Incivek or Victrelis?

I am on week 6 of Victrelis triple tx. I am fortunate to have no side effects other than tiredness. It seems most of the posters on Incivek are having major issues. I quizzed my doc on why they chose Vic for me and was told that many people quit Incivek because of the sides and that the success rate is about the same. For those not committed yet you may want to consider these facts.

[Advocate1955]

It seems like it's still unclear which of the two drugs doctors will lean toward. In my husband's hepatologist's office, they are trying to prescribe each about 50/50 and do not seem to be leaning toward one or the other.  My husband is on week 16 of Incivek.  The first 12 weeks were rough, but manageable.  The side effects have improved since week 12.  Here is a link to my journal, where I have copied an article that HectorSF, another forum member, shared with us recently:
http://www.medhelp.org/user_journals/show/332526/Incivek-or-Victrelis
Advocate1955

[micheall]

I asked my dr this question,for I hated Incivek because of the 20 grams of fat which is eaten 30 minutes before Incivek.He told me that the Incivek program is shorter in time than the Victrelis.This is great to hear of limited side effects.Have you done this before?This is my 2nd treatment and the sides are not as bad as the first.1st treatment the 2 drug and the 3rd triple treatment.

[pooh55811]

"I am on week 6 of Victrelis triple tx. I am fortunate to have no side effects other than tiredness. It seems most of the posters on Incivek are having major issues. I quizzed my doc on why they chose Vic for me and was told that many people quit Incivek because of the sides and that the success rate is about the same. For those not committed yet you may want to consider these facts. "
____________________________________________________________

It's great that you are not having many side effects. You are fortunate.

I have no specific preference for Incivek over Victrellis. It happens my doctor uses only Incivek.

I am not sure I agree with the conclusions of the rest of your post.

To begin with, I think the majority of the posters are on Incivek so naturally more posts are going to deal with Incivek and the experiences of the people on Incivek. I don't think that means that most of the people on Incivek are having major issues. I suppose it depends on how one defines major issues.

It is true that there are anal issues and probably more rashes with Incivek. The anal issues have taken some time and some trial and error remedies to figure out (not sure why the trial docs never figured out the remedies). I think those of us who have dealt with the anal issues, have found out how to prevent the severe internal pain (keep the stools firm) and deal with the other issues (keep the stools firm and the butt clean, and use creams and Hemorrhoid supp. as needed). Once a person figures this out, the anal issues are not usually a major problem. As far as the rash is concerned, that can usually be dealt with too, especially if it is dealt with early. (Some docs have not figured that out either.) These two side effects seem to be the main posting topic for Incivek side effects. In my opinion, if the docs knew what they were doing and were a bit more proactive, they would have some protocols developed which they could give to the patients for the anal issues (and for the other issues). The anal issues can be dealt with. It is just that those of us on Incivek have had to figure it out ourselves with no help from the docs. If I had known when I started Incivek to keep the stools firm, I probably would never have had any internal rectal pain. The rash can usually be dealt with effectively too but it seems the docs are often a bit slow to properly treat the rash. If they were more proactive and got on the rash immediately, fewer people would be posting about it.

I don't know why your doc said many people quit Incivek due to side effects. Where are the statistics for that conclusion? If you look at frijole's spreadsheets, most people are taking Inc. Very few of them had to stop treatment due to side effects. One I can think of that had to stop had a rash that her doc was not paying attention to, even after calls to the office, and eventually it got so bad she had to go for urgent care and stop the Inc. I wonder if that would have been necessary if her doc had been more proactive and treated the rash before it became severe. (I am not saying frijole's spreadsheets are necessarily statistically relevant in terms of the bigger picture and the number of people taking Inc and Vic. They cover only about 100 people and they are not taken from a controlled study. I am just saying that most on her spreadsheets are on Inc and very few have had to stop treatment.)

Victrellis is not side effect free. It may not have the anal issues, but it appears to me from what I have read, Vic has more issues with anemia  (50%) sometimes/often necessitating injections with procrit. You also have to take Vic a lot longer than you have to take Inc.

Both drugs seem to have good SVR rates. So I suppose it depends on how long one wants to be taking the PIs and if one wants to deal with anal issues and more rash issues (Riba also causes rashes) or if one wants to deal with a higher possibility of anemia.

