Anyone attain SVR on Victrelis with less than 1 log drop at 4 weeks?

[FaLaLa137]

Hello,

I'm just looking for a little encouragement here.  My 4 week VL test only showed about .7 log drop.  In reading the Victrelis studies it looks like I only have a 28-38% chance of SVR if I have less than 1 log drop at the 4 week mark prior to starting Victrelis.  Anyone able to get undetected and SVR with these type of numbers starting out?

Starting Viral Load: 3,340,000
4 week Viral Load: 882,000

Thanks for the info! :)

[FaLaLa137]

Hi

Bovary: Yes, I am treatment Naive, so I'm hoping to do 28 weeks.

Willbb: I knew you, out of anybody would know, if there were statistics at 6 week viral load. :)  A 3.6 log drop sounds great to me(thanks for doing the math)!  My work computer doesn't allow me to access any of the Log drop calculators, so I am in the dark on this and my small children at home don't allow me much time on the computer after work.

I will update you all on week 8 VL.  Hopefully I am undetected and it will give hope to some other people in a similar situation to mine. :)

Best,

Falala

[willbb]

Hi.
Actually you have had another 3 log drop from the 4 week lead -in and a 3.6 log drop from total at baseline.
There really is no stats avail. that says what you chances of success are at the 6 week mark,however the 8 week test is the important one as far as how long you will treat as I mentioned in a prev. post (either 28 or 48 wks)

Also if you are UND. at wk8 the chances of success are very good indeed.

Congrats on the good reduction in VL ..keep up the good work..
Will

[Bovary73]

I haven't any info for you on the SVR rates on 6 weeks VL, but it sure sounds like a very good drop to me! If you are UND at week 8 (week 4 with Victrelis) your SVR rate is up at about 86-90% (if you're tx naive).

Good luck and wish you UND at week 8 :)

[FaLaLa137]

Greetings!

So I just got back my 6 week VL and it is 941.  This is good, right?  This looks like almost a 1 log drop from my 4 week.  Does anyone know if there are any statistics for VL drop at 6 weeks and the likely hood of SVR on VIctrelis with the numbers below?

Starting Viral Load: 3,348,215
(lead in to Victrelis) 4 week VL: 882,335
(on Victrelis for 2 weeks) 6 Week VL: 941

Thank you! :)

[FaLaLa137]

Thanks Linda!  I really appreciate the extra encouragement!  My Dr said it was important I retained a positive attitude even with the less than stellar 4 week results. Your results have given me hope that it is possible :)

[tiredturkey19564]

Let me know your results, I'm sure you'll be UND!!! I'll be waiting to hear GREAT NEWS!!!

Linda

[can-do-man]

Will has provided the correct info, what more is there?

[80mecheng]

We need some more info, when you say 4 weeks is that the lead n 4 weeks with Int/Riba only?  I was fortuante and had a 3 log drop in the first 4 and after 4 on Vic was clear and have another 4 weeks to complete 28 weeks.

The link below has current guidelines and a good summary of data showing effectiveness and decision based treatment.  You can clear but the success rate is lower but not 0:

http://www.aasld.org/practiceguidelines/Documents/2011UpdateGenotype1HCVbyAASLD24641.pdf

[FaLaLa137]

Hi Linda'

it sounds like you are doing well with a lesss than 1 log drop so that is good to hear.  I go for my 6 week VL test on this Monday, so I;m hoping for some lower numbers, much lower.

Will-  thanks for the info, you are very well informed. :)

no whine- I didn;t realize the resistance I may build up, so I will have that conversation with my Dr. next time I see him.

Bovary73- Yes, 4 weeks is my lead in before Victrelis.  I've been on Victrelis for a little over a week.

Hopefully I  will be one of  the few in  the 28-38%; that attain SVR.  I will post my results regardless in case it helps anyone else.

Best

FaLaLa

[nowhine]

I agree with willbb. If you are a 1a the odds of success are lower. You obviously have a poor response to INF. I would talk with your doc regarding resistance to PI-protease. If you treat and fail you may not be able to treat again with a PI. The studies are showing 2 plus years before the resistant mutations return to wild type. If you decide to wait the hope is the new DAA meds together in combination with or without INF/Riba may prove to do the job. If you have already built up resistant mutations to a protease than a combination including a protease may not work. The studies are now being done. You would also need to consider the new DAA combos probably will not be available, other than in trails, for 3-6 years, if at all. I would talk with your doc regarding resistance to PI's.

