Hepatitis Researcher or Anyone one else with a good idea

[St. George]

How would someone taper off Infergen at the end if they were taking 15 mcg daily the entire treatment?  Would they taper off a few months leading up to the end of their 48 week treatment or might they finish up the entire 48 weeks at full dosage(15 mcg) and then have a 1-2 month extension which would be used to taper down?  Any thoughts anyone?

[Rangle]

I'm presently @ 8 weeks of a 6 month treatment....my VL results from 6 weeks (heptimax) is 272,

I'm a geno 3 ...
Jim: if you recall when I started treatment I sort of tapered in,... 1/2 IFN 1st week,..then 3/4 second week...full dose of riba at the time was 800mg a day,from the beginning...then full 180 pegasys 3rd week..riba was increased to 1000mg a day, (per your sugesstion weight based riba I weigh 155lbs)...Riba wasn't increased until the 6 1/2 week mark...we wanted to make sure my hemo didn't drop past 11...it's 11.4 ....If I get to SVR I will ask my doctor about tapering off as HR suggests

Right now my 6 week VL is still detectable...so the PA said I may have to go to a full yrs tx
Now this has me thinking did I shoot myself in the foot by not starting on full dose the first 2 weeks? My enzymes were extremely high,.. (they went as high in the summer as 2300/1800 ALT AST),... that was the reason for tapering in.

Or should I count the 8 week VL results as a measure of further treatment instead of the 6 week?
I want to have my best chances of SVR as possible...if I get that far, I definitely will taper.
Any comments would be appreciated.

Happy New Year
Rangle

[St. George]

It may be more so drug manufacturer driven.  What if hypothetically we could get away with treating only until the virus is registered und and then begin a low dose and gradual tapering schedule.  This would mean alot less interferon sold and possibly unnessary riba after und is reached.  The above study didn't even have riba at its disposal!!!

[merryBe]

Thanks for answering this so well HR. Everything I've read made the case for tapering off more appealing.

It's true of other body parts, like thyroid, or adrenals for instance...once a person is put on "the substance needed" the body then shuts down it's own production...and it take a long time to come back on line, unless the drug dujour is tapered off very gradually dramatic illness can follow.

Why this would not be the same case for the immune system/bone marrow T-cell production as it is for so many other systems is the question. It seems not only more logical, but also already proven in myriad systems besides the endocrine.
And Shiffman is more prolific a researcher than the average bear so it's a puzzlement isn't it?

So, the question might be, is this more insurance driven... since tapering off for 2 or 3 months, from the insurances point of view, is still just that many more weeks of treatment. The overseeing/lab costs etc. being the costs that the dose reduction savings hardly compensates for... from their viewpoint?
MaryB

[St. George]

It seems to me its not about pounding the virus into submission( current medical establishment view) but rather finessing it to sleep, not unlike singing a baby to sleep.  The medications reduce viral levels to manageable numbers.  Our immune systems now have  time to reboot  then our own bodies take over where the meds left off.  Tapering needs to be looked into!!!!

[jmjm530]

Haven't digested the full study yet -- but since the taper group treated for 48 weeks versus 24, couldn't it just be the xtra weeks of interferon  as opposed to the taper effect? What it did seem to show, however, is that 48 weeks with a 24 weeks taper was as effective as 48 weeks of full dose. But again, this was with non-pegalayted interferon and no riba. Would be real nice if duplicated with Peg, cause that would mean less Peg for the last 24 weeks.

As to your theory, you might want to read about Dr. Lake-Bakaar's (he's an associate of Dr. J. in NYC) pulse theory. Similar to what you suggest except that they stop the peg abruptly on UND and then only start up again when viral load is detected. They keep up the pulses until patient remains UND. Besides the theory of viral kinetics involved, it also is supposed to be much kinder to the patient. That said, as of a year or so ago, they did not achieve any SVRs but they still may be tweaking the approach.

-- Jim

[St. George]

This study is in direct line with my theory which I posted a few months back which hypothesized, what if we were to only treat until UND and then taper off slowly over afew month time(5-8).  Think of the time, pain,and suffering this strategy could present.  In essence the above study pretty much proves the virus only really is in a stae of remission when we finish treatment.  It is our own immune systems which either keep it in check or are overwhelmed at the end of treatemnt.