Boceprevir or Telaprevir?

[Missy114]

Hi everyone! I haven't been on here in a long time, but I am considering starting treatment now and I have a question.  First of all, my doctor recommended Boceprevir over Telaprevir because she says she "thinks" Boceprevir is more effective and reduces Tx time more than Telaprevir does. I know there are a lot of very knowledgable people on here that I can trust so I was wondering what you thought about that.  I honestly have not spent a lot of time researching this topic. It does seem as though Telaprevir is more popular for whatever reason though.

Anyways, quick background on me: I was diagnosed 2 years ago with genotype 1a.  I've probably had the virus for 7-8 years from IV drug use.  I haven't had any labs done in about a year or so, but my VL has always been extremely low, so low once that it was undetectable. The highest it has been is a little over 13,000.  I had a biopsy about a year and a half ago (when I was first considereing Tx) which came back great. No fibrosis.  Because of that I decided to wait for the new meds to come out.

[Sentinel13]

RR: Having biopsy's before treatment are not as important as they used to be. Years ago, initiating treatment often used to (at least partly) be based on a biopsy result. Now-a-days, if treatment is going to be initiated regardless of the biopsy result then a biopsy is probably unnecessary.

I'm a data driven person and I personally like biopsy data. However, I would not want to delay treatment waiting for the VA to do a biopsy. I'm more interested in a biopsy after treatment so I know the condition of my liver for the future.

Regarding fatty foods, Pooh covered it thoroughly (as she does everything). I would like to emphasize her comment that you need some bulk in your stomach (at least with Incivek). One time I only ate 20 grams of peanut butter before taking my Incivek (I was a passenger in a car and that is all I had with me). I think the peanut butter landed on one side of my stomach and the Incivek landed on the other side -- so the Incivek passed through my system without being enveloped in the fatty food -- FIRE IN THE HOLE -- I really had pooper issues the next day. Cheers, GB

[Mustlovedogs99]

Thanks so much, Pooh!

[pooh55811]

Personally, I would want another biopsy if I had not had one in 6 years.

Liver damage progresses at different rates in different people. Some people have gone from Stage 2 to Stage 3 or 4 in only 3 years or so. So I would definitely want to know what stage I was at now before starting treatment.

If you don't think the GI is qualified, can you ask for a Hepatologist?


Fatty foods:

I ate a lot of regular Greek yogurt, eggnog, cheese (2 ounces of Cheddar or Havarti is 20 grams), avacado (1 medium has at least 20 grams), bratwurst (cannot remember how many, read the label), cream cheese, ice cream, peanut butter (read label), nuts. If I thought I was eating something without enough fat or was not sure, I added 20 grams of fat with butter, mayo, heavy whipping cream so I was sure to get 20 grams. I always ate some solid food. Toast and the Greek yogurt, egg and toast and the eggnog, toast or bread with the ice creame if I had ice cream at 10 pm. You need some bulk in the stomach as well as the fat so drinking 20 grams of fat via olive by itself won't do the trick.  If you eat nuts eat something else too, for bulk. I used to eat chicken soup and saltimes and then add something with 20 grams of fat like berries with a lot of heavy whipping cream on them. You have to get a little creative because food is not going to taste the same as it does not. Sometimes nothing was appealing. I also found myself stocking up on cheese and avacados, only to find that I could not stand eating them the following week. Another thing I did was add some condiments to the plate to make food taste like something besides cardboard. I would have meat and add a bunch of greek olives or herbed olives or pickled beets or plain pickles as a side to help get the meat down. It worked.  

I am going to try to find a link to another thread. I should have bookmarked it, lol: This link has some good ideas in it for fatty foods. Scroll down to 80mecheng's very long post with many, many foods to choose from.

http://www.medhelp.org/posts/Hepatitis-C/Are-these-fats-okay/show/1694773

[Mustlovedogs99]

Thanks so much, Pooh!  That makes sense.  What type of "fatty" food should the PI be taken with?  A burger and fries or something as simple as nuts with a high fat content?  

I am going to my Dr. tomorrow.  Unfortunately but fortunately, we are Army and on a base so I don't get to pick my Dr.  I have to see a G.I. from the VA hospital and I hope is knowledgeable of the new HCV tx.  I haven't had a biopsy since Jan 06.  Do you think I should get one before tx?  I do, just from all I've heard and all I've read!  I am so scared this Dr. will be a quack.  When I was first dx in 2005 the first Dr. I was referred to was a total quack and the only reason I knew that was because I had done so much research.  I went to his office.  He said I should probably get an ultrasound and I said, "shouldn't I have a biopsy?"  He said, "No."  He proceeded to write me a script for Interferon and Riba and sent me on my way.  That really put up some flags since I read how bad tx can be.  So I told my PCM to get me another Dr. and they sent me to The Liver Associates of Texas and my Dr. was THEE best!  I always felt comfortable and all of the staff could answer questions and if not get me an answer in a timely fashion.

I just hope the new Dr. is near that good.  I have a feeling I will be coming to this forum for help a lot!

[pooh55811]

The literature says 7-9 hours, but personally, I always aimed for 8 hours on the dot.

I set my alarms for every 8 hours and my timers for every 8 hours.I carried the timer everywhere I went even at home (room to room).

This was my schedule:
5:30 am get up, fix fatty food, eat fatty food
6 am take Incivek and Riba
go back to bed for awhile
1:30 pm fix fatty food, eat fatty food
2 pm take Incivek
6 pm eat again and take Riba
9:30 pm fix fatty food, eat fatty food
10 pm take Incivek

If you aim for every 8 hours you are more likely not to screw up your Incivek dosing. It takes time to fix the food and then to eat it and then to take the Incivek. No, I was not always right on the dot with the Incivek because some foods took longer to cook or fix, but I was never more than 15-20 min. longer than 8 hours (so I was still well within the 7-9 hour time frame).  

This is from the Vertex site:

"The recommended dose is 750 mg (two 375-mg tablets) taken 3 times a day (7–9 hours apart) with food (not low-fat)"

http://www.incivek.com/hcp/patient-counseling

[Mustlovedogs99]

So it would be OK if you are a few minutes late of taking the dose?  I was just concerned it had to be 8 hours ON THE DOT... that's what she made it seem like!