Aa
How to stop tx???
Dear all
I have completed 21 weeks of tx )total tx is of 24 weeks). I was geno 3, 30 years of age, dx in 2001-2002, Tx in 2008 , initial VL was 272,000 IU/Ml at the start of tx and U/S & Bx showed no significant demage done to liver, My ALT never goes upto 60 (45 max) however i was feeling some symptoms like fatigue, joint pain and loss of apetite before tx. . My First PCR- Qual was done on 16th week and showed UND, I dont know what was the PCR result at week 4 or 12. I am on standard Interferone and 1200mg Riba ( my weight at the start of tx was 83kg). I acouldnt affoard peg-interferone at this time but in future there is possibility of affoarding if neceassary ( Godforbade) .My doc says that according to him 24 weeks will be sufficient and according to some members of forum i should go for extended tx as PCR at week 16 has no importance for SVR. I had manageable sx during tx but from week 19 my hair starts thinning and falling with a rapid pace and this prob still continues. my question are
1- should i go for extended tx, if yes how much extension is neceassary 24 weeks or 12 or 6 ???
2- How to stop tx??/ should i stop shot and riba tab at the same time or i have heared that riba tab should be continued during 10-15 days after completeion of shot.
I have completed 21 weeks of tx )total tx is of 24 weeks). I was geno 3, 30 years of age, dx in 2001-2002, Tx in 2008 , initial VL was 272,000 IU/Ml at the start of tx and U/S & Bx showed no significant demage done to liver, My ALT never goes upto 60 (45 max) however i was feeling some symptoms like fatigue, joint pain and loss of apetite before tx. . My First PCR- Qual was done on 16th week and showed UND, I dont know what was the PCR result at week 4 or 12. I am on standard Interferone and 1200mg Riba ( my weight at the start of tx was 83kg). I acouldnt affoard peg-interferone at this time but in future there is possibility of affoarding if neceassary ( Godforbade) .My doc says that according to him 24 weeks will be sufficient and according to some members of forum i should go for extended tx as PCR at week 16 has no importance for SVR. I had manageable sx during tx but from week 19 my hair starts thinning and falling with a rapid pace and this prob still continues. my question are
1- should i go for extended tx, if yes how much extension is neceassary 24 weeks or 12 or 6 ???
2- How to stop tx??/ should i stop shot and riba tab at the same time or i have heared that riba tab should be continued during 10-15 days after completeion of shot.
Extended Drug Therapy for Hepatitis Is Challenged
Sign In to E-Mail or Save This Print Reprints Share
LinkedinDiggFacebookMixxYahoo! BuzzPermalink By RONI CARYN RABIN
Published: December 3, 2008
Patients who do not initially respond to standard drug therapy for treatment of hepatitis C are unlikely to respond to long-term maintenance therapy as well, according to a new study.
Skip to next paragraph
Related
Health Guide: Hepatitis C »Yet many patients who do not at first respond to drugs are placed on maintenance therapy, which is expensive and can be both physically and psychologically grueling, in hopes that long-term treatment will keep the disease in check. The practice is ineffective and possibly harmful, the study’s authors said.
“To the extent there are still patients out there who are on this form of maintenance therapy, there is a real take-home message: It should be stopped,” said the lead author, Dr. Adrian M. Di Bisceglie, professor of internal medicine and co-director of the liver center at St. Louis University School of Medicine.
The maintenance therapy failed despite the fact that it was effective at lowering the amount of virus in patients’ blood and reducing conventional signs of liver damage, Dr. Di Bisceglie said.
The report appears in Thursday’s issue of The New England Journal of Medicine.
The standard treatment for hepatitis C is a regimen of two potent drugs, peginterferon and ribavirin, that can produce side effects like fever, debilitating fatigue and depression. But the treatment clears the virus from the body in about half of all patients.
Those who do not respond to the initial one-two punch in six months to a year are often advised to continue with a lower, maintenance dose of peginterferon alone for an indefinite period.
The new study, conducted at multiple medical centers and supported by the National Institute of Diabetes and Digestive and Kidney Diseases, followed 1,050 patients with advanced liver disease who had failed to respond to initial treatment for three and a half years. Most of the subjects were men, and their mean age was 51. About half received low doses of peginterferon, while half received no therapy.
Patients on long-term peginterferon fared just as poorly as nonresponders who were not taking the drug, the investigators found.
About a third in each group developed serious complications of hepatitis C, like liver cancer and liver failure.
