Aa
SVR % rates
I'm sorry for maybe posting a repeat question, but I'm confused.
I have seen many post SVR % rates for geno 1's around 55%. And that is only if clear at 12 weeks, then after 48 weeks about 60%. Some have stated that if clear at 6 months, and at 1 year, SVR% is about 80-90%.
Well yesterday I had this exact discussion in my Dr's office. She told me I was misinformed. She told me that those odds are more likely true about geno 2's, the 90% after tx ended. She states that for geno 1's, even if clear at 6 months after tx, only about 65-70%.. Then if clear at one year, rates are near 70-80% to remain SVR.. She told me that she has had NUMEROUS people obtain SVR, then come back positive after 2 to 3 years.
My response was whether she believed it to be reinfection, or relapse. She told me in 95% of the patients, it was relapse, as it was same geno. Does anyone have any links to show on these higher rates? Actual trials or studies? She also told me about the IDEAL study and how it was going. Still early, but Higher dose Peg is coming on strong. She told me that Pegysus was screening people, and turning away stage 3 and 4 patients to keep numbers up.And that if you did not clear at 12 weeks, tx was ended. That is what she accounts Pegysus higher claims at SVR rates for geno 1's compared to Peg 2b. Anybody else hear this??
I waiting to prove her wrong, as she was amazed at how well I am doing. She must have asked me 3 times if I felt a difference between the meds, and I responded with "Heck Yeah!!!!" She also made it very clear that I was not doing extended tx under her watch.
I have seen many post SVR % rates for geno 1's around 55%. And that is only if clear at 12 weeks, then after 48 weeks about 60%. Some have stated that if clear at 6 months, and at 1 year, SVR% is about 80-90%.
Well yesterday I had this exact discussion in my Dr's office. She told me I was misinformed. She told me that those odds are more likely true about geno 2's, the 90% after tx ended. She states that for geno 1's, even if clear at 6 months after tx, only about 65-70%.. Then if clear at one year, rates are near 70-80% to remain SVR.. She told me that she has had NUMEROUS people obtain SVR, then come back positive after 2 to 3 years.
My response was whether she believed it to be reinfection, or relapse. She told me in 95% of the patients, it was relapse, as it was same geno. Does anyone have any links to show on these higher rates? Actual trials or studies? She also told me about the IDEAL study and how it was going. Still early, but Higher dose Peg is coming on strong. She told me that Pegysus was screening people, and turning away stage 3 and 4 patients to keep numbers up.And that if you did not clear at 12 weeks, tx was ended. That is what she accounts Pegysus higher claims at SVR rates for geno 1's compared to Peg 2b. Anybody else hear this??
I waiting to prove her wrong, as she was amazed at how well I am doing. She must have asked me 3 times if I felt a difference between the meds, and I responded with "Heck Yeah!!!!" She also made it very clear that I was not doing extended tx under her watch.
Thanks for posting those. Like an interferon-laced knucklehead, I never saved those studies I am referring to when I first ran into them about 6-8 months ago. Maybe they'll fall into my lap again at some point.
In the meantime, I did run across this (<a href="http://www.hivandhepatitis.com/2003icr/03_assld/docs/1029/102903_j.html">Age and Adherence Are Significant Predictors of HCV Treatment Success</a> which is interesting to play around with in terms of SVR predictors. Though I'm not sure how applicable it is since they use geno 1 data from two overseas trials and they don't spell out just how much riba was assigned. It certainly does point out how much increasing age is a negative predictor. And how much adherence plays a role.
TnHepGuy
In the meantime, I did run across this (<a href="http://www.hivandhepatitis.com/2003icr/03_assld/docs/1029/102903_j.html">Age and Adherence Are Significant Predictors of HCV Treatment Success</a> which is interesting to play around with in terms of SVR predictors. Though I'm not sure how applicable it is since they use geno 1 data from two overseas trials and they don't spell out just how much riba was assigned. It certainly does point out how much increasing age is a negative predictor. And how much adherence plays a role.
