Is it a FACT that the protocol in Europe has been changed?

Does anyone KNOW if G1s, with low starting V/L, RVRs are being treated for only 24 months??
March 6th, 2007

PEGASYS(R) Gets European Approval for a Shorter Treatment Duration for Some Genotype 1 and 4 Hepatitis C Patients who Show a Rapid Response to Therapy
http://www.prnewswire.co.uk

- Shorter, Simplified Treatment Option May Encourage More Patients to Seek Treatment

Some hepatitis C patients with difficult-to-treat HCV genotype 1 who respond quickly to treatment with a combination of PEGASYS(R) (pegylated interferon alfa-2a (40KD)) plus COPEGUS(R) (ribavirin) can benefit from a shorter and simplified course of therapy, following Thursday's Commission decision. With the new approval, a subset of patients with genotypes 1 and 4 HCV who achieve rapid viral response can now receive a shortened, 24-week duration of treatment with Roche's PEGASYS plus COPEGUS. This is half the normal treatment duration.

Shorter, Simplified Treatment Shows Excellent Chance for a Cure
The EU approval is based on data from two pivotal clinical trials for PEGASYS plus COPEGUS.(1,2) Results from these trials show that among patients who achieved a rapid viral response (undetectable viral load at week 4) in the first month of treatment up to 93 per cent of patients with genotype 1 HCV with a low pre-treatment viral load and 83 per cent of patients with genotype 4 were cured following only 24 weeks of therapy - a similar cure rate to that seen following 48 weeks of therapy.(3)

"This is excellent news for patients with hepatitis C," said Dr Peter Ferenci, Professor of the Department of Internal Medicine IV, Gastroenterology and Hepatology, at the University of Vienna, Austria. "This means that patients can find out within one month of starting therapy if they have an excellent chance of being cured and can benefit from a shortened treatment duration. This is likely to encourage patients to seek treatment and motivate them to stay on therapy."

New Recommendations for Treatment
A shorter, 24-week course with PEGASYS plus COPEGUS is now an option for the following patients:(4)

Genotype 1 HCV with a low pre-treatment viral load (defined as <800,000 IU/mL) and an undetectable viral load at weeks 4 and 24;
Genotype 4 HCV regardless of pre-treatment viral load and an undetectable viral load at weeks 4 and 24.
"This licence change reflects Roche's commitment to finding better treatment solutions for patients with HCV by improving treatment with existing therapies and developing new medicines to treat hepatitis C," said Claire Steers, PEGASYS Lifecycle Leader at Roche in Basel, Switzerland. "Roche is committed to finding solutions for a broad range of hepatitis C patients by continuing to simplify treatment with PEGASYS."
Clinic of Internal Medicine II, Department of Medicine, Saarland University Hospital, Kirrbergerstrasse, 66421 Homburg/Saar, Germany. [e-mail]
BACKGROUND/AIMS: Previous studies using standard interferon and ribavirin combination therapy suggested that patients infected with HCV-1 and a low pretreatment HCV-RNA level can be treated for 24 weeks without compromising sustained virologic response rates. The aim of the present study was to investigate this schedule in the era of pegylated interferon-alpha plus ribavirin. METHODS: Patients chronically infected with HCV-1 (n=235) and a screening viremia < or =600,000 IU/mL (real-time PCR) were treated with peginterferon alfa-2b 1.5 microg/kg subcutaneously once weekly plus ribavirin 800-1400 mg/day based on body weight for 24 weeks. RESULTS: End-of-treatment and sustained virologic response rates were 80 and 50%, respectively. The 48-week historical control (Manns et al., Lancet 2001;358:958-65) had similar end-of-treatment (74%) but higher sustained virologic response rates (71%). This difference was due to a high virologic relapse rate after 24 weeks of therapy (37%) compared with the historical control (4%). A subset of patients who had undetectable serum HCV-RNA at treatment week 4, however, achieved similar sustained virologic response rate (89%) as in the control group (85%). CONCLUSIONS: HCV-1 infected patients with a low baseline HCV-RNA concentration who become HCV-RNA negative at week 4 may be treated for 24 weeks without compromising sustained virologic response rates.

