Aa
Not clear on svr percentages?????
Am I getting this right? What I think I am finding is that around 35% of geno 1 attain svr and 33% of those relaspe after treatment is complete. If this is so, in the spirit of Borat I say "WHAT, thats not good for me!"
if I was a hard to treat subject, I would concentrate on non SOC results, since the SOC most likely fail me.
valtod, what happened to the 44 who they were not followed? if you look at the bottom of the graph ie 21/46, 28/48, etc. the denominators all add up to 187 in the 72 wk follow up, but only 143 were followed, where did they place those 44 who were not followed up?
Cuteus, about the numbers in the diagram above:
First disregard columns C and D (which are not SOC), and take the numbers only from columns A and B (which are SOC with Pegasys 180 um/wk).
Start of Tx total patients in A and B: 46 + 47 = 93
End of Tx responders in A and B: 21 + 27 = 48
SVR at 72 wk in A and B: 13 + 15 = 28
ETR (End-of-Tx Responders) = 48/93 = 51%
SVR of ETR = 28/48 = 58%
Hence, the Relapse Ratio =100% - 58% = 42%
I hope the numbers now make sense...
Also, as I wrote in
http://www.medhelp.org/forums/Hepatitis/messages/44014.html
Almost every 4th of these difficult to Tx patients (24%) falls in a subgroup of even MORE difficult to Tx.
These are the Delayed Responders DVR (Delayed Viral Response) with > 2 log drop at 12 wk and UND at 24 wk.
And ultimately only 13% of the final SVR group is actually from the DVR group. Let's call them DSVR.
http://www.natap.org/2006/images/110606/Figure3-4.gif
DSVR = 13% * SVR = 13% * 28
DVR = 24% * ETR = 24% * 48
Then the percentage of Delayed Responders who achieve SVR is DSVR/DVR = 31%.
Hence, the Relapse Ratio of Delayed Responders is 69%!
Much worse than 42% for the average difficult-to-cure group.
All this is for 48 weeks standard treatment. That's why it seems the Delayed Responders MUST treat for 72 weeks just to bring their chances back to the level of the rest of the group.
First disregard columns C and D (which are not SOC), and take the numbers only from columns A and B (which are SOC with Pegasys 180 um/wk).
Start of Tx total patients in A and B: 46 + 47 = 93
End of Tx responders in A and B: 21 + 27 = 48
SVR at 72 wk in A and B: 13 + 15 = 28
ETR (End-of-Tx Responders) = 48/93 = 51%
SVR of ETR = 28/48 = 58%
Hence, the Relapse Ratio =100% - 58% = 42%
I hope the numbers now make sense...
Also, as I wrote in
http://www.medhelp.org/forums/Hepatitis/messages/44014.html
Almost every 4th of these difficult to Tx patients (24%) falls in a subgroup of even MORE difficult to Tx.
These are the Delayed Responders DVR (Delayed Viral Response) with > 2 log drop at 12 wk and UND at 24 wk.
And ultimately only 13% of the final SVR group is actually from the DVR group. Let's call them DSVR.
http://www.natap.org/2006/images/110606/Figure3-4.gif
DSVR = 13% * SVR = 13% * 28
DVR = 24% * ETR = 24% * 48
Then the percentage of Delayed Responders who achieve SVR is DSVR/DVR = 31%.
Hence, the Relapse Ratio of Delayed Responders is 69%!
Much worse than 42% for the average difficult-to-cure group.
All this is for 48 weeks standard treatment. That's why it seems the Delayed Responders MUST treat for 72 weeks just to bring their chances back to the level of the rest of the group.
Ya might take a look at this. The only place I,ve found with a near 50% eot srv hivandhepatitis.com/2005icr/aasld/docs/111605_u.html
there are several studies out there, with either pegasys or pegintron that state those percentages. the 30% stated above is for hard to treat population, those that would have been in the relapsing group. You have to do your own search, with several variations of your search phrase, i would try vivisimo.com because they cluster the results of your search for you.
if you do the model to predict outcome of tx, that I gave you above, you can get an approximation of the outcome in your case.
some good websites to search;
natap.org
hcvadvocate
if you do the model to predict outcome of tx, that I gave you above, you can get an approximation of the outcome in your case.