TnHepGuy
chevy: I think I remember someone posting a while back for whom the genotyping test could not distinguish 1 vs 2, and the inability to determine subtype(1a vs 1b ) is pretty common (I'm in that group). The genotype test amplifies a specific fragment of the viral RNA and then runs those fragments through a gel which separates out different sequences based on their weight. The major genotypes (1,2,3,4) correspond to a particular sequence of GCUAs in that fragment, but since rna viruses mutate with such abandon the genotyping can easily get fuzzy. I'll see if I can find anything on what the fraction of tests are ambiguous.
tn : sorry, I'm not sure which studies you're referring to. The original pegasys clinical trial (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12324553">Fried, et al</a>) reported 69% undetectable at EOT for the standard dosage and the pegintron clinical trial (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11583749">Manns, et al</a>) reported 65% but neither of them broke those percentages down by genotype.
tn : sorry, I'm not sure which studies you're referring to. The original pegasys clinical trial (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12324553">Fried, et al</a>) reported 69% undetectable at EOT for the standard dosage and the pegintron clinical trial (<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11583749">Manns, et al</a>) reported 65% but neither of them broke those percentages down by genotype.
Is the doctor in question a Liver Specialist or a regular Doctor. My family doctor was so misinformed, I had to make his education. If she is a Liver Specialist, I really dont undertstand that she seems to be the only one with this opinion.
Good Luck!
Good Luck!
Hey guys, what is your take on the above statement regarding relapse rates after 6 months SVR? I do not know of studies supporting those high relapse rates quoted by Snook_man's doctor, are you aware of any?
I posted a question on the Hepatitis Neighborhood site, which was answered by one of the top experts (doctor). Here is the question and the answer:
Micabo
48 weeks!!! Done today... Geno 1b, viral load of 17,432 at the beginning, undetectable at 12 weeks, now I need to wait... what are my chances of clearing now, still in the 50% range or higher, I was on full treatment the whole time. Thanks!
JorgeLHerreraMD
Your initial viral load was very low (most people have over 500,000 IU at baseline) that is a good sign. If at week 12 you were totally negative (with a qualitative PCR test), then your chances of cure are about 75%. Add to that about 5-10% for having had such a low viral load, and you are looking at an 80%-85% chance of cure! Congratulations! NEXT
Micabo
48 weeks!!! Done today... Geno 1b, viral load of 17,432 at the beginning, undetectable at 12 weeks, now I need to wait... what are my chances of clearing now, still in the 50% range or higher, I was on full treatment the whole time. Thanks!
JorgeLHerreraMD
Your initial viral load was very low (most people have over 500,000 IU at baseline) that is a good sign. If at week 12 you were totally negative (with a qualitative PCR test), then your chances of cure are about 75%. Add to that about 5-10% for having had such a low viral load, and you are looking at an 80%-85% chance of cure! Congratulations! NEXT
honey15637
Here is a study I think you were interested in. Just about done lady and I hope yoou husband has a quick return to self....
<a href="http://clinicaloptions.com/hep/news/news_AASLD2004_126.asp">48 Weeks VS 72 Weeks</a>
http://clinicaloptions.com/hep/news/news_AASLD2004_126.asp
----------------------------------------------------------------
egylated interferons (peginterferon alfa-2a and alfa-2b) remain the backbone of therapy for chronic hepatitis C. When administered in combination with ribavirin, intention-to-treat analyses demonstrate SVR in 54% to 63% of treated patients.[1-3] It has long been recognized that genotype is the predominant pretreatment virologic factor that drives SVR. Genotype 1, present in most patients in the United States, is more resistant to therapy, with uniformly lower rates of SVR than genotypes 2 or 3, regardless of agent. Recent data indicate that treatment can be individualized for patients based upon genotype.[3,4]
Hadziyannis and colleagues[3] reported the results of a randomized trial designed to determine whether subgroups of patients would derive similar benefits from shortened durations of therapy and lower doses of ribavirin, with the aim of reducing exposure to side effects and costs associated with therapy. This randomized, double-blind trial compared SVR rates in patients treated with 1 of 4 regimens:
Peginterferon alfa-2a 180
Here is a study I think you were interested in. Just about done lady and I hope yoou husband has a quick return to self....