[zazza]

I live in Sweden and I was told that the protocol had changed in Europe for low viral load when I started tx in November 2006. I was enrolled in a study that was to verify that 24 weeks was enough for low viral load - below 600'000 IU/ml - and RVR. I did however not reach RVR so I was taken out of the study. They told me the study was a formality that was required. It had already been decided that this was the protocol for Europe.

[nygirl7]

The 48-week historical control (Manns et al., Lancet 2001;358:958-65) had similar end-of-treatment (74%) but higher sustained virologic response rates (71%). This difference was due to a high virologic relapse rate after 24 weeks of therapy (37%) compared with the historical control (4%).

it's all about SVR - not how quickly we can finish treatment.  

I wouldn't have considered it in a million years - but thats just me. I wanted to make sure I got every single one of those suckers outta me and never had to do this again!

[orleans]

So you are saying that they are shortening treatment to 24 weeks for RVR/low V/L EVEN THOUGH the relaspe rate is nearly 10 times as high? That doesn't make much sense. jerry

[zazza]

"RESULTS: End-of-treatment and sustained virologic response rates were 80 and 50%, respectively. The 48-week historical control (Manns et al., Lancet 2001;358:958-65) had similar end-of-treatment (74%) but higher sustained virologic response rates (71%). This difference was due to a high virologic relapse rate after 24 weeks of therapy (37%) compared with the historical control (4%). A subset of patients who had undetectable serum HCV-RNA at treatment week 4, however, achieved similar sustained virologic response rate (89%) as in the control group (85%)."

Let's look at what the above excerpt really says for the group with low viral load and RVR:
SVR with 24 weeks: 89%
SVR with 48 weeks:85%

I take it to be that the "high virologic relapse rate after 24 weeks of therapy" is for those not RVR.

I remember studying a paper when I was being enrolled for the 24 week study. (Unfortunately I cannot find it today. It is here somewhere.:)) This paper compared the low viral load patients in Mann's 48 week historical control with low viral load patients in a more recent 24 week study. There was no difference in SVR rates for the patients with low viral load and RVR whether they went 24 or 48 weeks. That is why I decided to go with this protocol. And for those who know me from the forum, you already know that I would never go with less than I thought necessary for the best possible chance of SVR.

Notice the conclusions in the excerpt (my capitals):
"CONCLUSIONS: HCV-1 infected patients with a low baseline HCV-RNA concentration who become HCV-RNA negative at week 4 may be treated for 24 weeks WITHOUT COMPROMISING sustained virologic response rates."

[orleans]

Thanks for the clairification. That is the way I was reading it also. How VERY TEMPTING!! My starting v/l(G1a) was 283,000. I was UND at 13 DAYS <10. I did the sensitive test at 6 weeks and was UND < 2. This treatment is KICKING my BUTT. The rash is intoleratable, joint pain, total fatigue, running at about 10-20% I wonder why there isn't more talk of this. I know the drug companies gain nothing from shortened treatment, but to cut this hell in half sounds like heaven to me! jerry

[jmjm530]

This is nothing new and has been referenced for some time. Part of the reason you haven't heard more is because most here had pre-treatment viral loads >600,000 IU/ml. Given your symptons -- if you don't have signficant liver damage (stage 3 or above) I would seriously consider the 24-week shorter course. Of course check with your doc, but if you're not seeing a liver specialist (hepatologist) then they probably will not be sophisticated enough to analyze the studies. In that case you might want to get a second consult from a hepatologist. Of interest -- to the best of my recollection we have had around a dozen geno 2's and 3's who have taken the shorter course (12 or 16 weeks) and one or two geno 1's. As far as I can remember all ended up SVR. This is not surprising since they all were RVR and I believe the geno 1's, at least, had a low starting viral load.

-- Jim

[zazza]

UND at 13 days! I like that! And this is with regular SOC?

[nygirl7]

IF you are one of the people that relapse........you're gonna wish you never took the chance and always wonder if the reason was the shorter duration.

