Aa
2nd tx update
hi,
some of you "regulars" may remember me. i haven't posted lately so here's an update. i'm on my 2nd tx now with a different Dr., a good hepatologist in Atlanta. i relapsed my 1st tx last year due to ending tx. too early. i was a slow responder as it took 5 mos. to clear. my 1st Dr. a Gastro didn't want to go 72 weeks ( i was willing). so 5 mos. after stopping i restarted and the results thus far are good. i cleared at 4 weeks this time and my ALT, AST dropped to normal. my HG did go down to 10.7 but came back up to 11.1. as for my stats briefly: male 52 , geno 1. stage 1, grade 2. 1st tx VL 3 mil 2 years ago. after 48 weeks of Peg/riba (180 mg/ 1200 mg, resp.) i relapsed and VL went to 633,000 befor re- tx. now here's something i did that i would not recommend but i weighed the risks and believe it was the right decision for ME. i had extra riba left from the 1st tx. so i took 1400 mg for the 1st couple of months. i was getting tested every 2 weeks and when my hemo went down to 10.7 i dropped the dosage to 1200, which was well after i went UND. i am on my 11th week (#12 Friday) .i could have handled the higher dose longer but i was concerned about my HB going to low. i keep saying i, i , i because i never told my Dr. about the increase for various reasons, one to prevent him from being complicit if my sx got bad. anyway, that's my story. evaluate, analyze and critique, if you want. BTW- i feel great, have been excersizing and lost 20 lbs in 3 months. my sx are basicaly non-existant physically and mentally. incidently, this hep Dr. initially wanted to do 72 weeks but is now backing off to 1 year because my response was pretty fast. i'm still skeptical of that, but i have time.take care,
ant
some of you "regulars" may remember me. i haven't posted lately so here's an update. i'm on my 2nd tx now with a different Dr., a good hepatologist in Atlanta. i relapsed my 1st tx last year due to ending tx. too early. i was a slow responder as it took 5 mos. to clear. my 1st Dr. a Gastro didn't want to go 72 weeks ( i was willing). so 5 mos. after stopping i restarted and the results thus far are good. i cleared at 4 weeks this time and my ALT, AST dropped to normal. my HG did go down to 10.7 but came back up to 11.1. as for my stats briefly: male 52 , geno 1. stage 1, grade 2. 1st tx VL 3 mil 2 years ago. after 48 weeks of Peg/riba (180 mg/ 1200 mg, resp.) i relapsed and VL went to 633,000 befor re- tx. now here's something i did that i would not recommend but i weighed the risks and believe it was the right decision for ME. i had extra riba left from the 1st tx. so i took 1400 mg for the 1st couple of months. i was getting tested every 2 weeks and when my hemo went down to 10.7 i dropped the dosage to 1200, which was well after i went UND. i am on my 11th week (#12 Friday) .i could have handled the higher dose longer but i was concerned about my HB going to low. i keep saying i, i , i because i never told my Dr. about the increase for various reasons, one to prevent him from being complicit if my sx got bad. anyway, that's my story. evaluate, analyze and critique, if you want. BTW- i feel great, have been excersizing and lost 20 lbs in 3 months. my sx are basicaly non-existant physically and mentally. incidently, this hep Dr. initially wanted to do 72 weeks but is now backing off to 1 year because my response was pretty fast. i'm still skeptical of that, but i have time.take care,
ant
I'm SO GLAD you got a good doctor this time - I really think you have all the ducks in a row for this treatment and it will pay off (obviously this time being UND at week 4 is the BEST sign of that!)
Lookin Good and hoping you will continue to let us all know the good news!
Riba is so CRUCIAL - hard and fast is the ONLY way to go when fighting this disease. You have a lot of common sense and I'm sure with your knowledge this time you'll make it!
YAY!
Lookin Good and hoping you will continue to let us all know the good news!
Riba is so CRUCIAL - hard and fast is the ONLY way to go when fighting this disease. You have a lot of common sense and I'm sure with your knowledge this time you'll make it!
YAY!
i just reread my post and made an error on my riba dose. i was taking 2 extra riba's a day for a total of 1600 mg. that's 50% increase and explains my response, and HGB drop. i had planned from the beginning to go 72 weeks this time. i have plenty of time to persuade (or be persuaded) to do otherwise. to Orleans no my Dr.'s name starts with an M and he's at Crawford -Long. i don't want to give more info because of my extra dosing, ya know? FLguy- yes i was fully compliant last time and this time. except for 1 missed dose of riba last week, oops.
