Monotherapy 'non responders'

I am curious on this, reading other's tx's here.

We know that a non reponder with Peg, Riba must extend, harder to achieve SVR, etc. but when one is noted as a non responder with monotherapy, is it, should it really be considered non responder?  Being it's a different tx, and was usually not very successful. Not too sure I'd do 72 weeks due to that. Would the possibility of built resistance to interferon apply here?

LL

[Kristina538]

If a person didn't respond to mono, they are less likely to respond to peg.  I think this is mainly to do with a person's body chemistry than resistance to interferon because of doing 2 tx's.

While I was called a 'non-responder' to mono, my specialist told me last week (when I showed him my 1994 bloodwork),  that while I didn't hit UND in 1994, I did actually respond with all my other bloodwork (ALT/AST etc which were as good as what Zazza has achieved of late :-) and that 12 months of tx on mono should've cleared me (they only did 6 months tx in those days), and I therefore, should correctly be categorised as a 'relapser' to mono.    

Being a 'relapser' gave me a much higher chance of responding to the Peg/Riba tx this time.   Two months after the end mono my ALT/AST shot off the roof when the virus reattacked my system then stabilised back to a high normal.    

So, I don't think you build up resistance;  but your historic status statistically  counts as to whether the current treatment will be successful  (I think they were treating me as a 'non-responder' because I didn't get UND in 1994 which is why they didn't expect me to get RVR - but now, despite not getting UND in 1994, I'm told I responded well but didn't get long enough).  

Not responding to mono once makes you predisposed to not responding again.

Responding and relapsing after Mono is not seen as such a biggie, because mono was such a tepid tx anyway.   As you said, not many people achieved SVR in those days.

[HCA]

Was you first treatment peg or the old intron A?
If the latter virtually no-one responded to mono therapy particularly geno 1 patients.
There is not much evidence for inbuilt resistance to interferon.Many clear at their second or third attempts..
I think you should consider yourself a naive treater and go for it.

[moahunter]

I didn't respond to monotherapy - although during the acute stage (Pegasys). My doctors decided to wait 1 month (to ensure inital hit of drug strong), then to start combination therapy with Pegetron. It worked. While that's a bit different (i.e. during acute stage), I don't think a failure to respond to mono precludes a succesful combination treatment. You will have a good idea about 4 weeks in anyway, as to how it is going.

[moahunter]

PS. further to that - in saying I did not respond - my viral load did come down significantly under mono- but not a 2 log drop. My doctors were wise enough to stop treatment right away (I was annoyed at the time, but appreciate the decision they made now).

[alagirl]

moahunter - I always wondered, why did they put you ON monotherapy to begin with?  Was it because you were an acute and they thought it would be sufficient?

[moahunter]

There is a European study that suggests that monotherapy is very succesful for acutes - the results were better than combination therapy. However, the number of patients was very small, only about 44. I was told I am the second case in my city, where an acute  failed monotherapy, and then cleared with combination therapy. After me, I understand that the protocol has changed here (I don't think due to me). It always seemed illogical to do mono instead of combination, but it seems it is debated. If I had done combination staight off the bat, maybe I would have just needed 24 weeks as a 1A with acute, with RVR and low viral load. As it was, I ended up doing 12 of mono, then 48 of combo (doctors thought 48 best bet, as I had failed mono).

[alagirl]

I was told I am the second case in my city, where an acute  failed monotherapy, and then cleared with combination therapy.
------------------------------------------------------------------------------------------------
At least they've HAD other acutes there.  With me they were completely clueless.

Yeah, I read that study you're talking about, I was wondering if that's the reason they did it.  UAB's protocol is 12 weeks combination therapy for acutes.  Unfortunately I didn't get to the folks at UAB until I'd completed more than six months.  But anyway...

[moahunter]

"At least they've HAD other acutes there.  With me they were completely clueless. "
I guess that it is very hard to do research on acutes (unless researchers were to intentionally infect peope - which probably wouldn't go over to well). We pop up once in a blue moon in any given city, but will always be the exception not the norm. For this reason, I hope they are tracking tthe results of those of us who are treated.

[Lady Lauri]

HCA....I already treated and cleared (6mth labs next week). I was Geno 2b, 24 wks.
I was curious on this reading others tx issues. Thanks for the input, will help another in that scenerio.

Thanks for all input :)  I have wondered on this before as Kristina said, it's such a tepid tx compare to. I also am confused why they do monotherapy at all, even acute, as they odd's are better with combination tx. (as in your case Moa)  and the European study was pretty small to 'prove' that theory. I'll assume to lesson the drugs damage on the body, etc.

Kristina, you did 12 mths. ? mono? How was that tx, as far as sides, tolerated? Just curious.

LL

[Kristina538]

In 1994 I did 6 months monotherapy (I believe it was either "Riferon" or "IntronA").  Compared to this tx it was a breeze.  Well, not exactly a breeze, but no riba to contend with and a healthier liver 14 years ago.   I was told that given my response, I would've cleared in 12 months, but they didn't have a budget for 12 months tx then.

Since then, I've had to wait until 'significant progress' on a biopsy to be eligible for peg - that time has well and truly come!!!

The 1994 mono was 3 weekly injections and the sx's came on a couple of hours after, tx'd with panadol (tylenol) - had no insomnia, no speediness.  My platelets took 5 months to drop to  what they have dropped in 2 weeks on peg which I initially found terrifying - but, I'm sure that may be the state of health more than the type of tx, and I'm still managing at week 6!!!!   I did get very dry itchy eyes, and had some back and leg pain (apart from the flu-like shivers which were occasional and contained to a couple of hours after the shot - didn't last long).  I did sleep a lot and felt dehydrated.   I didn't know to drink lots of water; there wasn't a lot of support.  It took at least 3 months to recover.

There are 2 tx's being offered here - the peg once a week injection (plus riba) and the interferon 3 x a week injection (plus riba).  I'm not sure of the criteria - I think for harder to treat cases, they go with the peg.   I know all the studies point to the efficacy of riba, but I wonder if there are cases where riba doesn't need to be used at all.  If I would've responded to 12 months mono without Riba, it would make sense to do 12 months mono without riba.  mmmmm  :-) - perhaps that's how they treat the actute cases??

[comeagain]

Do you have your platelets nr from 1994 before you started the mono.

I wonder because as you know we have almust the exact same nr today and I´m suspisios at my bx result because of my platelets nr.

ca

[Kristina538]

I sent you these via a message but bloods in 1994 (baseline) hovered between 188 and 244.  They slowly dropped to 148 in week 12 and then came back up again.

Platelets this time around went from 188/ 140 / 127 over four weeks (its my neuts WBC and hgb I'm more interested in!!!!)