to identify the most appropriate PEG-IFN treatment stopping rules. Methods Roche's internal database, PubMed and conference abstracts were searched for studies that enrolled >50 treatment-naive patients with CHB who received PEG-IFN treatment for 48 weeks. Stopping rules were identified using receiver-operating characteristic curve analyses and pre-specified biomarker cutoff target performance characteristics (sensitivity >95%, specificity >10%, negative predictive value >90%). Robustness of proposed stopping rules was assessed using internal/external validation analyses. Results Eight study datasets were included in the m...

BMC Gastroenterology, 2022

Background Sarcopenia is associated with disability, mortality, and poorer survival in cirrhotic ... more Background Sarcopenia is associated with disability, mortality, and poorer survival in cirrhotic patients. For the evaluation of muscle volume, computed tomography (CT) is the most accurate tool. Unfortunately, it would be hard to apply a muscle mass measuring CT to daily practice. This research aims to study the utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA) to detect sarcopenia in cirrhotic patients compared with CT as the reference. Methods In cirrhotic patients who met inclusions criteria (age 20–70 years, ascites < grade 2 of International Ascites Club grading system, no active malignancy, and no cardiac implanted device), HGS were measured using a Jamar dynamometer. Subsequently, patients with low muscle strength (defined as JSH criteria, < 26 kg in male, < 18 kg in female) were then underwent CT and BIA (Tanita MC780 MA) on the same day to measure muscle volume, the definition of sarcopenia by CT was according to the Japan Society of He...

Hepatology International, 2021

Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains... more Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liverrelated morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. Methods All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. Recommendations We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.

Journal of Hepatology, 2020

In univariate logistic regression analysis (Table 3), HBeAg positivity had the highest odds ratio... more In univariate logistic regression analysis (Table 3), HBeAg positivity had the highest odds ratio (OR) [OR: 2.920, 95% confidence interval (CI): 1.558-5.371, P = 0.001] and was more than twice that of HBsAg positivity (OR: 1.417, 95% CI: 1.019-1.969, P = 0.038). In the subsequent multivariate analysis with other significant factors, HBeAg positivity was still the strongest predictor of synCRLM (OR: 2.473, 95% CI: 1.081-5.661, P = 0.032) (table 4), the OR of HBsAg positivity was 1.671 (95% CI: 1.060-2.633, P = 0.027) (table 5). Conclusion: HBeAg positivity is a clinical risk factor for CRLM that can be readily identified and addressed. It is yet unclear if antiviral treatment can decrease the risk of liver metastasis in CRC patients, but future studies with carefully designed prospective trials will be needed to better define this. THU470 Identification and etiology-dependent evaluation of diagnostic algorithms for early detection of hepatocellular carcinoma

Journal of Viral Hepatitis, 2019

is an employee of Roche and declares ownership of Roche stock. Vedran Pavlovic and Hua He were em... more is an employee of Roche and declares ownership of Roche stock. Vedran Pavlovic and Hua He were employed by Roche. Aruna Bansal has been a consultant for Roche. Graham Foster has been a speaker and consultant for Roche, AbbVie, BMS, Merck, Gilead, Janssen, Tekmira and Alnylam. Pietro Lampertico has been an advisory board member or speaker for Roche, BMS, Gilead GlaxoSmithKline and MSD. Georgios

Journal of Hepatology, 2012

The Lancet Gastroenterology & Hepatology, 2020

during the COVID-19 pandemic. 13-15 These position papers provide general high-level recom mendat... more during the COVID-19 pandemic. 13-15 These position papers provide general high-level recom mendations on institutional arrange ment and care principles for patients attending clinic and hospitals. Some recommendations, including telemedicine and decentralisation of care, might not apply in some parts of the Asia-Pacific region. In this position statement, developers from the Working Group formulated a list of questions of discrete clinical scenarios that physicians are facing in their daily practice. The recommendations in this position statement are based on specific clinical scenarios and will supplement other regional position papers on COVID-19.