Eight patients on peginterferon died, compared with two who were not taking the drug, a statistically significant difference, researchers said.
“This is a treatment that should not be done,” said Dr. Howard Worman, professor of medicine at Columbia University College of Physicians and Surgeons, who was not involved in the study. “Patients should just sit tight and wait for new treatments or drugs to be added, which will happen within a few years.”
Dr. David Bernstein, chief of gastroenterology and hepatology at North Shore University Hospital on Long Island, said there might still be a “glimmer of hope,” though very little evidence, that some hepatitis C patients who failed the initial course of treatment might benefit from extended maintenance treatment.
But for now, Dr. Bernstein added, “there’s no reason to make someone feel sicker than they generally feel.”
I have discussed my problem ( duration of tx whether 24 weeks or extended with an other doc who says if your doc is insisting on 24 week tx then go for it or extend it to week 28 or 30 max ( i or 1.5 months) as my first PCR was done at week 16 which shows UND but i cant make sure what was my result at week 4 or 12.
What you people suggest, should i go for extended tx of 4 weeks or just rely on 24 weeks ( I am Geno 3) starting VL was 262,000 iu/ml, dx in 2002 and tx in 2008
What you people suggest, should i go for extended tx of 4 weeks or just rely on 24 weeks ( I am Geno 3) starting VL was 262,000 iu/ml, dx in 2002 and tx in 2008
"How to stop tx??/ should i stop shot and riba tab at the same time or i have heared that riba tab should be continued during 10-15 days after completeion of shot."
Most doctors say you can stop shot and riba at the same time, but I preferred to do it the "old-fashioned" way with continuing the riba for a full week after my last shot. Just to be sure I was fully dosed on riba my last shot-week as well.
"should i go for extended tx, if yes how much extension is neceassary 24 weeks or 12 or 6 ???"
Nobody knows the answer to this question, since you did not have a week 4 test. If RVR week 4, then 24 weeks would be enough; if non-RVR week 4 but UND by week 12 then you should do 48 weeks. So you just have to make a decision, nobody can do it for you. You have to in some way find a decision you can live with.
Most doctors say you can stop shot and riba at the same time, but I preferred to do it the "old-fashioned" way with continuing the riba for a full week after my last shot. Just to be sure I was fully dosed on riba my last shot-week as well.
"should i go for extended tx, if yes how much extension is neceassary 24 weeks or 12 or 6 ???"
Nobody knows the answer to this question, since you did not have a week 4 test. If RVR week 4, then 24 weeks would be enough; if non-RVR week 4 but UND by week 12 then you should do 48 weeks. So you just have to make a decision, nobody can do it for you. You have to in some way find a decision you can live with.
heres another link to the shorter version of the above study
http://www.medhelp.org/posts/show/575996
http://www.medhelp.org/posts/show/575996
this is last years, the one I'll send next is even better
By: Mitchell L. Shiffman, MD
Source: New Management Strategies for HCV Nonresponders and Relapsers
"Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks.[8-10,20] In each of these studies, the relapse rate was reduced from more than 50% to less than 20%. Two of these studies suggest that this benefit may be less or nonexistent in patients with higher HCV RNA levels at baseline and at Week 12.[8,9] However, these observations will need to be confirmed in future studies before these patients are not considered for treatment extension. Therefore, for now it appears that prolonging the duration of therapy will increase SVR rates in patients who are slow to respond and should be routinely practiced".
8. Sanchez Tapias JM, Diago M, Escartìin P, et al. Peginterferon alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology. 2006;131:451 460.
9. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa 2a plus ribavirin. Gastroenterology. 2006;130:1086 1097.
10. Sanchez-Tapias JM, Ferenci P, Diago M, et al. How can we identify HCV genotype 1 patients who may benefit from an extended treatment duration with peginterferon alfa-2a (40KD) plus RBV? Program and abstracts of the 42nd Annual Meeting of the European Association for the Study of the Liver; April 11-15, 2007; Barcelona, Spain. Abstract 641.
20. Ferenci P, Laferl H, Scherzer TM, et al. Customizing treatment with peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) in patients with HCV genotype 1 or 4 infection: interim results of a prospective randomized trial. Program and abstracts of the 2006 Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, Massachusetts. Abstract 390.