<a href="http://clinicaloptions.com/hep/news/news_AASLD2004_126.asp">48 Weeks VS 72 Weeks</a>
http://clinicaloptions.com/hep/news/news_AASLD2004_126.asp
----------------------------------------------------------------
egylated interferons (peginterferon alfa-2a and alfa-2b) remain the backbone of therapy for chronic hepatitis C. When administered in combination with ribavirin, intention-to-treat analyses demonstrate SVR in 54% to 63% of treated patients.[1-3] It has long been recognized that genotype is the predominant pretreatment virologic factor that drives SVR. Genotype 1, present in most patients in the United States, is more resistant to therapy, with uniformly lower rates of SVR than genotypes 2 or 3, regardless of agent. Recent data indicate that treatment can be individualized for patients based upon genotype.[3,4]
Hadziyannis and colleagues[3] reported the results of a randomized trial designed to determine whether subgroups of patients would derive similar benefits from shortened durations of therapy and lower doses of ribavirin, with the aim of reducing exposure to side effects and costs associated with therapy. This randomized, double-blind trial compared SVR rates in patients treated with 1 of 4 regimens:
Peginterferon alfa-2a 180
According to my Doc if your clear at 12 weeks and remain clear to the end you have between a 60 to 75% chance of a SVR depending on liver condition, age, weight, viral load and so on. And over 90% of patients with an ETR will relapse within 3 month of treatment. Less than 5% relapse after SVR within 5 years.
Yes,,,My dr stated that if you make it to 6 month post Nondectable,,,then you are home free. However,,,,while on tx at 3, 6, and then 12 month,,,,if all come back clear,,,,I thought odds were at about 70% for SVR and my dr said yesterday with me being clear all year,,,,Being geno 1,,,I have about 42% SVR chance which really threw me...
I thought that from the initial comment in the thread that we were talking about type 1's that had ALREADY achieved their six month , POST-TX undetectable result, or standard SVR. This is the group that Snook's doctor is saying has a high relapse rate. We are now discussing apples vs. oranges. vs. pears throughout the thread. The original question pertains to : How many Type 1's with 6-month undetectable PCR results (SVR's) will go on to RELAPSE.
DoubleDose
DoubleDose
that high a post svr relapse rate seems far out line with any study I've read. See for example <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15361504"> a recent European follow-up</a> and it's "related articles". The SVR durability reported for peg tx seems even sturdier (<a href="http://www.natap.org/2004/AASLD/aasld_20.htm">see </a>).
Relapse vs. re-infection is pretty hard to distinguish unless you actually sequence the RNA, which never seems to get done outside of research settings. Since about 70% of those infected in the US are 1a, (<a href="http://hcv.lanl.gov/components/hcv-db/new_geography/geography.comp?region=world&form=show">see</a>) getting the same results on a genotype test doesn't do much to disprove re-infection. Perhaps this Dr. has seen more patients in at-risk populations (iv users, prisons, military) and thus has experienced different odds?
Relapse vs. re-infection is pretty hard to distinguish unless you actually sequence the RNA, which never seems to get done outside of research settings. Since about 70% of those infected in the US are 1a, (<a href="http://hcv.lanl.gov/components/hcv-db/new_geography/geography.comp?region=world&form=show">see</a>) getting the same results on a genotype test doesn't do much to disprove re-infection. Perhaps this Dr. has seen more patients in at-risk populations (iv users, prisons, military) and thus has experienced different odds?
my NP will discuss the post tx stats at our next meeting, will let you know what THAT research hospital has found in their practice. what she mentioned briefly, does not support snook's dr.
maybe you misunderstood her, snook?
maybe you misunderstood her, snook?