Gastroenterology, 2018

PLTs<150.000 had 73(67.6%), and <110000 had 40(37%) of patients. LS>20kPa was observed in 56(51.9... more PLTs<150.000 had 73(67.6%), and <110000 had 40(37%) of patients. LS>20kPa was observed in 56(51.9%) and >25kPa in 35(32.4%). In our cohort, BAVENO VI criteria could predict the absence of HRV with sensitivity and NPV of 100%. 12/59(20.3%) could avoid UGE. No patient with HRV full filled the BAVENO VI criteria for non-screening endoscopy. Adopting the expanded criteria, 52(48%) supposed not to undergo screening UGE. Among them 10(9.26%) had HRV. Sensitivity was 80.8% and NPV 60% (p=0.372). When PLTs replaced by spleen diameter<13cm, 31/108(28.7%) would avoid screening UGE. Only 1 patient with HRV was misclassified in the non-endoscopy group. Sensitivity was 96.8% and NPV 96% (p=0.001). Conclusions: Our study validated the predicting value of BAVENO VI criteria even if only 20% of cirrhotics could safely skipped screening UGE. The expanded criteria couldn't be validated, showing high rate of misclassification among patients with HRV. Replacing PLTs by spleen diameter, could safely avoid screening UGE at 28.7%, with minimal possibility patients with HRV to be missed.

Asian-Pacific consensus statement on the management of chronic

Clinics in Liver Disease, 2021

Pegylated interferon-alpha therapy is one of the first-line chronic hepatitis B treatment. Finite... more Pegylated interferon-alpha therapy is one of the first-line chronic hepatitis B treatment. Finite treatment duration, absence of drug resistance, delayed response, and higher hepatitis B surface antigen loss than nucleos(t)ides analog therapy are the advantages of pegylated interferon-alpha treatment. Common side effects and subcutaneous injections requirement limit its use. Identifying patients likely to respond to pegylated interferon-alpha and optimizing treatment is reasonable. Motivating patients to complete the 48-week treatment is necessary. Treatment is stopped or switched to other treatment strategies in patients with stopping rule criteria. Combination therapy with nucleos(t)ides analog may improve response, but remains controversial.

Journal of Gastroenterology, 2020

Asia has intermediate-to-high prevalence and high morbidity of hepatitis B virus (HBV) infection.... more Asia has intermediate-to-high prevalence and high morbidity of hepatitis B virus (HBV) infection. The use of guideline-recommended nucleos(t)ide analogs with high barrier to resistance, such as entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), is one of the key interventions for curbing HBV infection and associated morbidity in Asia. However, there are some challenges to the use of ETV and TDF; while ETV is associated with high resistance in lamivudine (LAM)-exposed (especially LAM-refractory) patients; bone and renal safety issues are a major concern with TDF. Hence, a panel of twenty-eight expert hepatologists from Asia convened, reviewed the literature, and developed the current expert opinion-based review article for the use of TAF in the resource-constrained settings in Asia. This article provides a comprehensive review of two large, phase 3, double-blind, randomized controlled trials of TAF versus TDF in HBeAg-negative (study 0108) and HBeA...

Annals of Hepatology, 2019

Introduction and objectives: The Baveno VI criteria to rule out varices needing treatment (VNT) w... more Introduction and objectives: The Baveno VI criteria to rule out varices needing treatment (VNT) was introduced in 2015. Soon after, the expanded Baveno VI and stepwise platelet-MELD criteria were proposed to be equal/more accurate in ruling out VNT; however, neither has been widely validated. We aimed to validate all 3 criteria in compensated cirrhosis from assorted causes. Materials and methods: We conducted a cross-sectional study including all adult compensated cirrhotic patients who underwent endoscopic surveillance at our center from 2014 to 2018 and had transient elastography (TE), and laboratory data for criteria calculation within 6 months of endoscopies. Exclusion criteria were previous decompensation, unreliable/invalid TE results, and liver cancer. The diagnostic performances of all criteria were evaluated. Results: A total of 128 patients were included. The major cirrhosis etiologies were hepatitis C and B (37.5% and 32.8%, respectively). VNT was observed in 7.8%. All criteria yielded high negative predictive values (NPVs) > 95%, missed VNT was observed in 2%, 2.7%, and 2.8% in the original, expanded Baveno VI, and platelet-MELD criteria, respectively. The expanded Baveno VI and the platelet-MELD criteria yielded significantly better specificities and could spare more endoscopies than the original Baveno VI criteria. Conclusions: All 3 criteria showed satisfactorily high NPVs in ruling out VNT in compensated cirrhosis from various causes. The expanded Baveno VI and the platelet-MELD criteria could spare more endoscopies than the original Baveno VI criteria. From a public health standpoint, the platelet-MELD criteria might be useful in a resource-limited setting where TE is not widely available.