By: Mitchell L. Shiffman, MD
Source: New Management Strategies for HCV Nonresponders and Relapsers
"Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks.[8-10,20] In each of these studies, the relapse rate was reduced from more than 50% to less than 20%. Two of these studies suggest that this benefit may be less or nonexistent in patients with higher HCV RNA levels at baseline and at Week 12.[8,9] However, these observations will need to be confirmed in future studies before these patients are not considered for treatment extension. Therefore, for now it appears that prolonging the duration of therapy will increase SVR rates in patients who are slow to respond and should be routinely practiced".
8. Sanchez Tapias JM, Diago M, Escartìin P, et al. Peginterferon alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology. 2006;131:451 460.
9. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa 2a plus ribavirin. Gastroenterology. 2006;130:1086 1097.
10. Sanchez-Tapias JM, Ferenci P, Diago M, et al. How can we identify HCV genotype 1 patients who may benefit from an extended treatment duration with peginterferon alfa-2a (40KD) plus RBV? Program and abstracts of the 42nd Annual Meeting of the European Association for the Study of the Liver; April 11-15, 2007; Barcelona, Spain. Abstract 641.
20. Ferenci P, Laferl H, Scherzer TM, et al. Customizing treatment with peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) in patients with HCV genotype 1 or 4 infection: interim results of a prospective randomized trial. Program and abstracts of the 2006 Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, Massachusetts. Abstract 390.
low liver damge is helpful of course, but even tx damages some livers and can cause liver failure even, so the idea is not to treat twice if you can avoid it.
The verdict is out on type 3 and 4's, from what I've read in here in recent studies and elsewhere many docs are in favor of longer treatments simply because even if your success rate is 80 or 90% if longer tx could get them to 100% then why the heck not.
In fact that subject has come up more than once, many unsuccesssful type 3 treaters saying they felt gyped when a few more weeks could have gotten them there.
The issue in a recent study of the hardest to treat (type 1) proved that those treating out the longest had the best rate of success. Even the super late responders in that study SRV'd at 100%....the ones that stuck it out...even though normal success rate for that genotype is only 50%.
I will post you that study so you can see the corelations.
they used to say VL had more to do with it than now a days...in the last year, the rate and quickness of clearance seems to play a larger role in the thinking. I was told the VL being wiped out rapidly is the most accurate predictive of the liklihood of reaching SRV and staying there....more important than how many virons you had was how weak and easy they were to knock out in other words....
BUT we must add to that statement that time treated out from going UND has now been proven to have been grossly underestimated as to it's importance....so again, there no one single determinant.
That why information is so vital. The patience needs to advocate for themselves,
and the only one who stands to win by the arbitrary cut offs of 6 months or one year, are the insurance companies. They look at people as statistical risks and aren't eager to treat out if the chances are not great that a person might clear.
If it were me, and just based on when you finally found out you were UND, I'd want to extend at leat to 36, especially when you have a genotype so likely to be knocked out with enough tx.
now let me find you that link. Pay attention to the rates of those treated out. Notice that the success rates that used to be used for late responders and super lates was 3-5%....
until last year....now studies show this year rates as high as 50, even 100%.
things change rapidly in what we are learning about this disease.
Don't expect every doctor to know all the latest or newest statictics or studies either..
my doctor was educated at Stanford and is very smart, yet I had to bring him these studies AND those concerning Alinia before he would agree to extend tx. Truth is, he was too busy treating so many patients to have kept abreast in what was a very changing year....so don't be afraid to print up pertinent studies and take them to your doc. They are more willing to work with someone who wants the best for themselves and has done their homework.
I'll find that study.
mb.
The verdict is out on type 3 and 4's, from what I've read in here in recent studies and elsewhere many docs are in favor of longer treatments simply because even if your success rate is 80 or 90% if longer tx could get them to 100% then why the heck not.
In fact that subject has come up more than once, many unsuccesssful type 3 treaters saying they felt gyped when a few more weeks could have gotten them there.
The issue in a recent study of the hardest to treat (type 1) proved that those treating out the longest had the best rate of success. Even the super late responders in that study SRV'd at 100%....the ones that stuck it out...even though normal success rate for that genotype is only 50%.
I will post you that study so you can see the corelations.
they used to say VL had more to do with it than now a days...in the last year, the rate and quickness of clearance seems to play a larger role in the thinking. I was told the VL being wiped out rapidly is the most accurate predictive of the liklihood of reaching SRV and staying there....more important than how many virons you had was how weak and easy they were to knock out in other words....
BUT we must add to that statement that time treated out from going UND has now been proven to have been grossly underestimated as to it's importance....so again, there no one single determinant.
