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Avatar universal

2 week treatment

my gastro doc had told me that when the bx came back, that if there was enough liver damage done, he wanted to do tx for 2 weeks to see if the vl dropped, as that would determine if i was a non responder. anyone ever geard of this ? i go back to see him today with the results of bx. grade3, stage 2. signs of mild fibrosis. hep c, geno 1a
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Avatar universal
There appears to be a growing trend for earlier PCRs (week 4 or earlier) to help determine how successful treatment might be. Personally, for someone with little or no liver damage -- especially a genotype 1 -- I see this as an excellent approach for some -- the mindset being why treat now unless the odds are really stacked in your favor.

That said, in another 12 weeks we will have preliminary SVR data from the 24-week VX-950 trial group and some even longer data from the 12-week group. Therefore, especially if you have little or no liver damage, you might want to wait for this data and then review it with your gastro instead of proceeding right away.

Good luck and please keep us posted.

-- Jim
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Avatar universal
I've heard of testing at 4 weeks to see if the virus has been wiped out, but not at two weeks. If he is testing to see how you are coming along that is a good thing for you, I wish I had a 2 week PCR. If he is planning to use that test to determine if you should keep treating, I'd say that is a bit premature to make that call. Just because you dont completely clear the virus in the first few weeks doesn't mean you won't clear it, it can mean you have to treat longer though or that you need to adjust your dosages. The standard is to see if you have cleared the virus in the first 12 weeks and then determine if the treatment should be continued. More recent info. indicates that people who clear the virus in the first 4 weeks have a much higher rate of success with treatment. However, these early PCR tests should not be used to cut you off of therapy in my opinion but rather be used as data to determine dosages and length of treatment.



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Avatar universal
he said it was to see if the vl dropped at all in those two weeks, then continue for 48 weeks
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Avatar universal
In that case, I think it is a very good thing. To me it means he is on top of it, and is aware of the latest info. Plus you will have that info. If you do clear the virus by week 2 that is even better. Is he planning on doing another one week 4? I'd request one if you can. The earlier you clear it, the better your chances of success. Good luck and let us know the results! Hope to see UND!
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Avatar universal
Hi mike.  My doc told me the same a few months ago - that they can now tell at two weeks if the meds are working and if so - continue on.   Best of luck!  (if you do decide to treat)
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96938 tn?1189799858
Interesting approach. But, he would need to rx at least 4 weeks of meds.  The pcr after week 2 would be the day of week 3 shot.  And it makes sense that if it's a viral response test to continue on, without interruption.
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Avatar universal
Next time you speak to your doc, you might ask him how much of a log drop they're looking for in two weeks. Also, if they're basing this on any particular studies or what? If they can spot non-responders -- or relative non-responders -- at week 2, this will certainly save a lot of unecessary exposure to the drugs for those who can afford and want to wait for better odds. FWIW my week two viral load was <600 IU/ml from 1.5 IU/ml pre treatment and tx did result in SVR.
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85135 tn?1227289772
FLGuy +1. The PCR results take 5-10 days. If you stop at 2 weeks, that will be 2 weeks wasted cause you will need to start over.
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Avatar universal
FLGuy and Sunspot have good points. Even though your doctor will determine further treatment based on your 2-week PCR, in actuality, you won't have the results of that PCR for anywhere from 4 days to two weeks, depending on what test is ordered, etc. Therefore, it's important that you keep taking the shots (and riba) until the test results come in, which may indeed mean you will take shot 3 and perhaps 4, even if the week 2 PCR suggests you stop treating.  I'm pretty sure that is what your doctor has in mind anyway.

-- Jim
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96938 tn?1189799858
After thinking about it a little more, if i went into a 'RVR Test' scenario I go in thinking I was going to do the full 48 and put all the 'life' planning steps into place thinking I was going in for the long haul.  Although the approach is interesting, it doesn't seem to make sense to go the 2-4 weeks and then stop just to start again a few months down the road, even if you have the greatest of responses.  In fact, why not a 1-week pcr? Riba will not have reached concentration anyway.
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Avatar universal
Hi Jim.  I don't know if he was talking about in the context of spotting nonresponders or not. We were talking about newer drugs in the pipeline, the benefits of tx now with SOC vs. waiting, and I know we were talking about what had happened to me in that 2nd week during my first tx attempt. He was talking about trying to get me to 12 weeks when / if I treated with SOC, and that's when commented that they are now able to tell at 2 weeks if the meds are working.  I'll definitely ask him if I see him again.  It's possible, though, I'll be transferring my care to a different hepatologist. I'm going to get a second opinion Thursay on biopsy, treatment, and - for sure the rescue drug issue.
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Avatar universal
Sounded like Music's doc might use the two-week test as a possible stopping rule but maybe he will clarify. Good luck with your new doc and you might want to ask him the fesibility of waiting another 12 weeks for some preliminary VX SVR data if waiting makes sense in your case.

-- Jim
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Avatar universal
Thanks. And after reading this most recent email from Vertex, I will definitely be asking.  I feel like a huge weight has been lifted off my shoulders going to see another hepatologist  (made my decision on that a few days ago, many thanks to some great contributions here and reading archives here and links provided, etc.)  I just haven't been feeling all too comfortable about the way some things have been going down lately (was beginning to feel like I was being slated more for the purposes of lab rat than someone having my best interest at heart, if ya know what I mean.)  They had talked about the importance of rescue drugs over a year ago; nothing has changed with respect to how I did the first time - until a Phase II came along with no rescue drugs, and then rescue drugs were suddenly not important. hmmmm. Sometimes some things might fly right over this head of mine, but not all things :)  See ya around!  
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Avatar universal
They had talked about the importance of rescue drugs over a year ago; nothing has changed with respect to how I did the first time - until a Phase II came along with no rescue drugs, and then rescue drugs were suddenly not important.
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Yeah, it goes like that sometimes, and not just with medical studies :) Not sure, but I believe the current VX phases doesn't allow rescue drugs for the first 12 weeks and then does. Not ideal, but often there's some trade offs in trials. I do know this -- that if the SVR figures look good for the current VX trial, I'd probably forgo rescue drugs in the next trial phase if that was the conditions, although really don't know what the Prove III protocol  will be.
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