You say that those people considering treatment and not yet committed should consider "these facts." My problem with this is that no facts were presented in your post. Your observation (that most people on Inc are posting about major side effects) was presented, but that observation/conclusion is arbitrary and relative. What defines a major side effect? How many people on this forum are on Inc. versus Vic.? Are the docs responding appropriately to the side effects?

Also, your docs statement that many people on Inc. are quitting due to side effects seems to be just that, a statement. Where are the studies and statistics that would back up his statement? Docs say a lot of things to justify their choices. Unless they can back up their statements with facts, those statements are just opinions or preferences.

I am not trying to pick a fight and I don't mean to sound argumentative or disrespectful. I just don't agree with some of the statements/conclusions in your post and I do not think any actual facts were presented. Therefore people not yet committed to a drug have no facts (from your post) on which to base a conclusion. I would encourage people not yet committed to a specific drug to do their own research and base their decisions on published scientific statistics which were gathered from scientific studies.

Again, it is great that you are doing so well and having so few side effect. Hopefully the rest of your treatment will have few side effects too.

[Aquisi]

Thanks Melvyn for your opinion.

[can-do-man]

I kinda have to agree Melvyn, at least from reading here and my own experenice.......... Good luck

[printze]

I haven't started tx yet have been gathering months of info reading posts from everyone. I would prefer Vic over Inc, mainly because I will need to work and if I can eliminate the fat intake and anal issues while working that's one issue , I am trying to figure out based on my own situation if Vic is better. I thinkif I was able to be home during tx and somebody there with me I would opt for Inc, because I am alone and need to work, Vic seems more doable  hoping the anemia does not get too bad. It is not an easy decision , so far it is the Vic, lastly everyone reacts different also to the meds. There certainly are more on Inc than Vic even with the extra 4 weeks I believe itmight be worh it for my situation. I will know late summer of this year. Bottom line , tx is not easy for anyone, it's a mixed bag.

[MelvynB]

Ok then. I was not reaching any conclusions of one being better than the other. I just wanted people that have not started yet to consider both. Thanks for your thoughtful response.

[MelvynB]

Michael- this is my first shot at treatment. I am stage 1 and grade 1. I actually questioned my doc on Inc vs Vic and he prescribes Vic 90% of the time. The Vic is not that bad and the thought of 24 weeks is certainly manageable given my current experience. My hgb has stabilized at 10.5 and doc said it likely won't drop below that for the rest of the course. The worst is the Pegintron which kicks me to the curb for about 36 hours. I know I still have 19 weeks to go and anything can happen but so far so good. Good luck with your treatment!

[tiredturkey19564]

Hi, I'm also on VIC and glad my doc picked it over Inc. My main side is anemia. My last hgb was 9.6 from 9 without any helpers. My energy has been rising in the last 2 wks. I just had my 29th dart a few minutes ago.
Linda

[brianmo]

I spent two months weighing pros, cons with my doctor. She gave me both options and went over all the details with me. I picked Vic because I did not want to deal with all the fat. Bottom line.

Not to say I do not have sides but so far it's all doable with no helper drugs. The anemia has not been great and the itching of scalp has been relentless but under control with certain shampoo. Are these sides from Vic??  No one can really sort that out. Interferon causes anemia, RIBA causes itching, who's to say.  There is a person on forum doing SOC. whose anemic doing helper drugs. Look at frioles chart.   My doctor also told me 90 percent of patients in her office chose  Incivik because of shorter tx time.  So, welcome to the Vic club and keep us posted as to how you are doing!   Hang in there......Mo

[pooh55811]

"I was not reaching any conclusions of one being better than the other. I just wanted people that have not started yet to consider both. "
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It looks like we agree on things. That was /is what I think too, that people research both and consider both. Then make a decision.

I re-read my post several times before posting but I find it a bit difficult to get a good concept of a post when I can see only a few lines in the box. After posting and re-reading my post again, I realize it probably came off as being very critical (of you) and I really did not mean it that way. My main concern is as stated above, that people research both and make their decisions  based on factual research. I do apologize if my post sent the wrong message. I should have worded it better.

[willbb]

Just some facts and figures on the two ..

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02718.x/full

[summer7799]

I feel like we are in similar situations. I also am leaning towards choosing VIC. I have the option of doing either drug or going in a trial. And I think VIC may be the best choice for me. I also have to work full time thru treatment, I won't have any outside help, and I'm a single parent. Also I hate the idea of eating that much fat. So, I feel like VIC may be best for me too. Can I ask why you are waiting till end of summer??