The big difference is that with hi current treatment he became undetectable at WEEK 4 whereas with his first treatment he didn't clear until WEEK 20. That is a big difference. I am not advocating 48 weeks or 72 weeks. I am only suggesting that this is probably influencing his doctor's thinking.
Mike
Mike
Again, I have to concur with FL guy. High dosing has been good, but I would think twice about not going the full 72. You said you were handling treatment well, so why not just plan on completing the 72. I would probably do the same thing you did - upping the riba dose from the start.
Pro, - thanks for posting that study. I thought the current thinking was that induction dosing (increased interferon up front) was not effective -- but I would have to look for the study.
frijole
Pro, - thanks for posting that study. I thought the current thinking was that induction dosing (increased interferon up front) was not effective -- but I would have to look for the study.
frijole
Your skepticism about going 48 weeks, I think, is well placed. It seems that if you conclude at 48 weeks this time it is basically the same treatment that you did the first time around, with the exception of one extra riba a day for a couple of months. Maybe that will make the difference. Wherever this tx goes, you and the doc should make sure it's the last tx you'll need. Maybe the difference will be the 4 weeks RVR vs the five month slow response. Were you compliant with the med schedule in the first go 'round?Good luck Ant.
I remember you well. Your news is great! I wish you the very best this time around.
Good luck, Mike
Good luck, Mike
Sorry, forgot to post a link to the snippet
http://clinicaloptions.com/Hepatitis/Annual%20Updates/2008%20Annual%20Update/Modules/Sulkowski/Pages/Page%203.aspx
The opinion I've formed (for what that is worth-probably not much (g))
the faster the drugs can get one to, and maintain the walking wounded stage (emphesis on still walking-may require helpers) the better the chance of SVR..
jmho
http://clinicaloptions.com/Hepatitis/Annual%20Updates/2008%20Annual%20Update/Modules/Sulkowski/Pages/Page%203.aspx
The opinion I've formed (for what that is worth-probably not much (g))
the faster the drugs can get one to, and maintain the walking wounded stage (emphesis on still walking-may require helpers) the better the chance of SVR..
jmho
Re: adding estra riba---good move imo,,,Here is a snippet from a recent clincal care CME by Mark S. Sulkowski, MD (maybe the hep community is finally waking up to the huge importance of riba, not only for the first 12 weeks, but throughout treatment.
"Altering Dosing of Peginterferon or Ribavirin
High-dose interferon has been extensively studied either as induction or as continuous therapy. High-dose peginterferon has been associated with high rates of on-treatment HCV RNA negativity. In the CHARIOT study, in which patients received an induction period with peginterferon alfa-2a 360 mg/week plus ribavirin 1000-1200 mg/day for 12 weeks followed by standard peginterferon dosing for 36 weeks vs standard peginterferon dosing for 48 weeks, preliminary data suggested that high-dose peginterferon plus ribavirin resulted in higher complete EVR rates (HCV RNA < 15 IU/mL at Week 4) in genotype 1 HCV–infected patients compared with those treated with a standard peginterferon dose (74% vs 60%, respectively; P 800,000 IU/mL) and heavy body weight (> 85 kg) received peginterferon alfa-2a 180 or 270 mg plus ribavirin 1200 or 1600 mg/day (Capsule Summary). Of interest, among the 4 treatment groups, subjects treated with high-dose peginterferon and high-dose ribavirin achieved the highest SVR rates (46.8%) compared with those treated with standard doses of both drugs (28.3%). Although the end-of-treatment response rate was similar in subjects treated with high-dose peginterferon and either high- or standard-dose ribavirin (both 55.3%), the rate of viral relapse was higher in those who received standard ribavirin dosing compared with high-dose ribavirin (46.0% vs 19.0%, respectively). In a separate study, Shiffman and colleagues[40] found that genotype 1 HCV–infected patients treated with peginterferon alfa-2b plus high-dose ribavirin 15.2 mg/kg/day (1000-1600 mg/day) supported by adjuvant epoetin alfa were more likely to achieve SVR than those treated with a standard ribavirin dose (13.3 mg/kg/day [800-1400 mg/day]) and epoetin alfa support (49% vs 29%, respectively; P < .05).
