Boston '08

Haven't heard much about it this year, ya'll remember last years' hub bub. Nothing exciting on the agenda this year I guess.

[eureka254]

Dunno what's on the agenda, but it's scheduled for San Francisco this year 10/31 thru 11/4.  Guess we'll have to wait until next week to see if there's anything to 'hub bub.'

[eureka254]

That is, if you're referring to the AASLD yearly conference.

[willing]

as soon as the press embargo lifts the more interesting abstracts will get picked up by the advocacy sites like hivhepatitis however the abstracts can be searched now through the itinerary planner. I haven't looked in depth but there's some good news from Roche's ns5B inhibitors r7128: 86% RVRs for g2-3 non responders, as good as the 85-88 RVR they saw on G1 naive (see abs LB10)  Also, finally, Roche is releasing some data on combined ns3/ns5b tx  (abs 1885) - of course using both of its own drugs itm-191 and r7128/r1626 - but it's *still* on cell replicons - no patients.

"Drug-drug interaction studies over a 3 day incubation period demonstrated additive to slightly synergistic interactions between the two inhibitor classes...These findings suggest that the combination of ITMN-191 with R1626 or R7128 may confer significantly greater antiviral activity than has been observed with these agents in previous monotherapy trials."

duh..

ya can - literally -  die waiting for'em to get their butts in gear

[willing]

a couple more items from aasld. which may be relevant to tx planning.  Abstracts 117 looks at long-term low dose maintenance again (up to 6 years of 0.5 uk/kg) in a fairly large group. This area has yielded confusing prior results (eg HALT-C at last year's aasld vs EASL). Here they found a definite beneficial  effect -strengthens the argument for wait-watch-and-low-dose

Abstracts 1326, 1224 and 1873 looked at extended tx. All found extended benefited LVRs.

1326 tried adjusting  duration depending on und at 4,8,12 or 16-24. w4 did 48 and 100% SVRr, for w8 UNDs it was 52 and   for w12 UNDs 60 weeks - this combined group did 81% - but they don't break out w8 vs w12; for w16-14 UNDs it was 72 weeks and 50%. SVR. An interesting point here is the suggestion that the standard 48 weeks is a bit short  for UND at w12.

[jmjm530]

Willing: An interesting point here is the suggestion that the standard 48 weeks is a bit short  for UND at w12.
----------------
Maybe that's why many docs have been testing at week 4 for a number of years now in order to make better treatment decisions? BTW I was UND at week 6 and treated for 52 weeks but then again my medical team has a seer on staff who reads these papers 2.5 years prior to being published :) I haven't had a chance to get into the "planner" yet but thanks for the updates.

-- Jim

[merryBe]

thanks for posting these....I've been thinking the same about the 48 and 12 equation.
Even for extended tx it's 60 wk after und and not the 50 wks they still subscribe to.

It's something I'm waving in front of my doc and suggesting we all do the same.

the idea that not extending tx a month or two when it is proven to vastly increase SVRs in criminal....but until the patients start insisting their doctors pay attention to new research they will just happily cut folks off right before the final pooch gets screw.ed...and in this case, if that pooch doesn't get it...then we do.....

mb

[willing]

it's a never ending source of irony that *years* after introduction of ifn-based therapy we still have no real clue as to what 'optimal' tx duration is. At least the "new" move towards extended has brought the question back for examination - extend, but  for how long?

My hunch is the reason it's easier to make progress on the molecular biology front is that the problems there, difficult as they are, are easy compared to the sociological/ethical issues of experimenting with tx dose/duration on real patients.

[zazza]

I always wondered if I was not very lucky to have that borderline result "detectable" at week 12 and therefore just not making complete EVR. If I had instead been just barely UND at week 12 and only gone 48 weeks, I think the risk is great I would have relapsed.

[merryBe]

I have a theory that I developed after reading all of HR's stuff. Yes they know the virion can hide better in the liver cells, and the drug has trouble getting in there....

but my theory is maybe it isn't as impossible to happen as some think.
otherwise, it shouldn't matter whether you do 48 or extended tx...the stats should remain the same.

Yet they aren't the same. SVR goes up, and I think the last stat was even late responders had the same 50% rate as early responders provided they treated out to 60 wk beyond going und.   (whereas earlies stats showed 3 % chances for these, it goes to 50 with extended tx..

and that can only mean that sooner or later enough drug is getting into those hidden cells or effecting all the virions whereever they may be to render them helpless.
Now even if half of people are resistant, that doesn't mean the other half shouldn't benefit from the new stats on extended tx does it??

Now I'm starting to wonder how many that were declared resistant really were or if they were cut short.
I was declared resistant, refused to discontinue tx, went UND a month later and have been UND for 8 months.  How many patients were cut off because their response was not textbook that could have gone on to SVR.

Only God knows.

mb