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Recommendations for increasing possibility of SVR before Incivek?
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Recommendations for increasing possibility of SVR before Incivek?

Hi, I am a 60 years old woman infected with HCV genotype 2b. I took Ribavirin and Interferon for 6 months. I was able to achieve a non-detectable result very fast, but fail to sustain it after the therapy was over.  
I want to try the Incivek therapy, but I want to help the meds as much as I can. I read that people that weigh more than 75 Kg have a higher relapse rate so I began working out to lose weight.

Is there anything else I can do? Maybe take vitamins or eat something that can help?

I am worried because there is almost no information on Incivek results on genotype 2b, they only focus on genotype 1b.

thanks!
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317787_tn?1373214989
Hello, if you are being put on the Incivek, you have a really good chance of SVR.  It sounds like you responded to the first tx but like me realpsed.
I finished the Incivek Peg Riba 6 months ago and am SVR
During my first tx I read that controlling sugar levels was very important, then after finishing this last tx, I read that B12 may help
It was a coincidence however I was taking B12 all through tx due to leg pains.

I wish you the best
Dee
17 Comments Post a Comment
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Avatar_m_tn
Incivek is not approved for geno type 2 as studies shown it was not effective in treating those people... There are other drugs in trials that do look good for type 2......... Best to you
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Avatar_f_tn
You can't take Incivek because it is only for Genotype 1's, but I believe there are trials right now with GS 7977 for 2's.
Advocate1955
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317787_tn?1373214989
Hello, if you are being put on the Incivek, you have a really good chance of SVR.  It sounds like you responded to the first tx but like me realpsed.
I finished the Incivek Peg Riba 6 months ago and am SVR
During my first tx I read that controlling sugar levels was very important, then after finishing this last tx, I read that B12 may help
It was a coincidence however I was taking B12 all through tx due to leg pains.

I wish you the best
Dee
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Avatar_f_tn
Thanks! I will read about GS7977.  Thank you!
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Avatar_f_tn
Hi, thanks for your answer, I know it wasn´t design for genotype 2, but I am 60 years old and I am afraid that if I keep waiting, I won´t have the strength to resist the side effects of such a strong therapy.
Furthermore, I read that it had no effect on genotype 3, but showed improvement against genotype 2.
http://hepatitiscnewdrugs.blogspot.mx/2011/06/telaprevirincivek-isnt-useful-for-all.html



Best to you.
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317787_tn?1373214989
Good luck, let us know how you are doing
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2061362_tn?1353283118
Good luck with trying the triple therapy. I hope it works out. I did a lot of research on this topic before I started tretament. I took vitamin E (mixed tocopherols) and D3, as well as sublingual B complex with high B12 (eventually up to 5000 ug). Some say that the B12 should be in shot form, but not too sure. Always discuss supplements with your Dr. before taking them.
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Avatar_f_tn
Your doctor may be willing to prescribe Incivek or Victrelis but most insurance companies will not pay for a protease inhibitor for genotype 2 & 3 because of the overall unfavorable response in the clinical trials.  The manufacturers of both drugs will only provide the drug for genotype 1 in their compassionate use programs.  Your doctor may be able to pull it off if he's crafty enough.
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Avatar_m_tn
Here is the very latest on HCV Genotype 2 including current treatment and also future therapies..

Good luck ..
Will

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02710.x/full


Recently approved DAA inhibitors of HCV replication are expected to provide a major step forward in the treatment of HCV infection. Several small molecules, mainly inhibitors of HCV NS3/4A protease and NS5B polymerase are in the process of being commercialized in Europe.


Although DAA will improve virological response rates in patients with genotype 1, the development of small molecules effective against HCV genotypes other than one is in earlier stages [23]. Telaprevir, the first agent to directly target viral replication, has been shown to be active against HCV-2, but not against HCV-3. Telaprevir is a powerful oral protease inhibitor [24, 25] that can increase the SVR in genotype 1 HCV by about 30% compared to standard PEG-IFN/RBV. The activity of telaprevir was investigated in patients with HCV-2 and HCV-3 in the C209 study. The combination of telaprevir plus PEG-FN alpha-2a and RBV was evaluated in five patients with HCV-2 and compared to telaprevir alone in nine patients and to PEG-IFN and RBV in an additional nine patients in the control group. The triple combination therapy resulted in SVR rates of 100% which is remarkable considering the 89% rate observed in patients receiving standard PEG-IFN/RBV [26]. Conversely, telaprevir monotherapy had little or no activity in patients infected with HCV-3. In that study, telaprevir was administered as monotherapy or in combination with PEG-IFN for only 2 weeks, while the overall duration of treatment was 24 weeks in each arm. It should be noted that the histological diagnosis of cirrhosis was an exclusion criteria in this study.