[summer7799]

That question was meant for printze :)

[pooh55811]

Thanks for posting that, Will. It was quite informative.

[MelvynB]

Thanks Pooh. I must admit I was a bit taken aback with your response but I understand where you are coming from. We are good. All the best to you as we both battle this thing.

[evangelin]

My husband is on Victrelis and it is looking like it could be successful.  He has had the standard interferon and Ribavirin 3 times before this and I can say, for him, the SX have not been much worse with Victrelis than without.  The only major difference is that the Victrelis looks like it might work.  :>)
I think his Dr. picked the Victrelis for him because she knew he already had such substantial SX with SOC that she was afraid he couldn't tolerate the Incivik.  My husband has cirrhosis and of course was a poor responder before.  She said that she is glad it appears to be working for Joe because she has not seen this in all her patients with his profile.
He sleeps all the time, is ghastly pale, he acts as if you asked him to climb a high mountain if you ask him to shave,  grouchy sometimes, and of course he is the only driver on the road that knows how to drive right now. He has been just like this on SOC but with no SVR to make it worth it.  I see more  hope  this time.
Ev

[printze]

I saw the liver specialist  on the 4-01-12 , in October went for my fibroscan but I think the girl doing it did not do it properly so it did not take. When I saw my hep doc 2 weeks ago he looked over my US, and lab results and does not see advanced liver disease earlt fibrossis. I also mentioned to him that Iwould prefer to start tx in the fall and not in su,mmer, anyway he mentioned something about our gov't picking up the cost not sure exactly so in July I will redo fibrscan and do biopsy and then see from there. I live in Canada and I am no expert on this disease it is new to me , so I am just listening to him whatever he says I also have to loose a few pounds . That's where I stand . But I think I will do VIC , looks more doable in my situation. So another 6 mts of waiting , I also did more labs when I saw him. We will see.

[ringofphoenixdw03fire460]

there is one
aspect of the sides that is driving me nuts and that is the anal. Will this haunt me the entire 12 weeks of the incivek portion of the 3X therapy,

[1oftheclub222]

Talk to Pooh55811, she has a lot of good advice ont his matter, you may want to send her a PM.

[80mecheng]

I am on Vic and my doctors recomendation/concerns were the same as MelvynB's.  Was undetectable at week 8 and am in week 26 of a 28 cycle.  Main side effect has been anemia that at week 18 doctor added Procrit that after 6 shots has stopped the dropping but very little improvement.  SX  has included a cough since week 1, everything tastes like cardboard.  All in all it's a grind but can be completed.

[pooh55811]

Welcome to the forum.

I had severe anal/rectal pain (not discomfort, severe pain, like crapping shards of glass and it was internal.)

It took me a while to figure out what works to prevent it but this is what I came up with:

For external burning:
At first I used Lidocaine cream with hydrocortisone (prescription). After the burning stopped, I used Prep H cream for the hemmorhoids. Then much later in treatment it got irritated and itched and I used Desitin cream. I am about to move back to Prep H cream. (Some people have said they have used Butt Balm, Baneal, A&D ointment. It's all in the same Aisle with Prep H. Desitin may be in the baby aisle.) The other big factor is to keep the butt exceptionally clean. Huggies baby wipes with aloe are good for this as are tub baths or showers (let the water run over the area for a while.)
Also, keeing the stools firm helps. It is the diarrhea that causes most of the external irritation.

For the shards of glass internal pain I did a couple of things:
I used Prep H supp every night before bed.
I kept the stool very firm. Not hard as a rock, but very firm.
At the first sign of soft or loose stools I took loperimide tabs (over the counter).

It took me two tries to figure this out (or two severe shards of glass rectal pain episodes). I did some trial and error. Once I figured out that the stools cannot get soft, I had no internal pain episodes again.  

A couple of other tips. Eat plenty of fat, even more than the recommended amount. It seems to help with the stools (others have noticed). Also, drink plenty of water. My doctor said to drink a gallon of water a day. Another thing is, eat some solid food when you take the Incivek pills (not just liquid).

I am still using the Prep H supp at night as I am trying to get rid of the hemorrhoids (which I did not have before treatment, lol). I don't really want extra souveniers left over from treatment.

I think that is my little list of tips. They worked for me.


If you get a rash, get on top of it immediately. The rashes can get bad fast.

Post any side effects you have and we will all help. Among all of us, we have had most of them, I think.

Best of luck on treatment.