Only a 1.25 log drop after 4 weeks doesn't look good for SVR

[nelson958]

So  what should I do, try and get into  a prove trial, or what? I'm feeling pretty bummed out now so any thoughts would be appreciated.

[Terrylee8]

Hi, I too was slow at week 4, but then it really started to fall and I cleared at week 8, so don't lose hope.

[nelson958]

My doc is  a gastro, but  supposedly the  top Hep C in the area. I'm gonna  try  and  keep positive (major struggle  right  now)  and hope  and pray as I  await the  12 week test  and results. Thank you so much for your kind  thoughts and prayers.

[ladywhy]

as you are in mine. Is your doc a Hepatologist? Explore all your options. At one appt., he and I talked about switching from Pegasys to Pegintron? Don't give up hope, my friend
Thank you for your prayers...that really is the best thing we can do for one another.
Yvonne

[nelson958]

I'm gonna ask about increasing my riba.  Thanks lady, you're in my prayers.

[ladywhy]

My 4 wk PCR drop was 1.33 or something like that...12 week went 1.5. I upped my riba from 1000 mg. to 1400mg @ 11 wks...hoping that might help with the PCR. I think I did it a little too late in the "game." My doc was on vacation so..i went ahead w/o authorization. After PCR...I dropped down to 1200 mg. Then when doc returned..I asked him if I could do 1200 mg. He gave the ok. Before the end of that appt., I asked could I go up to 1400mg. He then looked @ my HGB...and gave the ok for that..so that's where I'm at. The reason I went to such extremes was my ins. would not treat without a 2 log. drop @ 12 wk. PCR. Due to a screwup with my previous dr., I did not have a PCR done before tx. Insurance was going by a little over a year old PCR. That was my loophole. Ins. approved an extra month for the injectible (I already maxed out prescription plan on the riba) and now I wait 'til the 23rd of this mo., for the PCR. I'm praying for that 2 log drop. Talk to your dr. about the possibility of upping the dosage? don't give up....believe me I know it's tuff...but if I can do it...so can you.

In no way am I endorsing changin' dosage of meds w/o dr.'s apprroval. I was desperate..and it could have been dangerous...thankfully..i haven't had any fainting spells or whatnot. Dizzy, yea..but nothin new there. :)

[CockSparrow]

The hepatitisandmore link is in German all I understood was the graphs.
Seems like a good site pity i cant read it.

nelson958
There are studies that indicate that Pegasys doest have the anti viral effect of PegIntron in the early weeks of Tx. The good bit is that it catches up by week 8.

CS

[jmjm530]

In general, they like to see at least a one-log drop the first month, and you've got that.

That said, it's a complex question and a lot has to do with your genotype, viral response from here on out, amount of liver damage and other factors.

Ideally, at this point you would test viral load weekly until non-detectible -- or at a minimum try and get a week 8 test in addition to the usual 12 week.

All the best,

-- Jim  

[nelson958]

Thanks zazza, really appreciate the kind words.

[zazza]

Way to go, Nelson! Your dosing of both interferon and ribavirin is weight based, which is good. Your ribavirin dose is 15.7 mg/kg, which is also good. A talk with the doctor at your next appointment seems reasonable to me. Remember that all that is required at 12 weeks is a 2 log drop, even if we do strive for UND. Please keep us informed on your progress with beating this virus!

[nelson958]

I weigh 168 lbs, and am taking 1200 mg ribivirin (3 200mgs twice  a day) and one injection of 180 interferon per week. My next Dr. appointment is  August 3, at which time my 12 week lab results will be available. I may ask to increase dosage if not good results then.

[zazza]

One effect of viral load tests showing your progress during treatment is that it makes you have to face reality. Your reality is that you are responding, you are responding slowly but you still have a chance at SVR, but if you stop treatment now you KNOW that you will not get cured. I have seen people respond slowly, and then suddenly make faster progress. You need to go to week 12 and see what your reality is. If you quit now, you will not know.

What doses of ribavirin and interferon are you on now? May I ask what your weight is? It is good to have a ribavirin dose of 13-15 mg/kilo. (1 kilo = 2.2 pounds. So take your weight in pounds and divide it by 2.2. That is your weight in kilos. Then divide the dose you are taking by your weight in kilos.)

Discuss with your doctor if you may raise your ribavirin dose. That is the recommendation I have heard of in cases like yours. Here is a link from the German magazine "Hepatitis & More" for hepatologists. In the middle of the last page is a chart which suggests a new consensus for treatment regime of geno 1. You can show it to your doctor, it is by the famous hepatologist Thomas Berg who has done studies about extended treatment. Notice that it says "RBV-Dosis up if detectable at > or = 10 IU/ml at week 4".

http://www.hepatitisandmore.de/archiv/2006-2/HEPandMORE_2006_2_S12_S13_S14_S15_S16.pdf

You have this one body. It responds slowly to SOC. Talk to your doctor and see if you can be proactive. Continue until the week 12 test and see what that result will tell you. You have a more than 1 log drop at week 4, which qualifies you to continue. You can do it! Don't give up now, that would mean you would lose valuable information about how you respond to treatment!

[zazza]

Oh, and prove trials, a fact to realize is that to get into a prove trial, you need to be either treatment naive or a relapser/non-responder. Right now you are neither, since you are responding to treatment. So keep going, and find out what category you belong to: sustained viral response - relapser - non-responder.

Best wishes,
Zazza

[CockSparrow]

Having the 4 week PCR test is a good thing. Yes you are responding a little slowly but because you know this you can try and do something about it. IF you can hit EVR and be clear you have an excellent chance at SRV. I missed my chance.
Your options to consider are taking the INF every 4 or 5 days depending which one you are taking. Increasing the amount of INF 270ug/360ug if on Pegasys, taking PegIntron twice a week or double dosing with the other Peg molecule.

There is plenty of evidence that increased INF doses increase EVR rates, so dont be disheartened you still have options. I would also get an 8 week PCR test to monitor whether changing the dose/schedule is having the desired effect. You can then use the 12 week test as the decision point to continue or lengthen Tx

Wishing you SVR
CS

[HappyDeb]

Yes, hang in there you just might have to extend your tx. I am getting my 4 week on Tues. July 17th and I can't lie I am alittle nervous too, but I will deal with anything they tell me but one thing I refuse to do is give up !!!! I made the decision to do this treatment and damn if I am not going to follow through. For me I am not a quitter. I will go beyond the call of duty to get to SVR. Or scream and kick getting dragged out of the Doctors LOL !! I AM VERY PASSIONATE ABOUT THIS FIGHT AS YOU SEE. I hope you are just as passionate about SVR, too. Wishing you all goodness and keep your gloves on.


                                                      :) Debbie

[jools57]

iam so sorry you are feeling bummed, hang in there, ...my doctor told me the 12 week test was the most important one...i'm a geno 3 and had a 2 log drop at week 4, so am considered a slow responder, and may have to extend treatment, or up dosage, tho i am doing weight based everything...so i would continue treatment...alot depends on genotype, and what your doc says...wishing you the best...and i hope you feel better...

[desrt]

Stay on treatment and see what your 12 week test is. The 4 week test is an useful tool for making tx decisions, but is not an absolute determinant of SVR.