BSMS > Research > Clinical and experimental medicine > Clinical medicine

Clinical medicine

An important research theme at BSMS is achieving hepatitis C virus elimination as well as improving symptom burden in advanced cirrhosis.

The Hepatology team at BSMS includes senior academics as well as Research fellows, Academic F2’s and research nurses working together to reduce the burden from chronic liver disease burden including improving quality of life of life in patients with advanced cirrhosis.

Hepatology research

The WHO has mandated that hepatitis C virus be eliminated globally by 2030. In line with this, BSMS researchers have led on developing nationally and internationally recognised holistic and patient centered community models of care for people who use drugs and the homeless.

Additionally, to improve palliative care for people with advanced cirrhosis, a clear unmed need, BSMS researchers are trialing novel interventions for refractory ascites. Hepatology research at BSMS has attracted funding from prestigious bodies including the NIHR.

Hepatology team

Prof Sumita Verma
Dr Lucia Macken, Clinical Senior Lecturer in Hepatology
Dr Adele Mourad, Clinical Research Fellow
Dr Yazan Haddadin Clinical Research Fellow

Researchers

Prof Sumita Verma
Prof Barbara Philips
Dr Karen Patterson
Dr Mansoor Khan
Prof Mahmood Bhutta

Current projects

END C study
Funder Gilead Sciences and Sussex ODN
A 4-year study (2019-2023) assessing a novel one stop community based model of liver care for homeless individuals based at multiple homeless sites in Sussex. This work (and the prior ITTREAT and VALID studies- see below) are in line with the national hepatitis C elimination strategy.

REDUCe 2 Study
Funder NIHR (HTA)
A 5-year 35 site national trial (2022-2027) assessing a new intervention (long –term abdominal drains- LTADs) to improve symptom burden in refractory ascites due to cirrhosis.

Past projects

ITTREAT
Funder Gilead sciences and Brighton and Hove Commissioners
An 8-year study (2023 to 2021) assessing a novel integrated model of care for substance users based at a Drug and Alcohol Treatment Centre. Collected clinical, patient reported, health economic and qualitative outcomes.

VALID study
Funder Dunhill Medical Trust
A 3-year study (2015-2018) based at a homeless hostel in Brighton with an aim to link homeless individuals into care for early detection and treatment of liver disease. Collected clinical and lab based data.

RECUCe Study
Funder NIHR
A 3-year feasibility RCT (2015-2028) assessing LTADs to improve ascites related symptoms in cirrhosis.

BACKGROUND IMAGE FOR PANEL

Publications

1. Hashim A, Bremner S, Grove JI, Astbury S, Mengozzi M, O’Sullivan M, Macken L, Worthley T, Katarey D, Aithal GP, Verma S. Chronic Liver Disease in Homeless Individuals and Performance of Non-Invasive Liver Fibrosis and Injury Markers: VALID Study. Liver Internat. 2022;42:628-639.

2. Aithal GP, Palaniyappan N, China L, Harmala S, Macken L, Ryan J, Wilkes E, Moore K, Leithead J, Hayes P, O’Brien A, Verma S. British Society of Gastroenterology. Guidelines on the management of ascites in cirrhosis. Gut. 2021;70:9-29.

3. Hashim A, Macken L, Jones AM, Mcgeer R, Verma S. Community-Based Assessment and Treatment of Hepatitis C Virus-Related Liver Disease, Injecting Drug and Alcohol Use Amongst People Who Are Homeless: A Systematic Review and Meta-Analysis. Int J Drug Policy. 2021; 96:103342

4. O’Sullivan M, Jones AM, Gage H, Jordan J, MacPepple M, Williams H, Verma S. ITTREAT (Integrated Community Test - stage - TREAT) Hepatitis C Service for People who Use Drugs: Real World Outcomes. Liver Int. 2020;40:1021-1031.

5. Macken L, Bremner S, Gage H, Touray M, Williams P, Crook D, Mason L, Lambert D, Evans CJ, Cooper M, Timeyin J, Steer S, Austin M, Parnell N, Thomson SJ, Sheridan D, Wright M, Isaacs P, Hashim A, Verma S. Randomised Clinical Trial: Palliative Long-term Abdominal Drains Versus Large Volume Paracentesis In Refractory Ascites Due to Cirrhosis. Aliment Pharmacol Ther. 2020;52:107-122.

BACKGROUND IMAGE FOR PANEL

Impact

Our novel community models of care for vulnerable adults have been nationally adopted and have played a significant role in achieving our goals of eliminating hepatitis C by 2025. This work was submitted as a REF Impact Case Study for the 2021 REF. The European Centre for Disease Prevention and Control has also acknowledged this work as one of the 15 internationally recognised models of good practice.

The REDUce and ongoing REDUCe 2 studies have raised the profile of patients with end stage liver disease thus bringing equity in provision of palliative care. This remains a clear unmet need in advanced liver disease. These studies have also informed the recent NICE guidance on use of LTADs in cirrhosis (Nov 2022).