Not clear on svr percentages?????

[orleans]

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!"

[Moniker]

I always thought that the odds were better than what you're saying. I figured that my odds were about 40% when I started tx, and that my odds were maybe 70% at week 12 when PCR indicated undetectable.

I was genotype 1A. I treated for 48 weeks with Pegasys and Ribavirin. PCR <50 showed undetectable at week 12, again at week 24, and at one week post tx. Now, six months after tx, PCR still indicates undetectable.

Treatment works for a lot of genotype 1 people. You could try treatment for 12 weeks and see how it's going, or if your liver is not too bad now, you could wait and see what new treatments comes along. There's no need to rush into anything.

Bob

[cuteus]

where did you read those percentages?  make sure that what you read is recent material and that the medications used are the new SOC, meaning pegylated INF and Ribabvirin.   if you are reading studies prior to 2003, the numbers might be outdated.  The svr rate for geno 1 with current tx is 50 to 57%.

[orleans]

It was somewhere on Janis. So, 50 to57%? Does that number include relaspers? Where can I find that.

[mremeet]

cuteus - Where did you see that recent type 1 stats are 50%-57% for SVR? Not trying to quibble with you, I've just never seen them reported quite that high. Usually I see ~40%-50% with current SOC.

orleans - From what I've seen the odds are about 40-50% on average if you're taking weight based riba and full doses of peg IFN (unless what cuteus has stated above is more current than what I've heard). Those are the general odds, but really the odds are dependent on indivualized parameters. People are less likely to respond/SVR if they have a high BMI (i.e. they're overweight), older (~45+), have significant/extensive fibrosis or cirrhosis, have a high starting VL, and have genotype 1 (compared to geno 2,3). 1b's are somewhat harder to treat than 1a's.

[cuteus]

those numbers are sustained viral responders, relapsers are not SVR.
if you do a web search for SVR rates for geno one, or something like that you should come up with quite a few hits.  SVRs are people without detectable hcv in their blood, relapsers have hcv in their blood, you don't count them in SVRs.
50% is out of 100%. some simple math. 50 get SVR, 50 relapse.
here is one result you might encounter when you search:
http://www.hepctherapy.com/hcp/early-treatment-hepatitis-c.aspx

[cuteus]

You must have just posted as I was hitting the post comment button.  that link takes you to one site with that percentage.  just as you stated that some negatives reduce the odds, there are positive predictors that increase the odds, such as mild damage.
take care

I know, it is Roche's site, but they can't pull numbers out of thin air...right?

[GoofyDad]

I belive that if it's 50/50 (close enough for discussion) most of the 50 who don't SVR will be fall out before end of prescribed treatment. I've tried to generate some discussion on this before -- with no real interest.

Maybe something like this:

50: SVR
15: Forced to quit due to bad reactions
20: Non-responders/no 2 log drop
05: Voluntary drops
10: Relapse
---
100

I know there are some pre-treatment folks trying to weigh odds right now. It would be helpful to get some discussion going about SVR rates, relapse rates, position preference (ooops wrong forum), fallout rates, etc.

[ladybug52]

I like how you broke those numbers down. It reminds me of how I invest in my 401K. Only my choices are more random because I don't have the 50% given when I start.

[returntosender]

When I finished treatment and got my three month Heptimax I was told my odds of SVR were 96%.  I relapsed 3 months later.  My real odds - 0%.  If I had one thing to do over on my last treatment, I would ignore the odds altogether and try not to get my hopes up.  I realize that the odds are helpful to keep going but boy is it rough to allow yourself to start feeling confident only to have those hopes dashed.  Remember, even with the best odds, unless it is 100%, that there is always a chance you will end up on the wrong end of the bet.

[Eisbein]

Ignore the odds and just treat or don't treat...my take too, but still a good idea trying to shift the odds in ones favor.

I tx in 2001 and relapsed. The odds were 80% in my favor, LOL according to studies.
It made relapse that much harder to swallow, after all, I had this most favorable genotype 2a.
The thought that tx could fail me was only a blip on the horizon.
It took me a year and Lexapro to overcome the disappointment.
Second time around I moved heaven and earth to put myself on the right side of the equation, knowing full well, that being type 2 was not enough to send me on the SVR road.

Ina

[Eisbein]

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

[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. 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.

[jmjm530]

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%

[sfbaygirl]

I love your probabilities of SVR. Someone always has to be in that 50% either way, huh?

[Valtod]

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">

[sfbaygirl]

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.

[cuteus]

so now you got the svr rates for the hard to cure and the easy to cure.

[Valtod]

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).

[cuteus]

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

[cuteus]

orleans, 58% hard to cure patients get SVR, I think those are excellent odds.

[jmjm530]

"...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)

[orleans]

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

[Valtod]

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%.

[cuteus]

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.