African Americans and response to TX

I have read a lot about low success rate of African American in the past. Some said it was bcos 90% are genotype 1 and some said it was bcos the gene.
I am a bit concerned bcos I am now planning my Tx and looking at all odds.
Does anyone has the latest update about this issue? Please contribute through your comments.

[lynda607]

The success rates have been show to be lower in African Americans with pegylated interferon and ribavirin only.  

With triple therapy (the addition of a protease inhibitor Victrelis or Incivek used in conjunction with pegylated interferon and ribavirin) population pharmacokinetic analysis of the protease inhibitors indicated that race had no apparent effect on exposure.  In other words, viral clearance was the same with all ethnic groups.

[spectda]

It seems that in the boceprevir trials african americans who achieved RVR were about the same as non-blacks, in the people that did not achieve rvr the difference was much greater.
-Dave

http://www.natap.org/2011/CROI/croi_126.htm
Arm 1: Peg/IFN plus placebo through week 48
Arm 2: Peg/IFN plus boceprevir through week 28, then continued PegIFN/RBV if HCV RNA detectable during week 8 to 24, or observation only if HCV RNA undetectable during week 8 to 24
Arm 3: PegIFN/RBV plus boceprevir through week 48 regardless of HCV RNA detectability during week 8 to 24.

The researchers split study participants into two cohorts: cohort 1 included 938 nonblacks and cohort 2 included 159 blacks. The primary endpoint was proportion of people who attained SVR among those who received at least one dose of study drugs. People with detectable HCV RNA at week 24 stopped treatment.

Age averaged about 49 in cohort 1 and 51 in cohort 2. About two thirds of cohort 1 members lived in North America and the rest in Europe. Almost everyone in cohort 2 lived in North America. More than 90% in both cohorts had an HCV load above 400,000 IU/mL. Proportions with a METAVIR F3/F4 score were 7%, 8%, and 12% in arms 1, 2 and 3 of cohort 1, and 2%, 15%, and 11% in arms 1, 2, and 3 of cohort 2.

Overall SVR rates were significantly higher in boceprevir arm 2 (63%) and boceprevir arm 3 (66%) than in arm 1 (38%) (P < 0.0001 for both comparisons). Relapse rates were 22% in arm 1, 9% in arm 2, and 9% in arm 3. In nonblack cohort 1 patients, SVR rates in arms 1, 2, and 3 were 40%, 67%, and 68%. In black cohort 2 patients, SVR rates in arms 1, 2, and 3 were 23%, 42%, and 53%. Differences between arms 2 and 3 and arm 1 were statistically significant in both cohorts.

[spectda]

Are you genotype 4? If so you would only be able to treat with interferon riba combination currently.
-Dave

[mikesimon]

I'm not certain of the question here but assuming zako is asking:

Are SVR rates with SOC + Victrelis or Incivek lower in Afro-Americans than in Caucasians?

The answer is yes, the SVR rates are lower among Afro-Americans.

The Protease Inhibitors significantly improve the SVR (success) rate for Afro-Americans but it is still lower than it is for Caucasians. I believe that one study showed a 62% SVR rate for Blacks with  triple therapy.

Good luck,
Mike

[beeblessed]

Excellent question!  I am so glad you asked the forum, as I am confused on this.  When I was first diagnosed, my docs were saying the odds of SVR for Blacks were below 50%.  Then when triple tx was on track to be approved, they made it sound like 75% or higher, regardless of ethnicity.  Just went to the doc a couple of weeks ago and was told it IS still lower for Blacks, but still better than SOC.  All the best to you and I hope others will chime in.

[hrsepwrguy]

Zako is GT 4 so is not a canidate for new PI's. They are only approved by FDA for GT 1 patients in US. He is only able to get SOC or join in a study for new drugs.

[RonGilbert316]

Start taking 2000 IU of Vit. D3 twice a day and continue throughout SOC tx. Your odds of reaching SVR will increase to about 85% according to an Oxford study done a couple of years ago.

Some people seem to hate this information because Doctors dont promote it, so read it for yourself and decide for yourself. I used it and it worked for me. Google "Oxford Vitamin D"

All the best.

[RonGilbert316]

corection on the study, its at hivandhepatitis.com

http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html

Also see this thred.

http://www.medhelp.org/posts/Hepatitis-C/Will-Vitamin-D-help-HCV-patients/show/756053

[SusieS2010]

In trials the success rate with incivek, interferon and ribavirin is approximately 63% for African Americans. That compares with 70-80% in Caucasians. It is a big improvement for both groups of people.

[SusieS2010]

Zako, I didn't realize you were a genotype 4. The stats I gave you are for genotype 1. Sorry.