Hep c treatment question

[camilleanne]

What are the options for someone with genotype 1a who is a null responder? My viral load is 100 after 12 weeks and the triple drug treatment I have been enduring will be discontinued.

[ceanothus]

Thanks so much Will!
Saelon

[willbb]

If during your last treatment with what was considered SOC at the time  (PEG/Riba) you were slow to respond ,however were stil [email protected] and  stayed UND. through your course of therapy and subsequently relapsed after medications were stopped you would be categorized as a previous "relapser"  

Previous "relapsers ", even with cirrhosis, although  not studied in very large numbers in the Tela trials still had excellent SVR results.

It would have been the ideal result obviously,as you know, to have been UND.during this treament @Wk.4 ,however week 8 is still considered a good result and your Hepa has given you good information about relapsers results.

I would not put too much stock on the result of your first attempt with just INF. as the odds were extremely low to succeed for everyone (approx. 25%) from the get go.

Again..as your Hepa has advised you have an excellent chance of success.

Wishing you well the rest of the way..
Will

[ceanothus]

Okay Hector, you are alarming me with those statistics. Can I ask what is the source, so I can read the whole article and see if my alarm is truly justified? I've got genotype 1A, i was a null responder to eary tx with interferon alone, then a slow responder and eventual relapser to a very long tx with interferon and ribavirin. I've had compensated cirrhosis since at least 2005. I'm on my 28th week of tx (initially with Incivek) and I've been UND since week 8. Tx is hell, and I've been leaning heavily on the SVR odds that my hepatologist gave me when I started tx – he said 80-85%. Your quote makes it sound like the complete inverse is true, or a 14% chance of SVR. I really hope I'm misunderstanding your quote.

[willbb]

I may be mistaken ,however I read your post to mean you possibly are on Victrelis and because your VL was >100at week 12 they are discontinuing your treatment.?
This is the proper protocol according to the drug labeling ,as it was shown in studies at this juncture tx. would be futile to continue and could actually result in resistance variants.

What are the options ?
---------------------
If this is the case then unfortunately they are somewhat limited currently.
The amount of liver damage(fibrosis) you have is information important to help answer what is next.

If you have minimal damage then trying to stay as healthy as you can until there is another generation of medications avail (possbly 3 years or so)  or if there is more significant damage then speaking to you doctor about possibly entering a drug trial using one of these medications could be an option.

Good luck and welcome..
Will

[HectorSF]

For those treating with INCIVEK

SVR by Baseline Fibrosis Stage and Prior Response:

Null responders

No, minimal or portal fibrosis (stages 0-2) = 41%
Bridging fibrosis             stage 3              = 39%
Cirrhosis                       stage 4               = 14%
---------------------------------------------------------------------------------
Boceprevir in Treatment-Experienced Patients
RESPOND-2 Study

Previous Null responders excluded. No data available.
----------------------------------------------------------------------------------

Hector

[can-do-man]

I'm curious as to what your starting viral load was and how you got the title null-responder?

[pooh55811]

Hello and welcome to the forum.

Can you giveus a few more details please so we can better respond with more accurate information. You said you are Genotype 1.

*What are your biopsy results (Grade/Stage)
*How many times have you treated. Is this the first time or did you treat before.
*What were the results of each treatment.
*What drugs are you treating with this time. You said you are 12 weeks into treatment. Are you on Incivek or Victrelis?
*What was your starting viral load for this treatment.
*Do you see a hepatologist or a gastroenterologist.

Here are the futility rules:

For all patients treated with boceprevir, the following futility rules should be employed:
*If HCV RNA is ≥ 100 IU/mL at Week 12, all 3 medications should be discontinued.
*If the patient has confirmed, detectable HCV RNA at Week 24, all 3 medications should be discontinued.

For all patients treated with telaprevir, the following futility rules should be employed:
*If HCV RNA is > 1000 IU/mL at treatment Week 4 or 12, all 3 medications should be discontinued.
*If HCV RNA is detectable at Week 24, pegIFN/RBV should be discontinued.

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%205.aspx

With more details hopefully we can offer some help.