Finally, the role of ribavirin in the achievement of SVR was further examined in a randomized, controlled trial that evaluated the discontinuation of ribavirin after 24 weeks of combination therapy (for the remaining 24 weeks, patients were given peginterferon alone) compared with continuous peginterferon/ribavirin for 48 weeks.[41] Of interest, the discontinuation of ribavirin was associated with high rates of viral breakthrough and relapse. Taken together, these data suggest that ribavirin dosing may be as important as peginterferon dose in maximizing SVR rate with peginterferon/ribavirin therapy.
Selection of Weight-Based Peginterferon alfa-2b or Fixed-Dose Peginterferon alfa-2a
Large clinical trials suggest that in genotype 1 HCV–infected patients treated with peginterferon alfa-2a or alfa-2b plus ribavirin (at variable dosing), SVR rates range between 42% and 46%. However, differences in study design, treatment regimens, and patient populations preclude comparison of the data across these trials. Recently, data from the Individualized Dosing Efficacy vs Flat Dosing to Assess Optimal Pegylated Interferon Therapy (IDEAL) study has provided a within-trial comparison of these 2 peginterferon regimens when used together with weight-based ribavirin dosing and demonstrated that SVR rates and tolerability were equivalent (Capsule Summary).[42] This US-based multicenter, parallel-group phase IIIb trial randomized 3070 treatment-naive, genotype 1 HCV–infected patients to receive either peginterferon alfa-2b 1.5 µg/kg/week plus ribavirin 800-1400 mg/day, peginterferon alfa-2b 1.0 µg/kg/week plus ribavirin 800-1400 mg/day, or peginterferon alfa-2a 180 µg/week plus ribavirin 1000-1200 mg/day. Ribavirin was dosed according to 4 weight categories. Patients aged 18-70 years were included, but patients weighing ≥ 125 kg, those with severe depression, or those with decompensated cirrhosis were excluded.
The SVR rate was not significantly different in genotype 1 HCV–infected patients randomized to receive peginterferon alfa-2b at a weight-based dose of either 1.5 or 1.0 μg/kg/week plus ribavirin or peginterferon alfa-2a at a fixed dose of 180 μg/week plus ribavirin (Table 7). Of importance, although the ribavirin dosing schema was different for the peginterferon arms, persons who were randomized to receive peginterferon alfa-2a received more ribavirin on a milligram per kilogram of body weight per day basis independent of viral response pattern (Figure 2a) and the need for ribavirin dose reduction (Figure 2b)."
"Altering Dosing of Peginterferon or Ribavirin
High-dose interferon has been extensively studied either as induction or as continuous therapy. High-dose peginterferon has been associated with high rates of on-treatment HCV RNA negativity. In the CHARIOT study, in which patients received an induction period with peginterferon alfa-2a 360 mg/week plus ribavirin 1000-1200 mg/day for 12 weeks followed by standard peginterferon dosing for 36 weeks vs standard peginterferon dosing for 48 weeks, preliminary data suggested that high-dose peginterferon plus ribavirin resulted in higher complete EVR rates (HCV RNA < 15 IU/mL at Week 4) in genotype 1 HCV–infected patients compared with those treated with a standard peginterferon dose (74% vs 60%, respectively; P 800,000 IU/mL) and heavy body weight (> 85 kg) received peginterferon alfa-2a 180 or 270 mg plus ribavirin 1200 or 1600 mg/day (Capsule Summary). Of interest, among the 4 treatment groups, subjects treated with high-dose peginterferon and high-dose ribavirin achieved the highest SVR rates (46.8%) compared with those treated with standard doses of both drugs (28.3%). Although the end-of-treatment response rate was similar in subjects treated with high-dose peginterferon and either high- or standard-dose ribavirin (both 55.3%), the rate of viral relapse was higher in those who received standard ribavirin dosing compared with high-dose ribavirin (46.0% vs 19.0%, respectively). In a separate study, Shiffman and colleagues[40] found that genotype 1 HCV–infected patients treated with peginterferon alfa-2b plus high-dose ribavirin 15.2 mg/kg/day (1000-1600 mg/day) supported by adjuvant epoetin alfa were more likely to achieve SVR than those treated with a standard ribavirin dose (13.3 mg/kg/day [800-1400 mg/day]) and epoetin alfa support (49% vs 29%, respectively; P < .05).