That why information is so vital. The patience needs to advocate for themselves,
and the only one who stands to win by the arbitrary cut offs of 6 months or one year, are the insurance companies. They look at people as statistical risks and aren't eager to treat out if the chances are not great that a person might clear.
If it were me, and just based on when you finally found out you were UND, I'd want to extend at leat to 36, especially when you have a genotype so likely to be knocked out with enough tx.
now let me find you that link. Pay attention to the rates of those treated out. Notice that the success rates that used to be used for late responders and super lates was 3-5%....
until last year....now studies show this year rates as high as 50, even 100%.
things change rapidly in what we are learning about this disease.
Don't expect every doctor to know all the latest or newest statictics or studies either..
my doctor was educated at Stanford and is very smart, yet I had to bring him these studies AND those concerning Alinia before he would agree to extend tx. Truth is, he was too busy treating so many patients to have kept abreast in what was a very changing year....so don't be afraid to print up pertinent studies and take them to your doc. They are more willing to work with someone who wants the best for themselves and has done their homework.
I'll find that study.
mb.
i think with that low starting VL you could stop at 24 weeks and be fine. personally i would taper off the drugs for a few weeks after finishing 24 full weeks. I'm curious, did you ask your doctor to test at 4 & 12 weeks? what did he say or if you asked him now why he didn't? I can see an old school doc not testing at 4 weeks but if he doesn't know to test at 12 weeks I would make sure he is a real doctor! best of luck
yes you are right my doc did me a disservice by not testing me at week 4. But that cant be undone now and i have see forward. Do my other factors like low VL or undemaged liver supports my case ??? or they have no impact .. I admit i already feeling symptoms of HCV before tx like fatigue, loss of appetitie, digestion prob , joint pain etc but urine color was normal. According to my understanding, all over the world Geno 2 & 3 is normally treated for 24 weeks, the Roferon(Roche) & Intron A ( Sherring) product detail also indicate this.
I was very happy that my tx is going to end in 2 weeks and i am UND but now m quite worried about what to do ??? what should be ideal extension ??? how many further weeks ( after completing 24 weeks) ?? should i opt 48 or 36 or anyother no.?
Whats the possibility if i wait and see about SVR??
I was very happy that my tx is going to end in 2 weeks and i am UND but now m quite worried about what to do ??? what should be ideal extension ??? how many further weeks ( after completing 24 weeks) ?? should i opt 48 or 36 or anyother no.?
Whats the possibility if i wait and see about SVR??
your doctor did you a disservice by not testing you at week 4.
Even though some type 3 people do well on shorter treatment it is only those who were Early Responders...and you have no way now to know if you were.
On the other side of the equation a late responder has a more likely chance of relaspe as a type 3 due to the shorter duration (6 mo) of SOC.
this article I think explains it well in laymans terms: http://www.webmd.com/hepatitis/news/20050622/shorter-hepatitis-c-treatment-works-for-some
if you are worried about your hair, it will grow back...many say thicker than before.
Stopping early, even by a month, in an already short regime of tx could lower your chances and cause you to have to repeat tx, and with a more resistant strain.
You didn't say which type of 3 you have, there id 3a through 3-f and also a variant called 10a which is part of the type 3 genotype....this also needs to be factored in, as well as your general liver condition. Any amount of fatty liver or NASH would also make stopping early more risky. This is a decision to weigh very carefully as you really have to weigh suffering for a much longer period (assume tx failure and retreatment) vs. a little more suffering now.
It's a choice to make carefully and prayerfully.
May the Lord grant you wisdom.
mb
Even though some type 3 people do well on shorter treatment it is only those who were Early Responders...and you have no way now to know if you were.
On the other side of the equation a late responder has a more likely chance of relaspe as a type 3 due to the shorter duration (6 mo) of SOC.
this article I think explains it well in laymans terms: http://www.webmd.com/hepatitis/news/20050622/shorter-hepatitis-c-treatment-works-for-some
if you are worried about your hair, it will grow back...many say thicker than before.
Stopping early, even by a month, in an already short regime of tx could lower your chances and cause you to have to repeat tx, and with a more resistant strain.
You didn't say which type of 3 you have, there id 3a through 3-f and also a variant called 10a which is part of the type 3 genotype....this also needs to be factored in, as well as your general liver condition. Any amount of fatty liver or NASH would also make stopping early more risky. This is a decision to weigh very carefully as you really have to weigh suffering for a much longer period (assume tx failure and retreatment) vs. a little more suffering now.
It's a choice to make carefully and prayerfully.
May the Lord grant you wisdom.
mb
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