some good websites to search;
natap.org
hcvadvocate
Here's some info. on interferon and histological improvement
http://www.medscape.com/viewarticle/407951_7
http://www.medscape.com/viewarticle/407951_7
From surfing around I am finding around 30% svr when all is said and done. Anyone have any hard numbers on fibrosis improvement with treatment? trials? studies? That info would surely come to play when trying to make an informed decision. I am also getting wind that there are some alternative treatments that can really help with fibrosis. HR eluded as much, the problem is seperating fact from fiction. Is'nt liver damage the real issue. Our guts are full of creepy crawlies, who cares if they are not causing seriuos injury. If my liver was healthy I could give a rats butt about how many villians were floating around in me. Alas, that is not the case.
Of course the odds have validity. If the odds of success weren't good enough these drugs wouldn't even be allowed on the market.
For discussions sake, if a stage 3 had only one chance out of ten thousand for success with the current drugs, would any doctor risk their patient's exposure to those drugs?
So somewhere between one chance out of ten thousand and one chance out of _____, different people will make the treat or not to treat decision. But the odds still are there and any responsible doctor will take them into consideration when advising a patient to treat, not to treat, to extend, not to extend.
-- Jim
For discussions sake, if a stage 3 had only one chance out of ten thousand for success with the current drugs, would any doctor risk their patient's exposure to those drugs?
So somewhere between one chance out of ten thousand and one chance out of _____, different people will make the treat or not to treat decision. But the odds still are there and any responsible doctor will take them into consideration when advising a patient to treat, not to treat, to extend, not to extend.
-- Jim
I'm trying to figure out what is it you are trying to say? That people shouldn't treat because the odds aren't great? Or that they should? Thanks for the great chart, by the way.
There are those of us who have no problem worrying about the odds at all "deciding" to treat. There is no option if your damage has progressed. If you don't try to treat it and at least suppress the virus even if you can't SVR then you will just progressively get sicker. It seems many lose sight of the fact that there is more than ONE goal of treatment, SVR is just one goal. Suppression of the virus and improving liver histology are a few more positive reasons to treat. MKAndrew is a perfect example. He has not been successful in achieving SVR yet he has reversed his liver damage from a stage 3/early cirrhosis diagnosis prior to several times treating to his current stage 1. That shows the dramatic positive effect treatment can have even if you can't manage to eliminate the virus, so his treatment(s) ARE successful in spite of not reaching the ultimate goal of treatment he has resurrected his liver in a MAJOR way. e also used a lot of "outside the box" additions to his treatment so who's to say what was responsible for his dramatic improvement. All the positive aspects of treating should be considered as well as the negatives that happen to a small percentage of treaters. The focus seems to be on the negatives of treatment here, but there are a host of positives for those of us with substantial liver damage. Sometimes you can "win" even if you don't reach your ultimate goal.
The luxury of worrying about the odds seems to me to be for those who haven't had the virus cause major damage to their livers already or those that are already ill from the virus.
The "watch and wait" people will NOT avoid taking IFN and Riba should some of the "pipeline" drugs actually come to fruition, they will just be adding yet another drug to the regimen.
It won't be cheaper or easier if they wait. If anything it will be more difficult and more expensive to wait and we do not know if the odds will improve. Maybe they will, maybe not.
I wish more was being done to add Alinia to the current med regimen. It is FDA approved already, has little to no negative side effects and is readily available. It also has shown very dramatic ability to kill the Hep C virus in research. That would add another med to the antiviral "cocktail" for current treaters and is very likely to improve the odds of success. I am adding it for the last 3 months of tx, but in order to do that I have to acquire it from another country, even though it is available here because it is considered "off label" to use it for Hep C patients. Hopefully the Romark trials will help to have Alinia added to the current SOC and insurance companies will cover it.
I agree with the poster who said not enough is done on the part of the doctors to "think outside the box" when it comes to difficult to treat patients. It seems they try tx, then when it fails they just throw up their hands and give up on the patient rather than examining the various options and treatment tweaks that could help the patient kick the virus. Then the patient is left to try to find a doctor who will work with the patient and manipulate the protocols for possible success.
Insurance companies who refuse to allow their patients to retreat obviously aren't cognizant of the fact that that patient is likely to continue to be sicker and sicker therefore costing even more than the cost of retreating. It makes no sense to me.