Finally, the role of ribavirin in the achievement of SVR was further examined in a randomized, controlled trial that evaluated the discontinuation of ribavirin after 24 weeks of combination therapy (for the remaining 24 weeks, patients were given peginterferon alone) compared with continuous peginterferon/ribavirin for 48 weeks.[41] Of interest, the discontinuation of ribavirin was associated with high rates of viral breakthrough and relapse. Taken together, these data suggest that ribavirin dosing may be as important as peginterferon dose in maximizing SVR rate with peginterferon/ribavirin therapy.
Selection of Weight-Based Peginterferon alfa-2b or Fixed-Dose Peginterferon alfa-2a
Large clinical trials suggest that in genotype 1 HCV–infected patients treated with peginterferon alfa-2a or alfa-2b plus ribavirin (at variable dosing), SVR rates range between 42% and 46%. However, differences in study design, treatment regimens, and patient populations preclude comparison of the data across these trials. Recently, data from the Individualized Dosing Efficacy vs Flat Dosing to Assess Optimal Pegylated Interferon Therapy (IDEAL) study has provided a within-trial comparison of these 2 peginterferon regimens when used together with weight-based ribavirin dosing and demonstrated that SVR rates and tolerability were equivalent (Capsule Summary).[42] This US-based multicenter, parallel-group phase IIIb trial randomized 3070 treatment-naive, genotype 1 HCV–infected patients to receive either peginterferon alfa-2b 1.5 µg/kg/week plus ribavirin 800-1400 mg/day, peginterferon alfa-2b 1.0 µg/kg/week plus ribavirin 800-1400 mg/day, or peginterferon alfa-2a 180 µg/week plus ribavirin 1000-1200 mg/day. Ribavirin was dosed according to 4 weight categories. Patients aged 18-70 years were included, but patients weighing ≥ 125 kg, those with severe depression, or those with decompensated cirrhosis were excluded.
The SVR rate was not significantly different in genotype 1 HCV–infected patients randomized to receive peginterferon alfa-2b at a weight-based dose of either 1.5 or 1.0 μg/kg/week plus ribavirin or peginterferon alfa-2a at a fixed dose of 180 μg/week plus ribavirin (Table 7). Of importance, although the ribavirin dosing schema was different for the peginterferon arms, persons who were randomized to receive peginterferon alfa-2a received more ribavirin on a milligram per kilogram of body weight per day basis independent of viral response pattern (Figure 2a) and the need for ribavirin dose reduction (Figure 2b)."
Hi there, you six-legged wonder :o).
I remember you well. Good luck this time around; I finished 96 weeks of IFN/high dose riba (2000 mg/day) last Friday; only have the rest of this week with riba.
I hope both of us have more encouraging results this time around. HCV bites weenies, doesn’t it?
Be well—
Bill
I remember you well. Good luck this time around; I finished 96 weeks of IFN/high dose riba (2000 mg/day) last Friday; only have the rest of this week with riba.
I hope both of us have more encouraging results this time around. HCV bites weenies, doesn’t it?
Be well—
Bill
congrats on your successes. we will keep our finger and toes crossed for SVR!!!
ant
may i ask what your weight was going into the second treatment?
Kalio
i heard a rumor that you were using alinia, if so did you pretreat with alinia and for how long?
i am geno 1 stage 4 with a high viral load and contemplating tx.
thank you
eric
ant
may i ask what your weight was going into the second treatment?
Kalio
i heard a rumor that you were using alinia, if so did you pretreat with alinia and for how long?
i am geno 1 stage 4 with a high viral load and contemplating tx.
thank you
eric
Hey I remember you. Good move hitting the Riba hard in the beginning. I kicked it with my second tx doing that and a few other tricks thrown in. I too stopped the mega doses after a few months but kept it at 1400 for the whole 72 weeks. I didn't tell the doc either, why rock the boat. After the first one failed and I found out he was WAY off on how much damage I had, I took what I could into my own hands. He thought 800 was plenty the first round. I also double dosed Interferon for the first month along with the 1800 riba. I cut it back to 1400 after awhile, I was really unable to function at all. Not too much better at 1400 a day.
It is definately worth the effort I can say in retrospect. I no longer have that fricking FATIGUE and am SVR. I feel better than I have in many years.
It's great you were clear by week 4.
Hang in there
It is definately worth the effort I can say in retrospect. I no longer have that fricking FATIGUE and am SVR. I feel better than I have in many years.
It's great you were clear by week 4.
Hang in there
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