Other NS3/4A protease inhibitors, nucleoside and non-nucleoside reverse replicase inhibitors as well as NS5A inhibitors have shown to have antiviral activity against HCV-2. One of the most promising drugs so far is PSI-7977, a nucleotide analogue polymerase inhibitor [27]. In the Proton study, an open label study, the drug was evaluated in 15 patients infected with HCV-2 and in 10 infected with HCV-3 as well as in a larger group of patients with HCV-1 infection [28]. That study, whose results were presented at the last EASL meeting, reported an RVR of 96% after the triple combination of 400 mg of PSI-7977 plus PEG-IFN/RBV. Twenty-four HCV-2 and -3 patients who completed the 12 weeks of treatment achieved SVR (96%). Patients with cirrhosis were excluded. The Electron study, an ongoing study, is currently evaluating this triple combination in an IFN sparing regimen strategy of only 8 weeks of triple combination treatment.
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1986676_tn?1329866071
Ditto:  Incivek is not usually used to treat Genotype 2.

Not sure you would want to try such a difficult tx as an experiment.

Also, doubt insurance would pay. You may end up needing more than
just Incivek while on treatment. It can turn out to be real expensive.

Wish you the very best!!!

Reva
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Avatar_m_tn
Not sure what going 5 for 5 in a trial of naive genotype 2 really means since their SVR rate is so high anyway. My guess is you could go 5 for 5 fairly easy with just SOC..... One would think if they thought there was much promise with type 2 and Incivek they would have included relapsers in one of their trials which would have really shown the difference.
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Avatar_f_tn
Thanks for the info Dawn, I will ask my doctor, but is always good to research a little so I can ask better questions when I see him.

I was really sad when I failed last time with interferon and RBV, so this time I will do my best. I will fight HCV with everything I can (as long as my doctor approves).


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Avatar_f_tn
Hi, thanks for your answer, I want to try Incivek because I already tried RBV and Interferon alone and relapsed.  I know that Incivek has not been proven extensively on genotype 2, but so far test results are positive. Last time I achieved a <50 IU/mL HCV-RNA result in week 4. I have read that is a very good sign that the HCV virus is responsive against interferon and RBV. Therefore, if Incivek helps a little I think SVR would be easy to get.
My sister also has HCV genotype 2, but she was only a partial responder. She has cirrhosis, so our doctor advised her not to wait for GS-7977 or other meds that haven´t been approved yet.
He thinks I could wait, but he recommends me to try the treatment. He is very positive about the outcome.
My insurance won´t pay, I know it will be very expensive, but I can still afford treatment. So that is not a big issue for me.

Best regards,
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3242225_tn?1348340121
Yes, I just finished with 7977 and Riba.  Here is a website for all the studies that are recruiting now: http://www.clinicaltrials.gov/ct2/results?recr=Open&cond=HCV&intr=7977+and+Ribavirin
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3242225_tn?1348340121
I am Genotype 2b.  I just finished a 12 week study of GS7977 and Ribavirin.  I do not yet know the outcome as it is double blind.  Here is a website with all the studies for 7977 and Riba currently recruiting. I sure hope it worked because it is virtually side effect free.
http://www.clinicaltrials.gov/ct2/results?recr=Open&cond=HCV&intr=7977+and+Ribavirin
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Avatar_m_tn
Although the Genotype II clinical trials are still being conducted my Dr. is very excited about the high success rate it has shown with Genotype 2 patients. Genotype two patients historically reponded better to Pegasys and Ribavarin. am genotype two and will begin the triple therapy in October 2013. Even with pending side effects I remain positive & hopeful that this can work. Plus I have a wonderful team of multi background healers that I will be working with throughout. Diet & supplements (the right ones) hopefully can make a big difference. I  am 65 and probably had the disease since the late 60's---late 70's. Good luck to all of you!
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Before i started treatment I was following Devon Nicholson, (Hannibal).  He too had genotype 2, did Interferon Riba, relapsed and did 2 nd treatment with " experimental" Incevick.  He has many videos detailing his treatment process that you might find interesting.  He is post treatment now and so far undetected, but only about 8 weeks.  

Personnaly with genotype 2, and if I did not have any liver damage (don't know about your case) and lived in US of A, I would wait for new therapy to be approved.  As sides with Incevick  can be severe. But I definately understand the need to be rid of this virus!

I take vitamins, B12, injections while on treatment, (1000ml per week) and also vitamin D,  as well Vitamin C.  All approved by doc.  So you should def discuss adding anything to your treatment regimen, with your doc, but would probably be okay to prepare pre-treatment, but still, I recomend discussing with your team.  My doc also recomended tumeric.  

Wishing you the best,
Shyrl
Link to Devon on utube:

http://m.youtube.com/watch?v=2g-u3zhDf1I

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