There are those of us who have no problem worrying about the odds at all "deciding" to treat. There is no option if your damage has progressed. If you don't try to treat it and at least suppress the virus even if you can't SVR then you will just progressively get sicker. It seems many lose sight of the fact that there is more than ONE goal of treatment, SVR is just one goal. Suppression of the virus and improving liver histology are a few more positive reasons to treat. MKAndrew is a perfect example. He has not been successful in achieving SVR yet he has reversed his liver damage from a stage 3/early cirrhosis diagnosis prior to several times treating to his current stage 1. That shows the dramatic positive effect treatment can have even if you can't manage to eliminate the virus, so his treatment(s) ARE successful in spite of not reaching the ultimate goal of treatment he has resurrected his liver in a MAJOR way. e also used a lot of "outside the box" additions to his treatment so who's to say what was responsible for his dramatic improvement. All the positive aspects of treating should be considered as well as the negatives that happen to a small percentage of treaters. The focus seems to be on the negatives of treatment here, but there are a host of positives for those of us with substantial liver damage. Sometimes you can "win" even if you don't reach your ultimate goal.
The luxury of worrying about the odds seems to me to be for those who haven't had the virus cause major damage to their livers already or those that are already ill from the virus.
The "watch and wait" people will NOT avoid taking IFN and Riba should some of the "pipeline" drugs actually come to fruition, they will just be adding yet another drug to the regimen.
It won't be cheaper or easier if they wait. If anything it will be more difficult and more expensive to wait and we do not know if the odds will improve. Maybe they will, maybe not.
I wish more was being done to add Alinia to the current med regimen. It is FDA approved already, has little to no negative side effects and is readily available. It also has shown very dramatic ability to kill the Hep C virus in research. That would add another med to the antiviral "cocktail" for current treaters and is very likely to improve the odds of success. I am adding it for the last 3 months of tx, but in order to do that I have to acquire it from another country, even though it is available here because it is considered "off label" to use it for Hep C patients. Hopefully the Romark trials will help to have Alinia added to the current SOC and insurance companies will cover it.
I agree with the poster who said not enough is done on the part of the doctors to "think outside the box" when it comes to difficult to treat patients. It seems they try tx, then when it fails they just throw up their hands and give up on the patient rather than examining the various options and treatment tweaks that could help the patient kick the virus. Then the patient is left to try to find a doctor who will work with the patient and manipulate the protocols for possible success.
Insurance companies who refuse to allow their patients to retreat obviously aren't cognizant of the fact that that patient is likely to continue to be sicker and sicker therefore costing even more than the cost of retreating. It makes no sense to me.
the numbers at the bottom of the graph, 21/46 is that the number of subjects or the percentage? I can't read the fine print and if it is numbers it does not add up.
the numbers don't make sense. starting number was 188 subjects, they were only able to follow 143, so how is it that the total in fig 3 is 187? It says that one person did not take the meds so that would be 187. What criteria did they use to place the other 44 people that were not followed?
cuteus, 58% of EoTR achieve SVR rate. But EoTR (End-of-Tx-Response) is around 50% for this group. So real SVR is 29%.
Keep in mind, that relapse ratio is usually defined as SVR to EoTR, not SVR to Baseline Group. That's why I gave 42% relapse ratio, meaning that 42% of those who are UND at end of Tx will eventually relapse. And that only 29% of those who started 48 weeks earlier will achieve ultimately SVR.
And, Jim, yes, you are right, SVR rate is around 30%.
Keep in mind, that relapse ratio is usually defined as SVR to EoTR, not SVR to Baseline Group. That's why I gave 42% relapse ratio, meaning that 42% of those who are UND at end of Tx will eventually relapse. And that only 29% of those who started 48 weeks earlier will achieve ultimately SVR.
And, Jim, yes, you are right, SVR rate is around 30%.
These kind of odds are not looking so good. The cost of treatment is huge in $$$ and life. I haven't had a bx yet but am hoping my liver is in decent enough shape to wait awhile. thanks guys, jm
"...For 'difficult-to-cure' patients: genotype 1, high initial viral load > 1 million, overweight > 200 lb
Standard treatment: Pegasys (180 ug/week) + RBV (1,200-1,600 mg/day) for 48 weeks
End of treatment response (UND): around 50%; around 40% of THOSE relapse..."
