HCV / Incivek Tx

[johnr1]

Hello..I'm on week 21 of Incivek triple tx. My viral lode was undetect. at 4 and 12 weeks.
However, my riba dosage has been reduced3 times. I'm at 400 mg/day. I  had some rough anemia at week 10 (got a transfusion)...and my gastro dr has been dialing down my rib since( I even discontinued for a week).
I suggested procrit a couple weeks ago..but he said it would take to long to work.
I am treatment naive prior to this tx.
My question: will the reduced riba intake jeoapardize my week 24 test outcome?
Thank you very much

[Dee1956]

Hey there!  Everyone above had given  you great advice.
  I agree with you, there were times I did not want to take the peg shot and people here (Willbb) helped me so much to continue.  As time goes on you realize that you are stronger than you ever thought possible.  I have had some eye opening experiences/revalations during tx.
You are doing a great job, there is recovery in your sights.   I wish you the very best.

[skiyaltr]

I am on triple, incivek, week 32.  Riba was reduced to 600 mg at week 6 and we have stayed there.Was UND at week 4, 12, and 24.  Hang in there.

[johnr1]

Thank you all very much for your support, experiences, and knowledge.
I almost quit tx 6 weeks ago.
You folks are playing a  BIG part in sticking it out.
Thanks again. I wish you all the best.

[uriah1]

and i can echo what your doctor saying that it takes the procrit a while to work....my hemoglobin didn't rebound until 4 weeks of procrit....
i know it's hard not to worry that we're not going to be UND or SVR....
good luck and keep it up!

[Dawn703]

You have gotten good info, but just wanted to tell you my experience. I was taken off riba completely for 9 days at around 10 weeks of treatment. I was UND at 4, 12, and 24 weeks.

[willbb]

Hi there..

It is never ideal to have to reduce any of the medications while doing HCV therapy,however  if one develops "hemolytic anemia" as a result the proper protocol is to reduce the RIBA.

The amount of reduction  still seems to be up to the individual treating doctor .Some will reduce by 200 mg increments to gauge effect and others will take it down to (usually 600mg) right away.

others will introduce the growth factoer"procrit as well as the reduction in Riba . and sometimes this modality on it"s own

The  ad-hoc studies show that Riba reduction has no effect on SVR rates..especially if instuited after one becomes UND/ (you did not mention when they reduced)

Reducing 3 times as you say tells me that possiblt the doctor as soon as you had HGB labs that showed you back with in proper range he upped the Riba to original amounts ,,which is not the correct protocol... at least until you may be well stabilized

Given you had an RVR(UND. @wk 4 ) and still at week 12 ,I would imagine your chances for an UND. at week 24 are very good..

Best of luck on your PCR
Will

http://www.hivandhepatitis.com/hepatitis-c/hepatitis-c-topics/hcv-treatment/3583-easl-ribavirin-dose-reduction-and-epo-both-work-for-managing-anemia-in-patients-using-boceprevir

Triple therapy raises the likelihood of a cure and offers the potential for shorter treatment, but it also increases side effects such as anemia (low red blood cell or hemoglobin levels). Various approaches are used to manage anemia including reducing the dose of ribavirin, adding erythropoietin (EPO; brand names Epogen and Procrit) to stimulate red blood cell production, and blood transfusion. Ribavirin dose reduction is risky for patients on interferon dual therapy since it helps lessen the likelihood of post-treatment relapse.

[Idyllic]

Reduced Riba has not proven to jeopardize your outcome. I feel like I am jinxing someone when I make blanket remarks like, "You have got this in the bag!" But the statistics are very much in your favor.

I'm not sure about not taking Riba for an entire week  but the trials show that Riba dose reduction did not impact SVR. Do you mean your dose is currently 400 mg/day? Being Und since week 4 is a very good indicator.

It means you were eRVR and 92% (195/212) achieved SVR with 24 week treatment duration. In telaprevir clinical trials, erythropoietin (Procrit) use was prohibited and anemia was managed through Riba dose reductions. Reduced Riba was not associated with lower rates of SVR.

Here is the link for the Incivek data:
http://www.incivek.com/hcp/extended-rapid-virologic-response-ervr


And here is the data for the Riba dose reductions & SVR:
I don't know if you can access this link from the Clinical Care Options web site but here is a cut and paste of the salient details:
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%206.aspx

In a pooled analysis of patients from the ADVANCE and ILLUMINATE trials, 12% of patients (44 of 361) who had hemoglobin reductions to < 10 g/dL required blood transfusion vs 5% of those from the control arms (5 of 92).[60]

In the same pooled analysis of treatment-naive patients in ADVANCE and ILLUMINATE, RBV dose modifications (reductions or interruptions) were not associated with lower rates of SVR in patients who were treated with a telaprevir-based regimen.[60] Anemia appeared to have no association with SVR rates. By contrast, anemia as well as RBV dose reduction was associated with lower SVR rates in patients treated with pegIFN/RBV only."....

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