72 weeks a good idea?

I had almost a  4 log drop of viral load at 12 weeks. I went from 500k IU to 72 IU. I was undetechtable at 24 weeks. I have F3 damage to my liver and have a 25 BMI. My Alt normalized after 1 month of treatment and remains low.

I have read seveal studies that would classify my response as slow. In these studies they relapse rate seemed to be cut in half with 72 weeks of treatment.

Does anyone have a sugestion on what I should do? My Doctor seems a little behind the times with respect to viral kentics and not suggested the increased treatment time(over 48 weeks)

[jmjm530]

You take is correct, although since you were so borderline not sure if the difference would be "half". Still, you're stage 3, so extending seems the right choice to me.

[FloridaMouse]

If it were me, I'd shoot for the 72.   I'm currently doing 72 weeks and have already done the 48.  I have Stage 3/4 damage and am a 1a.  My VL the first time went from 90,000 down to 300 by week 12, I was clear by week 24.  I stuck with 48 weeks only to relapse 5 months post.  This time around I started with a VL of 260,000, dropped to 109 by week 12 and again was clear by week 24.   I have been seen by Shands at the University of Florida and they highly recommend 72 weeks for geno 1's who do not clear until week 24.

Mouse

[HCA]

Current thinking is that Geno 1 patients with viral serum detected at 12 weeks however low should treat for 72 weeks.You are on the cusp.There is no definitive answer but statistcaly your chances are enhanced if you extend.
Your post is headed 'a good idea?'.
Answer has to be yes.

[jmjm530]

I'm sure the folks here can dig up plenty of studies favoring extending to 72 weeks should you need them for your doctor.

[raymondk]

I'am on month 8th of treatment and feel better then before. If you had asked me to do 72 week at week 24 I would have said no way. Did you exsperience a releif of treatment symtoms (symptoms) also?

[HectorSF]

I would agree with others that recommend 72 weeks of treatment. You don't want to get to Stage 4, as cirrhosis greatly reduces your chances of SVR. Now is the time that you have the best chance of stopping the progression of your liver disease by beating the virus.

Becoming undetectable after week 12 and before week 24 means you are a "slow responder". 15% of genotype 1's are "slow responders". "Slow responders" have an average SVR rate of 45% during 48 weeks of treatment.

By: Mitchell L. Shiffman, MD
Source: New Management Strategies for HCV Nonresponders and Relapsers

"Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks.[8-10,20] In each of these studies, the relapse rate was reduced from more than 50% to less than 20%. Two of these studies suggest that this benefit may be less or nonexistent in patients with higher HCV RNA levels at baseline and at Week 12.[8,9] However, these observations will need to be confirmed in future studies before these patients are not considered for treatment extension. Therefore, for now it appears that prolonging the duration of therapy will increase SVR rates in patients who are slow to respond and should be routinely practiced".

8. Sanchez Tapias JM, Diago M, Escartìin P, et al. Peginterferon alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology. 2006;131:451 460.

9. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa 2a plus ribavirin. Gastroenterology. 2006;130:1086 1097.

10. Sanchez-Tapias JM, Ferenci P, Diago M, et al. How can we identify HCV genotype 1 patients who may benefit from an extended treatment duration with peginterferon alfa-2a (40KD) plus RBV? Program and abstracts of the 42nd Annual Meeting of the European Association for the Study of the Liver; April 11-15, 2007; Barcelona, Spain. Abstract 641.

20. Ferenci P, Laferl H, Scherzer TM, et al. Customizing treatment with peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) in patients with HCV genotype 1 or 4 infection: interim results of a prospective randomized trial. Program and abstracts of the 2006 Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, Massachusetts. Abstract 390.

Best of luck with you treatment.
Hector

[merryBe]

I would print out the study Hector just gave you, and a couple more, and get in to see your doc with them.
All the recent studies show SVR can be reached at almost the same rate on slow responders when tx is extended. It is pretty much assumed you'll treat out that long unless your health prevents in my clinic.

If your doc is not on board with this, and doesn't write the proper letter (or just keep subscribing as many INS co. now know this is happeneing) but if he needs to write a letter and does not, it can hurt you.

So make sure he KNOWS, that YOU KNOW what the current research reflects.
Legally he is not going to expose himself to possible litigation by denying fell tx to a patient who is informed as to what that should be....even if he doesn't agree with the new stats chances are he will cover himself legally by extending your tx once you put the documentaion in his hand.

Failing this, you can get a second opinion...as soon as I had another doctor involved, who knew the new research, my doc backed off using the old numbers and agreed to continue and extend tx.
Failing this, get a new doc who will push for you. Your odds go up so much if you do treat out that to deny folks this now borders on the criminal.
MB