-----------------
I think this means the SVR rate is 30%. (relapse rate is 40% of 50% or 20%/ 50% -20% = 30% SVR)
Standard treatment: Pegasys (180 ug/week) + RBV (1,200-1,600 mg/day) for 48 weeks
End of treatment response (UND): around 50%; around 40% of THOSE relapse..."
-----------------
I think this means the SVR rate is 30%. (relapse rate is 40% of 50% or 20%/ 50% -20% = 30% SVR)
For 'difficult-to-cure' patients: genotype 1, high initial viral load > 1 million, overweight > 200 lb
Standard treatment: Pegasys (180 ug/week) + RBV (1,200-1,600 mg/day) for 48 weeks
End of treatment response (UND): around 50%; around 40% of THOSE relapse
See http://www.natap.org/2006/AASLD/AASLD_43.htm
<IMG SRC="http://www.natap.org/2006/images/110706/figure3ViroRes-4.gif">
Standard treatment: Pegasys (180 ug/week) + RBV (1,200-1,600 mg/day) for 48 weeks
End of treatment response (UND): around 50%; around 40% of THOSE relapse
See http://www.natap.org/2006/AASLD/AASLD_43.htm
<IMG SRC="http://www.natap.org/2006/images/110706/figure3ViroRes-4.gif">
Cool chart! But does that include only those that made it 48 weeks, or does that not include them?
Goof; Love those stats, but that would mean only 10% relapse? It would seem to be more. I know we talked about improved chances of SVR as each UND happens...at 12, 24, 36 weeks. It would be curious if the data about not dropping out, VL breakthrough, non responder, etc were not put into the equation.
Goof; Love those stats, but that would mean only 10% relapse? It would seem to be more. I know we talked about improved chances of SVR as each UND happens...at 12, 24, 36 weeks. It would be curious if the data about not dropping out, VL breakthrough, non responder, etc were not put into the equation.
right, and it means a 58% SVR rate, correct?
as stated by the chart in the above mentioned site
http://www.hepctherapy.com/images/hcp/fibrosis_genotype1.jpg
as stated by the chart in the above mentioned site
http://www.hepctherapy.com/images/hcp/fibrosis_genotype1.jpg
As you can see, there are 48 people on standard treatment (groups A and B), who are UND at end of treatment. 28 of those remain SVR. So 20 out of 48 relapse!
This is almost 42% relapse ratio in 'difficult-to-cure' patients (G1, VL >1 mil, BMI >30).
This is almost 42% relapse ratio in 'difficult-to-cure' patients (G1, VL >1 mil, BMI >30).
I love your probabilities of SVR. Someone always has to be in that 50% either way, huh?
goofydad: This has been rehashed over and over, but probabilities are just that... probabilities. Say the likelyhood of an event is 99%, and you find the 1% exception. That doesn't in any way invalidate the initial projection.
---------------------------------
The probablity of getting agreement here on the above is less than 1%
---------------------------------
The probablity of getting agreement here on the above is less than 1%
This has been rehashed over and over, but probabilities are just that... probabilities. Say the likelyhood of an event is 99%, and you find the 1% exception. That doesn't in any way invalidate the initial projection. Only by evaluating the lieklyhood of success can one make any type of informed decision about whether to treat, whether to discontinue, or whatever. To discount that tool seems pretty foolish to me.
Just think, I was the right geno, EVR, female, had a load of only 300000 or so, and didn't make it.
And on the other end you got New Sojourn, end stage liver disease, given 3 weeks to live, also type 2, and she makes it, on the old Intron.
So much for predictions.
You don't really want to be in the "bitterness" club :)...how about another consultation with an expert?
Now don't jump up and down my throat,I know you go to big shots, just a suggestion, just a suggestion.
Ina
And on the other end you got New Sojourn, end stage liver disease, given 3 weeks to live, also type 2, and she makes it, on the old Intron.
So much for predictions.
You don't really want to be in the "bitterness" club :)...how about another consultation with an expert?
Now don't jump up and down my throat,I know you go to big shots, just a suggestion, just a suggestion.
Ina
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