Here is a link in Clinical options you may want to review. You will need to sign up to clinical options to get to the link. Best of luck.

Clinical Implications of HCV Resistance: Laying the Foundation for Optimal Treatment Today and in the Future

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20Resistance.aspx

[willbb]

before Vic was introduced did better than if >1 log log drop in this time frame.

Should have read  " if <1 log drop in this time frame"

[willbb]

Will: are the chances of SVR only 28-38% if still detectable (no VL tests) at week 4 (before starting with Vic)?
-------------------------------------------------------------------------------------

No not necessarily.....the ad hoc analysis in the "sprint"  and 'respond" trial for Vic" (I have linked below for you to look at if interested) showed that patients who had a least a 1 log drop in viral load within the 4 week lead in before Vic was introduced did better than if >1 log log drop in this time frame.

So for example if one has a baseline viral load of 2,000,000 and drops  1 log during the lead -in (take one zero away from the end) so 200,000 then the odds showed better for success overall.

Long  winded way of answering your question ,,that in the trials...... they did not need to be UND. at week 4 only a 1 log drop to still have the better odds and less than the 1 log the stats you and FaLa la  were what the data showed..

Also ..being on Vic .your doctor should have taken a viral load test at week 4 just before strating VIc to better gauge your response ,however it is critical he take the viral load at week 8 to let him and you know how long your treatment will last. (google Victrelis dosing )

Hope that helps explain...
Will
(you will have to register to view this site below ,however it is free and has valuable info.

Predictors of Response and Early Viral Kinetics in Patients With HCV

Nonetheless, the highest SVR rates were found in patients treated with a boceprevir-based regimen who experienced a ≥ 1 log decline in HCV RNA after the lead-in phase,"

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%203.aspx

[Bovary73]

Hi Falala137,
I'm also on Vic and was detectable at week 4 (no VL was taken). This was after the 4 week lead-in with SOC (before starting with Vic).
When you mention your 4 week VL; is this before starting with Victrelis?

Will: are the chances of SVR only 28-38% if still detectable (no VL tests) at week 4 (before starting with Vic)?

I find myself still confused over all the blood work tests and results and prognoses of SVR...thanks for your education :)

Wish you all the best FaLaLa!

[tiredturkey19564]

Hi, I was 6 million VL when I started and 4 weeks 1 million. I was very depressed over this! I have been UND since I started the VIC. Tonite I took my 36th and last shot. Friday I have labs and Wed the results. I,m confident they,ll still be UND! So don"t give up hope!!!!

Linda

[Sentinel13]

Sorry to hear about your 4-week result. Mr. Will posted a most excellent response.

frijole maintains a picture of a table containing treatment results for lots of people on this blog. You might want to check it out (http://www.medhelp.org/personal_pages/user/223152).

[willbb]

I never enjoy telling anyone discouraging news,however one should always be aware of the facts when treating  their HCV with these very powerful medications   IMO.
Actually you have had  only a .58 log drop from baseline and yes the approx. odds of success are what you have stated from your research above given trial results.

The success depends on many factors,one of which and a very important one is early viral clearance.
Unfortunately you have not had a very good  response(most likely from a poor Interferon response) and therefore a  less than stellar early overall response.

Having said all that these are just statistics from trials and many people often go on to defy statistics.

I see from your profile you say you have St. 2/3 liver damage (fibrosis) and treating now was a good decision given the moderate moving into more severe damage.

If you continue on with this therapy you will need to be UND. at week 8 to do 28 weeks of total treatment ,and if not UND. at week 8 but still <100 at week 12 and ultimately UND. at week 24 the total time of treatment recommended is 48 weeks.

You have the option of stopping treatment now  because of the lowered odds and not exposureing yourself to the meds if you and your doctor feel these odds are not worth the benefit vs. the risk at this time and possibly waiting for an Intefereon free" regime,however this may be another 3 to 5 years away.

Hopfully you are being treated by a  doctor knowledgable (with these new drugs) and he can give you the proper direction .

Wishing you the best...
Will