I can't fathom how one study can say going longer is good and one study can say going shorter is good.  Too many unknowns to me (which is why I chose to extend to 72 (started with a low VL, had EVR at week 4 but no UND until after week 12).  It only seems LOGICAL to me that the more chance to clear all virus and the more time to train the immune system the higher the chance of SVR you have.

Until they come out with a test that would detect ANY VL left it you entire body - I just can't buy it a bit.

I'll shut up but until they do more studies to prove this information - I don't think it is worth taking the chance.


So glad I'm SVR and don't have to worry about it ever again.

[zazza]

I would say that there is probably no more reason for you to go more than 24 weeks than for a geno 2 or 3 who is RVR. As long as you don't have significant liver damage that is.

[jmjm530]

NY: I can't fathom how one study can say going longer is good and one study can say going shorter is good.
------------------
It's really the same concept. Both studies use viral response to determine treatment length. To over simplify -- if you RVR then treat for 24. If you are detectible at 12, then extend to 72. If inbetween, then treat for 48.

As far as "F you are one of the people that relapse........you're gonna wish you never took the chance and always wonder if the reason was the shorter duration" --

let's turn that around. How would you feel in the face of these studies,  if you treated for 48 weeks and developed permanent autoimmune issues in the second 24 weeks?

It's a gamble with risks and rewards. And in weighing the risks and rewards you have to factor in the potential damage of longer exposure to interferon and ribavirin.

-- Jim

[zazza]

There are always some people who fall in between. If everybody went 72 weeks instead of 48 I am certain more people would be cured. Still that is not recommended. The question is if Orleans thinks the very small chance that he is one that would benefit from 48 weeks instead of 24 is worth it. A chance so small it does not show in the statistics.

[zazza]

This is what is called individualizing tx according to tx response, right?

[jmjm530]

Zazza: If everybody went 72 weeks instead of 48 I am certain more people would be cured.
------------
Excellent point. And if everyone went 2 (or 3 years) I'm sure even incrementally more would be cured. And if everyone double dosed and did High Dose ribavirin, perhaps even some more.

The question you raise of course, is at what cost? At what cost to body, mind, career, family, friends, etc, etc, etc.

24 is no more a magical number than 48 or 72. These are just consensus numbers that have come out of study data to help guide us how long to treat weighing the risks versus rewards.

To discount 24 weeks because we might have a slightly better chance at 48 weeks is like discounting 72 weeks because you might have a slightly better chance with 3 years.

Sometimes people here state they will try for SVR "at all costs". I don't think this is wise or even that the people saying this understand what "all costs" can really mean. Of course, if you're late stage 3 or stage 4, then pushing the envelope makes more sense to me. But stage 1 or 2? At that stage I'd be looking hard at the potential damage of prolonged drug exposure.

-- Jim

[jmjm530]

Z: This is what is called individualizing tx according to tx response, right?
---------
Yes, and your friend "Berg" writes about this a lot.

[orleans]

Damage is an issue, I am stage 3. Zazza, I added Alinia to SOC off label, 28 day pre-dose, 500m x 2daily. I was considering some form of comprimise, maybe reducing ribe after 24 weeks, may doing 36 weeks like the G4 Alinia trials then maybe tapering. Tough decide. If I were having less trouble or even more trouble it would be clearer what to do. Thanks for the help guys( and gals!) jerry ps this is not the ONLY study that finds no benifit in going 48 weeks for this subset of G1s

[zazza]

Stage 3 - that does make it a harder decision. What Berg says is: viral load below 400'000 IU/ml and no cirrhosis and RVR <10 IU/ml - 24 weeks tx.

I am not into compromises though, especially not lowering ribavirin or tapering. My opinion is go full dosed weeks or quit. OK, 36 weeks is a thought.

I guess if you want to play it safe with your stage 3, 48 weeks it is. (Although stage 3 is not cirrhosis.) And your week 2 RVR is beautiful - that is what you want!