I sent an e-mail to Dr. Cecil and got the following reply.
My question follows his reply, and I have to add that I got undetctable result one year post treatment, but I asked this question while I was on treatment:
You have about an 80% chance of cure from what you tell me. If you are still undetectable for HCV-RNA 6 months after your last injection the chance of cure is above 99%.
On Sunday, May 18, 2003, at 01:32 AM, Dirac wrote:
Dear Dr. Cecil
I have heard a lot about you and the help you offer to hepatitis C patients.
I discoverd one year ago that I had hepc. I live in Boston where I work. I started treatment
8 months ago, with peg-intron 1.5 and ribavirin 1200.
The lab couldnot determine my genotype twice my doctor told me that is
because your genotype is not 1, 2 or 3 the famous ones in usa and he
decided to go for treatment for one year. My viral load was 1.6 million IU
and my alt was 56 and my ast was 36. I did not have any hepc symptoms.
After 12 weeks, my viral load was <615 and my liver enzymes both are normal
in the low twenties.
I repeated pcr at week # 24 and it came back <615 also.
I still have 4 months to go according to the 48 weeks treatment.
My question is
what is my chance to stay "undetectable" till the end of treatment?
and if I stay "undetectable" till the end of the treatment period what
is my chances of not relapsing after the treatment stops?
Thanks for your time.
My question follows his reply, and I have to add that I got undetctable result one year post treatment, but I asked this question while I was on treatment:
You have about an 80% chance of cure from what you tell me. If you are still undetectable for HCV-RNA 6 months after your last injection the chance of cure is above 99%.
On Sunday, May 18, 2003, at 01:32 AM, Dirac wrote:
Dear Dr. Cecil
I have heard a lot about you and the help you offer to hepatitis C patients.
I discoverd one year ago that I had hepc. I live in Boston where I work. I started treatment
8 months ago, with peg-intron 1.5 and ribavirin 1200.
The lab couldnot determine my genotype twice my doctor told me that is
because your genotype is not 1, 2 or 3 the famous ones in usa and he
decided to go for treatment for one year. My viral load was 1.6 million IU
and my alt was 56 and my ast was 36. I did not have any hepc symptoms.
After 12 weeks, my viral load was <615 and my liver enzymes both are normal
in the low twenties.
I repeated pcr at week # 24 and it came back <615 also.
I still have 4 months to go according to the 48 weeks treatment.
My question is
what is my chance to stay "undetectable" till the end of treatment?
and if I stay "undetectable" till the end of the treatment period what
is my chances of not relapsing after the treatment stops?
Thanks for your time.
I don't have a bunch of time right now, but here is a study showing EOT (End Of Treatment) response rates and SVR rates for geno 2's and 3's <a href="http://www.hivandhepatitis.com/hep_c/news/2004/060404_d.html">Peginterferon Alfa-2b (Peg-Intron) plus Ribavirin Treatment in Previously Untreated Patients Infected with HCV Genotype 2 or 3</a>
from the study:
"<i>The end of treatment (EOT) and sustained virologic response (SVR) was higher in patients infected with HCV-2 (100 and 93%, respectively) than in patients infected with HCV-3 (93 and 79%, respectively)</i>"
So, in this (rather small) study, 100% of geno 2's had EOT and 93% went on to SVR. 93% of geno 3's had EOT and 79% went on to SVR.
Here's another study using the data from Manns that shows a combined SVR rate of 91% for geno 2's and 3's who's bx = level 1 fibrosis:
<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0521/052104_hcv_b.html">Treatment with Peginterferon Alfa-2b (PEG-Intron) Plus Ribavirin Is Cost-effective for Hepatitis C Patients with F1 Fibrosis</a>
from the study:
"<i>Observed sustained viral response rates for peginterferon alfa-2b + ribavirin treatment of F1 were 63% overall, 52% for genotype 1 and 91% for genotype 2/3</i>"
<u>willing</u> - do you still have the two studies handy that showed EOT response rates for geno 1's? One had a rate of 75% the other had a rate of 85%.
