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CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners. Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www.gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams. Objectives: See article for specific learning objective. Exam 1: Telaprevir Alone or With Peginterferon and Ribavirin Reduces HCV RNA in Patients With Chronic Genotype 2 but Not Genotype 3 Infections Test ID No.: gastro00151 Contact hours: 1.0 Expiration Date: September 30, 2012 Question 1: Telaprevir inhibits the replication of the hepatitis C virus by: a. Inhibiting viral entry. b. Blocking the release of virions. c. Activating an antiviral immune response. d. Inhibiting the protease enzyme. e. All of the above. Question 2: In patients with previously untreated genotype 1 chronic hepatitis C infection, the following telaprevir con- taining treatment regimes can be used to improve the proportion of patients who achieve a sustained virologic response: a. Telaprevir monotherapy for 2 weeks. b. Telaprevir with ribavirin for 12 weeks. c. Pegylated interferon and ribavirin and telaprevir for 12 weeks, followed by pegylated interferon and ribavirin for 12 or 36 weeks. d. Pegylated interferon and ribavirin and telaprevir for 48 weeks. e. Pegylated interferon and ribavirin for 4 weeks followed by pegylated interferon and ribavirin and telaprevir for 24 weeks. GASTROENTEROLOGY 2011;141:e13– e15

Exam 1: Telaprevir Alone or With Peginterferon and Ribavirin Reduces HCV RNA in Patients With Chronic Genotype 2 but Not Genotype 3 Infections

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GASTROENTEROLOGY 2011;141:e13–e15

CONTINUING MEDICAL EDUCATION (CME)ACTIVITIES

CME Credits:The American Gastroenterological Association Institute (AGA Institute) is accredited by theAccreditation Council for Continuing Medical Education to provide continuing medicaleducation for physicians.

The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosure:In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Supportof Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or otherrelationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve allconflicts of interest prior to delivering the educational activity to learners.

Instructions:Category 1 credit can be earned by reading the relevant article and taking these CME examinations online athttp://www.gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.

Objectives:See article for specific learning objective.

Exam 1: Telaprevir Alone or With Peginterferon and Ribavirin Reduces HCV RNA in PatientsWith Chronic Genotype 2 but Not Genotype 3 Infections

Test ID No.: gastro00151 Contact hours: 1.0 Expiration Date: September 30, 2012

Question 1:

Telaprevir inhibits the replication of the hepatitis Cvirus by:

Question 2:

a. Inhibiting viral entry.b. Blocking the release of virions.c. Activating an antiviral immune response.d. Inhibiting the protease enzyme.

e. All of the above.

In patients with previously untreated genotype 1chronic hepatitis C infection, the following telaprevir con-taining treatment regimes can be used to improve theproportion of patients who achieve a sustained virologicresponse:

a. Telaprevir monotherapy for 2 weeks.b. Telaprevir with ribavirin for 12 weeks.c. Pegylated interferon and ribavirin and telaprevir for 12

weeks, followed by pegylated interferon and ribavirinfor 12 or 36 weeks.

d. Pegylated interferon and ribavirin and telaprevir for 48weeks.

e. Pegylated interferon and ribavirin for 4 weeks followedby pegylated interferon and ribavirin and telaprevir for24 weeks.

Ci

e14 CME ACTIVITY GASTROENTEROLOGY Vol. 141, No. 3

Question 3:

In patients with genotype 3 hepatitis C infection, whichof the following statements is (are) true?

Question 4:

Question 1:

Question 2:

a. Telaprevir has minimal antiviral activity and is notrecommended.

b. Telaprevir has sufficient antiviral activity to use incombination with pegylated interferon and ribavirin.

c. Therapy with pegylated interferon and telaprevir isrecommended.

d. Therapy with pegylated interferon and ribavirin shouldbe considered.

e. Combining telaprevir and ribavirin should be consid-

ered as an “interferon-sparing regime.”

Common side effects in patients receiving telaprevir incombination with pegylated interferon and ribavirin in-clude:

a. Severe anemia requiring systematic transfusions and/or erythropoietin use.

b. Skin rash.c. Diarrhea.d. Peripheral neuropathy.

e. Influenza-like symptoms.

Exam 2: Rate of Progression of Hepatic Fibrosis in Patients With Chronic Hepatitis C: ResultsFrom the HALT-C TrialTest ID No.: gastro00152 Contact hours: 1.0 Expiration Date: September 30, 2012

The rate of Ishak fibrosis score progression in patientswith chronic hepatitis C can be measured on serial biop-sies �10 mm in length obtained �4 years apart and:

a. Is helpful in predicting non– hepatocellular carcinoma(HCC) clinical outcomes (ascites, death, increase inChild–Turcotte–Pugh score) independent of the initialIshak score.

b. Is not helpful in predicting HCC.c. Correlates better with histologic inflammation than

aspartate aminotransferase (AST) and AST as indicesof liver injury.

d. Does not correlate well with the presence of varices,splenomegaly, and laboratory markers of deterioratingliver function.

e. Does not enhance prediction of clinical events derived

from blood tests alone.

A liver biopsy assessment for Ishak fibrosis score on asingle, �10-mm biopsy in patients with chronic hepatitis

can predict clinical events (ascites, death, HCC, increasen Child–Turcotte–Pugh score); which statement is true?

a. This applies only in cirrhotics.b. Each increasing Ishak score from 4 to 6 predicts a

greater likelihood of clinical events.c. The Ishak score is not helpful in predicting clinical

events because of sampling variability.d. The Ishak score is subjective and, therefore, not helpful

in predicting clinical events.e. The development of clinical events is independent of

the degree of fibrosis as assessed by the Ishak fibrosis

score.