Only 24 TX??

Why do I see so many that have such extended tx time and my doc only wants to do 24 weeks?  Is this normal?  I am a G1 (not sure subclass as they say they do not subclass up in Canada.....riiight) I have a fairly low Vl of 458000 and i think my ALT? was only 75.....Just Curious :)

[desrt]

If you have little or no damage and you're completely undetectable by a sensitive viral load test on your fourth week of tx, 24 might work.

[Bill1954]

Were you undetectable for virus at the four week juncture? You’re doctor may be using the study by Ferenci ’08:

http://www.hivandhepatitis.com/hep_c/news/2008/101408_b.html

“Based on these findings, the investigators concluded, "This prospective study confirms that a 24-week regimen of peginterferon alfa-2a plus ribavirin 1000-1200 mg/day is appropriate in genotype 1 and 4 patients with a low baseline HCV RNA level who achieve an RVR by week 4 of therapy."

Although I don’t believe this has carried much weight; at least here in the U.S., anyway. I do seem to recall the E.U. might support this though. Maybe one of our EU members will chime in with some thoughts; other than that, I wonder if some miscommunication has occurred somehow? Are you fairly certain your treatment was discussed this way at the beginning, or did this change during the course of Tx?

Take care,

Bill

[lsaldy]

Hey Bill

I am only on week one of tx....second shot on thursday.   I am hoping it is only 24 weeks and hey....if i can clear...all the better....just seems so many are on longer stints......from minute one the specialist said 24 weeks and thought that was normal till now hahahah......well give er a go...the best i can hope for is good numbers at the 4 week mark.

[Bill1954]

I think there very well might have been a misunderstanding then. Although most genotype 1 patients would love to do 24 weeks, the bulk of the study now involves extending treatment. I did 56 weeks, relapsed, and then did 96 weeks. The last one worked, but it took some effort. I’d check back with my doctor if I were you, and ask him what he’s basing your treatment time on; bets are an error was made somewhere along the line, and you’ll treat for 48 weeks minimum.

All the best to you,

Bill

[merryBe]

• 150 of the 516 patients (26%) achieved RVR.

• 143 of the 150 completed 24 weeks of treatment.

• The overall SVR rate in this subgroup was 80.4%:


• 78.8% for genotype 1;
• 86.7% for genotype 4.

• The following factors were predictive of RVR:


• younger age;
• lower body fat;
• low baseline HCV RNA (< 400,000 IU/mL);
• HCV genotype 4 rather than 1.

OK, what that shows is that early responders did ok with 24 in type 1 and 4 genotypes.
what it does not show is how that same subgroup faired at 48 wks,

when you factor in ALL people the average type 1, for instance, only has a success rate of 50%. However that's the average when adding all the old, sick, diebetic (diabetic), NASH, fat, alcohoic, stage 4 liver disease and what nots. In other words its the number inclusive of all the high risk patients as well.
A number I'd want to know was how did that subgroup of young skinny low VL do at 48 wks...better or the same?

also, we don't know your genotype...that has a lot of influence...also, you are only in wk 2??
So how can you be considered an early responder already?
Is the doc psychic or what?
Just wondering how he is deciding your regime when you haven't had 4 wks yet to even confirm an EVR.

It would be great to only do 24 wks if the odds were the same either way, but I'd want a lot more clarification from this guy.
I know they were cutting a lot of type 3's off at 24, and getting far worse results doing that, as type 3 relapsers have attested to in here.

I think what's telling about that research is the way it is introduced..

."beause of the cost" the intro states, in Bill's link.
If it were me, I'd want to know that my chemo therapy was likely to work FIRST and not that "we will settle for 10% less cured if we can cut costs in half."
My fear is, that's exactly the motivator, espeially as the research is coming from a socialized mediine nation where this thinking is the norm not the exception.

mb

[lsaldy]

That is what I was thinking, but I shall certainly advocate on my behalf if it comes to that...and lemme tell ya....they will have to extend if necessary just to SHUT ME UP ahhahhahah....I can be like a pitcull on a raw steak when the odds merit it.  Thank you all for the informative opinions...certainly appreciate it

[newleaf09]

If you are a 1b, that's a low viral load (and also pretty low for a 1a) and your doctor is anticipating for you to clear by week 4, called a rapid viral response (RVR).  24 wks is acceptable for that group (though good that you are in Canada; US docs are pretty cautious about reducing TX time).  If your 4 week PCR does NOT come back undetectable, however, you won't be a safe enough bet to stop in 24 wks. and will need the full 48 wk. TX.

Patients who extend beyond 48 wks. have been slow or late responders, showing that they are not as responsive to interferon and it's increased immunity reaction as would be hoped.   They are extended to increase their chances of killing every infected liver cell and keeping them clear (SVR).

[nygirl7]

I'm really not sure if he remembered correctly that you are a geno 1 because standard of care is 48 weeks for G1 and 24 for G2.  My doc once said "well your a geno 2" and I was like huh what I have Geno1A and Geno1B both. Duh.

It's nice to hope you are clear by week 4 but even here in the states the docs have looked at the study and decided better safe than sorry and stick to 48 weeks pretty firmly. I had a low VL about the same as yours and unfortunately for some of us it turns out to be harder to get rid of then the high VLs.  That's why I had to do 72. I didn't clear until somewhere after 12 but before 72. I got a 4 week VL of 411 but at week 12 it was still 419 - almost exactly the same. Bummer but you know at least I've been SVR for two years and haven't regretted extending at all.

The best chance you have to stay UND and get SVR is the first course of meds so you really DO want to make sure you have every odd on your side you can.

Good luck.

[newleaf09]

I think it's kind of funny (not funny ha-ha) that he assumed 24 wks. without having a clear PCR first.  That's the only thing that can verify a 24 wk TX for a geno 1.  Might be worthwhile to verify everything with him.

[frijole]

I think it would be pretty dicey to do 24 weeks no matter what.  Are you treating under a gastrointerologist or your family physican?  I would seek another opinion and do it before the end of your 24 week time.  Also, it would be important to have a sensitive test at week 4 and I am not sure that you can get a test that reads under 50 in Canada.  As others have said, the standard of care is 48 weeks.

NYgirl - your doctor must have been adding your genotypes together ( 1a + 1b = 2ab)
ha ha -- good thing you are smarter than the average nyer
frjijole

[lsaldy]

again thanks all for the great advise....will keep going after 24 even if it means finding another specialist!!!!