[jmjm530]

I would then look for any available study breakdown by stage. Also, the Alinia is a monkey wrench of sorts. Adding it all together I would then be more reluctant to shorten treatment as opposed to if I were stage 1 or 2 and made RVR without Alinia. That said, a sophisticated hepatologist would be useful for more input and that's what I would seek before making a final decision. Your profile says "3/1" which I read to be grade 3, stage 1, but it's been awhile since I've looked at my biopsy reports and perhaps yours is noted differently.

-- Jim

[sunspot]

I was a low VL 620,000 But my stoneage Dr only did the first PCR at 12 weeks and the test he ordered only checked down to 615 units. I might have been able to stop at 24 weeks but that's now in the past.

[alagirl]

I completely agree with the shortened protocol using the SOC for those who have a low starting vl and rvr, however, GOOD FRIGGING LUCK getting your American doc to let you try it out.  

Maybe if you are at a liver center with a good hepatologist they would be amenable.

[zazza]

Well, nobody can force you to continue beyond 24 weeks, can they?

[jmjm530]

Zazza: Well, nobody can force you to continue beyond 24 weeks, can they?
-----------
What about "NYGirl" :)

[zazza]

Lol!

[orleans]

life and very dirty death decisions, bummer! OK, let's approach this from another direction. Let's say someone with a RVR does stop at 24 weeks and DOES relaspe, Did that person lose thier chance of RVR the next time around? Are the relasping viron resistant and will they then set up shop like is expected with the vx-950/ no RIBA arm? Jim? Anybody, Lord I wish HR was around to chime in on this thread. jerry ps blood today, tanking WBC1.1, ANC .4, HMG 12.1 YUK, more drugs to the cocktail I fear.  













o

[alagirl]

Its true.  This is just my own personal hang up and has to do with my own treatment when I wasn't brave enough to buck my gastro who wouldn't let me stop at 12 weeks and I had to get a hepatologist at UAB to sign off on my stopping tx, and didn't get in to see him until a little after 24 weeks, or six months, or something like that.  I was a 1b, but I was an acute, hence I should have been able to stop at 12 weeks.

I guess I was worried about them screwing up my insurance further down the road if I didn't follow medical advice, or, God forbid if I had been one of the small fraction of acutes who don't achieve SVR, that they wouldn't let me treat again.  

If I had it to do over I would have stopped at 12 weeks anyway.  I got twice as much interferon (and one whole hell of a lot more ribavirin and blood transfusions) as I needed as it turned out and I should have been more brave about the whole situation.  God knows I worried enough people with my obsessive machinations about whether and when at the time.

[zazza]

"Let's say someone with a RVR does stop at 24 weeks and DOES relaspe, Did that person lose thier chance of RVR the next time around? Are the relasping viron resistant and will they then set up shop like is expected with the vx-950/ no RIBA arm?"

I would not worry that a failed SOC would have any impact at all on the next tx. We do not get resistant to interferon and ribavirin since they are not working directly against the virus. Interferon boosts our immune system. If you would relapse this tx, you would have the same chance with telaprevir as if you had never tx'ed before. This is my take on this issue.

I will say it again, that week 2 RVR is just lovely. I think it gives you an even higher odds of success than a week 4 RVR. I have seen a study for geno 3 doing 24 weeks which implies this.

[IAmTheWalrus]

Any shortening of TX that does not compromise odds of SRV is a great thing. There's the rub, though. Exactly how many tenths of a percentage point in SVR odds balance a tenth of a percent in odds of permanent autoimmune effects? I don't even know how to begin that calculation.

Being UND at 2 weeks is a fabulous thing. In the vein of "individualizing tx according to tx response" wouldn't you already have an extra 2 weeks of treatment since you were UND at 2 weeks rather than 4 weeks? Plus, your response was quicker than the standard 4 weeks. The rate of early response always seems to be a very important factor in SVR in many study treatments, from 12 week treatments to 84 week treatments.

It seems pretty safe to me to say that you could have a shorter TX than the standard 48 weeks with the same SVR odds. But how much shorter and at what, if any reduction in odds of SVR? Is there any hard data that defines this? Maybe someone else has got the answer. How about posting this to Dr. D?

Just some thoughts. I'd love to be making that decision with a 2 week RVR, though!

