Dr. wants to extend tx!!!!! yikes!

[jt57]

2nd tx.  rvr at 4 wks this time.   Now at 41 wks.  still und.  Got a letter from my doc today that he recommends I extend tx 24 more wks past the 48!!!  Even with und at 4 wks????  he states that it is because I relapsed last time.  But last time I was und at 11 wks.  not 4.  I have had a hard time with tx, 3 blood tx.  anemia is awful.  so are the side effects from the neupogen...just to name a few.  I cannot stomach even thinking about an extra six months....what are your thoughts guys?

[mikesimon]

From Smaug's post:

"....One hundred six patients with chronic HCV were enrolled
into this 24-month controlled, randomized prospective trial. All were treated
with 5 mU of interferon-alpha-2b three times a week for 6 months. Patients who achieved biochemical response were randomized to either stop or taper IFN gradually at monthly intervals as follows; 3 mu, 2 mU, 1 mU, and 0.5 mU (all
three times a week). 0.5 mU twice weekly and then once weekly...."

"...Of the 92 patients who completed the
initial 6 months of IFN treatment, 47 (51%) achieved biochemical response.
Twenty-one of these patients were randomized to stop IFN treatment and 25 to
taper (1 drop-out). At randomization patients were well matched with respect to
age, sex, race, serum alanine transaminase (ALT), and liver histology.
Biochemical relapse was observed in 19 of 21 (91%) patients who stopped IFN
treatment compared with only 60% who tapered IFN (P= .04). "


Of those patients who achieved a biochemical response (undetectable viral load I assume) at 6 months - one group (control group) stopped treatment and one group (the taper group) continued treatment for at least 4 more months and it looks like a 6 month extension albeit with decreasing doses of interferon.

So, if that is right, one group treated for 6 months and one group treated for at least 10 months and probably l12 months.

That's not the type of tapering I thought we were talking about - a 6 month taper! That looks a lot more like extending treatment beyond 6 months than it does a taper. No wonder we see twice the relapse rate! I haven't revisited the HR thread but I wonder why HR thought this said anything about "tapering" as I have seen the concept discussed here.

HCV treatment was in it's infancy when this study was conducted and provides no relevant information, in my opinion, regarding the impact of tapering following a standard course of treatment.


Mike

[jt57]

and mabe my withdrawals are the irritability leaving my body....

[jt57]

You all make very good points.  Maybe I should just suck it up, be happy I am off the drugs and live again.  Please pray that I am svr this time.   If Im not, I will tackle again down the road.  with a stronger body and mind.  but I pray this rvr is an indicator that I am done..  Love you all.  and hoping for svr for all of us!

Jean

[Trinity4]

Ribavirin has a very long half life and gradually leaves the body so your body basically tapers it all on it's own. Takes about 3-6 months.  I seriously doubt anyone would experience any adverse effects after stopping ribavirin.  As I said previously, the whole withdrawal thing is subjective anyway.  Pearlman wasn't on board with tapering and that was good enough for me.

Trinity

[paen53]

Jean,

I had planned on tapering after my 72 weeks for the same reasons you gave. It just seemed right after being on these drugs for so long, that an abrupt stop could create problems. My Dr. did not agree, but I had enough stash to carry me for a couple weeks if I wanted.

But in the end, 72 weeks was more than enough for me and I didn't feel any the worse in the initial post tx time - energy soared quickly. Three months later things changed somewhat, but I didn't experience any immediate withdrawal issues, just the sweet thought of finally being DONE.

[Trish77]

Rooting for you and hoping for you, Jean.  

Trish