TnHepGuy
from the study:
"<i>The end of treatment (EOT) and sustained virologic response (SVR) was higher in patients infected with HCV-2 (100 and 93%, respectively) than in patients infected with HCV-3 (93 and 79%, respectively)</i>"
So, in this (rather small) study, 100% of geno 2's had EOT and 93% went on to SVR. 93% of geno 3's had EOT and 79% went on to SVR.
Here's another study using the data from Manns that shows a combined SVR rate of 91% for geno 2's and 3's who's bx = level 1 fibrosis:
<a href="http://www.hivandhepatitis.com/2004icr/ddw2004/docs/0521/052104_hcv_b.html">Treatment with Peginterferon Alfa-2b (PEG-Intron) Plus Ribavirin Is Cost-effective for Hepatitis C Patients with F1 Fibrosis</a>
from the study:
"<i>Observed sustained viral response rates for peginterferon alfa-2b + ribavirin treatment of F1 were 63% overall, 52% for genotype 1 and 91% for genotype 2/3</i>"
<u>willing</u> - do you still have the two studies handy that showed EOT response rates for geno 1's? One had a rate of 75% the other had a rate of 85%.
TnHepGuy
snook_man
I just read a recently completed study. For Geno-type 1, without Bridging Fibrosis or cirrhosis, 48 weeks gives about a 60-65% chance of SVR....
The 80-90% is for Genotype 2-3's
This study was done using Pegasys and weight based Riba doseing...
More folks will chime in later.
God Bless
TonyZ
I just read a recently completed study. For Geno-type 1, without Bridging Fibrosis or cirrhosis, 48 weeks gives about a 60-65% chance of SVR....
The 80-90% is for Genotype 2-3's
This study was done using Pegasys and weight based Riba doseing...
More folks will chime in later.
God Bless
TonyZ
Almost every study that I am aware of, regarding relapse rates after the undetected six-month PCR (generally considered to be SVR) indicate somewhere around 97% to 99% maintain the SVR longterm.
Also, from personal experience doing large scale trials, and with a large private patient caseload, my doctor has indicated that he has NOT SEEN a case of relapse AFTER the six month undetected PCR, for any genotype, and only a couple after the three month PCR. He has treated many hundreds if not thousands of patients.
Also, check the statistics that Dr. Bennett Cecil provides on his site (the hepatitis doctor) regarding relapse after six months. Looks like his experience shows that over 97% will remain clear for the long term.
Most very large scale retrospective studies bear out the same numbers, and also seem to indicate that after two years of SVR, there are virtually zero relapses.
I am not sure how much hands-on experience your doctor has treating type 1's, or how well documented her relapse statistics are, but I have not heard this sort of information presented to ANY of the HCV conferences, or submitted in article form to any publications. If this is true, than your doctor's experiences with patients flies totally in the face of all the information currently being published, big scale and small.
In this case, I sure hope she DOESN'T know what she is talking about!
DoubleDose
Also, from personal experience doing large scale trials, and with a large private patient caseload, my doctor has indicated that he has NOT SEEN a case of relapse AFTER the six month undetected PCR, for any genotype, and only a couple after the three month PCR. He has treated many hundreds if not thousands of patients.
Also, check the statistics that Dr. Bennett Cecil provides on his site (the hepatitis doctor) regarding relapse after six months. Looks like his experience shows that over 97% will remain clear for the long term.
Most very large scale retrospective studies bear out the same numbers, and also seem to indicate that after two years of SVR, there are virtually zero relapses.
I am not sure how much hands-on experience your doctor has treating type 1's, or how well documented her relapse statistics are, but I have not heard this sort of information presented to ANY of the HCV conferences, or submitted in article form to any publications. If this is true, than your doctor's experiences with patients flies totally in the face of all the information currently being published, big scale and small.
In this case, I sure hope she DOESN'T know what she is talking about!
DoubleDose
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