[zazza]

That geno 3 study I mentioned looked at the entire group that was RVR by week 4. They divided them into those RVR already week 2 and those not RVR until week 4. Most of the relapsers were in the group not RVR until week 4.

Comeagain and I discussed this study thoroughly. It made us think that an RVR week 2 is what you really want. Generally these people are not separated from those not RVR until week 4.

How come you were lucky enough to get such an early viral load test?

[orleans]

The old fashioned way, I paid for it. Plastic can be a wonderful thing! jerry

[zazza]

LOL! That's a good one!

My thinking is that since you are not stage 4, RVR week 2 trumps stage 3. But don't blame me, if I am wrong. :)

[FormerLoser]

Hi,

Well I am in Italy (even though this trial is thanks to the americans who furnish the drugs....) and doing a TAILORED THERAPY trial. I am type 1 and had RVR at 13 days and shall continue 80 PegIntron and 800 Rebetol and SHALL stop at 16 weeks which is part of the trial (they multiply by 8 depending on when you are UND)......

Hope it never comes back.... I shall keep you all updated.....

Best of luck to you all.


(P.S. my viral load for 15 years was always low and at treatment was around 200,000 which is why I think I was accepted to do this trial.....)

[Bali05]

my current vl is only 46k iu/ml naive geno 4a,c
all this talk about RVR , 24wk tx ,SVR starting to get me thinking......
hmmmmmmmmmmmmmm

[Rockerforlife]

RVR TRUMPS EVERYHING...ITS THE MAIN CARD TO POUND ON THE TABLE.IF YOU HOLD THIS SVR CARD...YOU WIN

[jusjames]

dont be fooled by low vl,
i know someone who started with 350,000 and after four weeks their VL was 300,000 ! they must carry on to 12 weeks even though it looks pointless  

[newleaf09]

Geno 1, Stage 4 and URVR; I was UD on the one week PCR.  TX for 28 wks and now SVR.  Unfortunately you can't go by me, because 3 weeks after I went UD, boceprevir was added for 24 weeks.  I don't think my cirrhosis can be taken into account (for thumbing the nose at tradition) because it was caused by NSAID overuse, not Hep C virus.  It's all a good prognosticator for me but not much bearing on the prognosis of others, since my stage 4 was unusual and the addition of the PI guaranteed the outcome.

I am still a proponent for others to use response guided therapy (tailored) and think shorter TX is a good risk if it can reduce the odds of taking on damage from interferon.  I find the numbers 24 & 48 pretty arbitrary and would rather see them guide the length of therapy by, say, 'continue at full meds for 20 weeks past UD'.

[jusjames]

'continue at full meds for 20 weeks past UD'.

so if you were G1 and went und at wk 24 would you stop at 44 wk?

[Trinity4]

Could you please provide a study or backup documentation that shows cirrhosis in someone who has had hepc for 30 plus years as you indicate was the direct result of NSAID over usage?  Was the pathologist able to look at the slides and differentiate between the type of fibrosis produced by NSAID and that of hepc?  I can see where inflammation may be increased due to NSAID, but fibrosis naturally occurs in all patients do with hepc.  You had only one biopsy so do you know what the stage of your liver was 3 years ago or 5 years ago?  You have also stated you used alcohol  as well.   I have heard you say this over and over about NSAID's causing your cirrhosis and no one else on this forum has ever made that claim so I would like to understand the justification behind your statement.
Standard protocol for slow responders is 36 wks past UND, not 20 wks.  And you are correct, treatment duration can't be based on your experience because you part of the PI protocol.
Trinity

[mikesimon]

You said:

"I find the numbers 24 & 48 pretty arbitrary and would rather see them guide the length of therapy by, say, 'continue at full meds for 20 weeks past UD'. "

I find that not only arbitrary but, worse, unsupported by any studies that I have seen. If you can direct me to any support for your "opinion" I would appreciate it.

Again & again I ask myself - where do you come up with this stuff?

Mike

[Bali05]

you are right about trying to find a US hepatologist custom tailoring tx.

