How long should you cont tx

[yolie71]

I started triple tx in Feb. of this yr. Incivik, Rib, and Peg at week 2 came up Neg and week 4 UND every blood work since then has been the same. Of course everything dropped but not low enough for additional meds. Now at week 28 numbers are starting to go back up and still UND and Neg. At first doc wanted to do 24 weeks of tx, but changed it to 24 weeks post Incivick tx. Also this is my first time being treated and just want to get and idea from others that went through this. It was a tough road and just want to make sure I don't stop tx to soon. Thanks for your help

[yolie71]

I agree just was making sure I was not being over or under treated. I have no problem with doing 48 weeks the hard part is over with. That must be the reason why he wants me to do an additional 24 weeks of PEG and RIBA, but will keep u posted thanks and God Bless

[zako7]

Cando's point must be the reason why the doctor changed it. I think your doctor means well for you yolie, and you should stick to his advice and try and complete the treatment. Even without data, I think you have more odds for svr after 48 weeks being and African American
I am black too. Inerferon is not our best friend. I am doing 48 weeks too and might go to additional 12 weeks of peggy+riba if my doctor let me.
Is it not better to try and clear this virus at your first tx?

[willbb]

cando brings up an interesting point about race

In the Incivek advance trial for tx naives the success rates for whites was 75% and blacks 61%

This was doing the prescribed protocol as we have said above .
There is no data on whether blacks will have an overall better outcome if tx is extended ,however as candohas said this may be the doctors reasoning

With no data avail if this will be better for you against the risk of taking strong medications.I really can't say

Will

[can-do-man]

I think maybe I know why your Doctor is thinking a longer treatment, from your profile your African-American right? They have a much lower SVR rate when treating HCV. Given that maybe a little insurance so I really couldn't say whether I agree or not with that.

[orphanedhawk]

I think you need to ask your doctor why he wants you to treat longer than is the norm.
Seeing that you are at stage 1 fibrosis, and were und at 4 weeks this makes no sense.

You are doing this treatment, not your doctor and you deserve answers. Your doctor may have a good reason for telling you this but you deserve to know them.
We have to be our own advocates for our health.

Let us know what your doctor tell you.

Good luck.

[can-do-man]

Seems very strange to me also. Besides that not sure why a total of 36 weeks as its either 24 or 48 with Incivek... BTW, welcome here, would like to know your Doctors reason.

[Idyllic]

Yolie based on everything you said I am afraid your doctor's rationale escapes me. The treatment rules of duration can be complicated but it sounds like you have a very good understanding of them as well as your own medical condition. I would never encourage someone to not treat the way their doctor indicates so I hope someone else chimes in and offers their take on things.

Would you say your doctor (a GI?) treats a fair amount of folks with Hepatitis C?

So far it looks like you are treating four weeks longer than the Incivek rules outline. I mean you are a first timer, eRVR and no cirrhosis. I think I would need to hear something a little more solid or medically reasonable other than your doctor changed his mind.

Until then I hope others weigh in with their insight and experience. You are right your Hgb is pretty good. I am glad for that. Hang in there and be sure to check back!

[willbb]

Dosing Forms & Strengths


tablet
•375mg


Chronic Hepatitis C

Indicated for treatment of chronic hepatitis C (CHC) genotype 1 infection in combination with peginterferon alfa and ribavirin

Indication is specifically for adults with compensated liver disease, including cirrhosis, who are treatment-naïve or who have been previously treated with interferon-based treatment, including prior null responders, partial responders, and relapsers

750 mg PO TID (ie, q7-9hr) with food (not low fat)

Administer for 12 weeks in combination with peginterferon alfa and ribavirin (telaprevir must not be used as monotherapy)


Treatment Duration

Duration of treatment depends on HCV-RNA levels

Triple therapy: telaprevir, peginterferon alfa, and ribavirin

Dual therapy: peginterferon alfa and ribavirin


Treatment-naïve and prior relapse patients
•HCV-RNA levels undetectable at weeks 4 and 12: Administer triple therapy first 12 weeks, then dual therapy an additional 12 weeks
•HCV-RNA levels detectable at weeks 4 and 12 (ie, 1000 IU/mL at treatment weeks 4 or 12, OR
•HCV-RNA levels detectable at treatment week 24

[yolie71]

fibrosis stage is 1 and geno type 1a I will post labs next time I get them done. Doc is seeing me every 4 weeks now I get labs done 2 weeks before appt. Completed Incivick in May now on Rib and Peg till the end of tx. I was supposed to due 24 weeks since UND at weeks 4 and 12, but doc wants to to 24 weeks post Incivick. If I not mistaken it was 12.7. Doc said bloodwork is looking good numbers are starting to go up. But I will post my next labs thank you

[yolie71]

The protocol was to do 24 weeks total since I was UND at week 4 & 12 then he changed his mind and wanted me to do 24 weeks post Incivick which I finished in May. I'm still taking Peg and Rib doc said another 7 weeks of tx. I do not have cirrhosis and a geno type 1a. I have to do labs and will post next labs. I've come along way and thats another problem don't want to be on meds longer than I have too.

[willbb]

The protocol is to do 24 weeks total   (12 of the triple meds ) and another 12 of just PEG/RIBA if one is UND at week 4 &12 and does not have cirrhosis

If you doctor is not following drug prescribing protocol .. you need to question why.
These meds should never be taken longer than necessary

Good luck and welcome to the group

[Idyllic]

Hey Yolie! (Cool name by way!!)

if I am understanding you accurately you are treatment naive and you were UND at week 4. That means you were eRVR and the prognosis is actually supposed to be very good.

Based on much of what you said you would treat for 24 weeks but since you are on week 28 I must be missing something.

Are you a Genotype 1a or 1b?

What stage of fibrosis are you?

Why does your doctor want you to treat 48 weeks.

You have really come a long way and to not need rescue meds! How do you know you don't need them? Do you receive copies of your labs? Do you happen to know what your Hgb is?

I know this treatment is very harsh and you are really hanging in there. It would be great if you could post more info. Not just so we can see if you are treating the right length of time but to see if you are getting all the necessary medical interventions. I just mean every doctor has different ideas of when to intervene and I would hate if this were harder on you than it needs to be - especially if it does turn out that 48 weeks is the right treatment duration.

You have my utmost respect for making is this far!
_________________--
:
#1 "eRVR is used to determine treatment duration in appropriate patients."

#2 A 24-week total treatment duration did not compromise SVR in treatment-naïve patients with eRVR in the ILLUMINATE trial.

#3 Treatment-naïve patients with cirrhosis who have eRVR may benefit from a total treatment duration of 48 weeks

http://www.incivek.com/hcp/extended-rapid-virologic-response-ervr