Geno 4 in particular has been shown in some studies to be easier than 1

and in some just the same as 1 . Bottomline nobody really knows how long

Geno 4 should tx even with RVR. There is a study that shows only more severe

sx between 36wk and 48wk and same SVR.

Almost all of the shorter tx studies are foreign !

If I were to start tx with Alinia today they tell me to go 48wks regardless.

Sure , there is a saying in Germany "operation is a success , patient is dead"

in other words SVR at any price. In my opinion this is wrong ! SVR should be

attempted with tx only if drugs are tolerated well. But this is not the case.

The only way my hep dr. would agree to 36wks is if I had RVR and could not

tolerate drugs.

Well I am beginning to think , maybe I should try SOC just for 4 weeks.

If UND continue to 12 wks than 24wks , than 36wks BUT ONLY if tx is tolerated

well. I have a very low viral load so if it is not moving early on chances are

high for being a slow or non responder and if that is the case I need to wait

for PI like so many current non responders are doing anyway.

[nygirl7]

Well I am beginning to think , maybe I should try SOC just for 4 weeks. If UND continue to 12 wks than 24wks , than 36wks BUT ONLY if tx is tolerated "

There are a lot of folks who were not UND at week 4 who successfully obtained SVR.  The goal of treatment is to cure the disease not see how quickly you can stop treatment.  Customizing treatment doesn't mean just invent it as you go.  There are fact based studies that determine these things (ie: Berg Study, Sanchez Tapias).  You can't just arbitarily say Oh I was UND at week 6.5 I think I'll go to week 40.2. Well I guess you could but it would be foolish - they do study these things for a good reason, to give us the best chance at success that we can get!

[jusjames]

yes NYgirl but as Bali says some studies are foreign so they must be wrong!, much better to listen to people here!!!!!!!!!!!!!!!! yes just get und then tx a few more weeks , drift along see how you get on

[newleaf09]

What on earth are you talking about?  The word 'arbitrary' means at individual discretiuon, capricious or more or less pulled out of a hat.  Do you honestly believe that the 24 and 48 week guidelines are set in stone?  They are guidelines, not laws.  Someone had to spit out some numbers and they picked those because the researchers are unclear about exactly how much longer it takes to clear the virus from the rest of the body after clearing it from the blood.  Are you saying that if someone gets too sick at 40 weeks and discontinues that there is no way for that patient to SVR?  Get real; individual viral response is not guided by laws.  Do you need the links to all the studies that indicate that geno 1's who clear in 4 weeks may stop after another 20 weeks and SVR?  I've got them around here somewhere.

[nygirl7]

Scary scary stuff that folks believe they are smarter than the Jacobson's of the world. When I went I wanted to do 60 weeks. Two separate doctors told me "no we adhere to studies that have proven results you do 48 or extend 72".  It was at that exact time the forum found out about Sanchez Tapias - we hadn't access to it but Dr. J. did and shared it with me.  Now IJ is no little fish and I'd think that since the rest of the doctors at the top of the heap agree with him - who am I as a patient to disagree?

Nobody on a hep internet forum has more knowledge or education than the brightest men in the hep medical field.  Best to listen to them. A few small studies here and there do not a smart move make.

[Bali05]

I am aware of the studies out there here is one:

In patients chronically infected with hepatitis C virus (HCV) genotype 4, the optimum duration of therapy and the predictors of sustained virologic response (SVR) have not been adequately determined. In this study, 358 patients with chronic hepatitis C genotype 4 were randomly assigned to pegylated interferon (PEG-IFN) alpha-2b (1.5 mug/kg/week) plus oral ribavirin (10.6 mg/kg/day) for a fixed duration of 48 weeks (control group, n = 50) or for a variable duration (n = 318). In the variable-duration group, patients with undetectable HCV RNA at week 4 were treated for 24 weeks (group A, n = 69), patients with undetectable HCV RNA at week 12 were treated for 36 weeks (group B, n = 79), and the rest of the patients were treated for 48 weeks (group C, n = 160). The primary endpoint was SVR (undetectable HCV RNA 24 weeks after treatment cessation). Groups A-C and the control group had SVR rates of 86%, 76%, 56%, and 58%, respectively. After the study was controlled for predictors, a low baseline histologic grade and stage were associated with SVR (P < 0.029) in all groups. In addition, among patients in group C, older age (P = 0.04), a higher baseline body mass index (P = 0.013), and low baseline HCV RNA (P < 0.001) were also associated with SVR attainment. The incidence of adverse events and the rate of discontinuation were higher in patients in the variable-duration and fixed-duration groups treated for 48 weeks. Conclusion: In patients with chronic hepatitis C genotype 4 and undetectable HCV RNA at weeks 4 and 12, treatment with PEG-IFN alpha-2b and ribavirin for 24 weeks and 36 weeks, respectively, is sufficient.

PMID: 17943989 [PubMed - indexed for MEDLINE]


It is my believe that the patient should come first not the virus !

[jusjames]

bali you changed your tune i told you that you could do 24 wks you said no no not possible, now you believe it!!!!!!!!!!!!!!!!!!make up your mind please

[mikesimon]

Well, I guess your reading ability can't be questioned.
So, what are you talking about?
I never said nor implied nor suggested any of that.
Where do you come up with this stuff anyway?
Mike

[nygirl7]

the optimum duration of therapy and the predictors of sustained virologic response (SVR) have not been adequately determined."

To me it seems the smartest thing to do is err on the side of caution.  Of course you can do 12 weeks if you think that will work.  I know of a few folks that needed to quit due to medical issues and made it.  But I also know a lot of folks who followed the letter of the law and did all they could who relapsed.

It just depends on how many times you want to take the chance on doing treatment and failing. Of COURSE if someone is too ill to continue that is a different story-nobodys is stupid enough to say anything other.

[Bali05]

Not changing my tune , jusjames.

It is the Hepatologists who say no no not possible

I read all these studies months ago.

I am also on Nitazoxanide. It is the hepatologists I have a lack of

trust in and it is tough to decide to go into possible brain fog when

you don`t trust your doctors no matter what their titles may be.

[jusjames]

if the heptologist are saying, no no no why do i know someone who did 24 wks
why are you posting studies saying 24 wks is ok?????????, i tried to put you in touch with them and you thanked me by reporting cos i made a light joke, i dont understand you !!!!!!!!!!!

[nygirl7]

you don`t trust your doctors no matter what their titles may be. "

Bail we are not talking about regular old run of the mill hep docs we are talking the most experienced, cutting edge, knowledgable,  brilliant men in the field.

[Trinity4]

I'm thinking this conversation may be an exercise in futility.

[Bali05]

OK , than

When I asked Jacobson`s people what the success rate with Alinia + SOC + geno 4

was , guess what they copied and pasted the Romark trial in the email to me.

When I asked them if they ever treated any geno 4 with Alinia + SOC

They answered yes.

When I wanted to know what the success rate of that was

No more response !

Hmmmmmmmmmmm

[jusjames]

i 2nd that Trinity,
it astounds me!
student one day teacher the next

[Bali05]

how do I get in touch  with the geno 4s you know that are doing 24wks ?

I think I had tried but was not able to.

[nygirl7]

When I wanted to know what the success rate of that was No more response !
"

That is probably because most of us have to pay for a consult and didn't try to get that much free information out of them because they can only guess at things until they know your personal medical history.  No doctor would be wise to guess at things without running a history first it would be irresponsible.

If you are only looking to do 24 weeks without caring about the rate of success then good luck.  I don't think there is anything further that anyone can say to convince you that geno 4 is most often treated like geno 1 for a REASON.  And the reason has nothing to do with guessing or trying to get out of the full course,  it's because it is what is best of success.

NYgirl agrees with Trin and James.  Unfortunately I'm tired of banging my head on a wall.

[Poobah_Johnny]

Amen Sister!

You people are arguing based on your personal opinions.
NYGIRL, you state yourself that you were dictating your own extended treatment.

I just failed treatment at Mt. Sinai in NYC, under the direction of Dr. Dietrich and Fierer.
The preferred treatment protocol is 24 weeks.