Shortened tx period may be possible?

[GrandOak]

I found this interesting and thought I'd share.

According to:

A. Mangia (2007)
Short-duration therapy for hepatitis C: suitable for all?
Journal of Viral Hepatitis 14 (4), 221

[GrandOak]

Thanks, the summary looks to be identical and so it's a good bet that the full article link you provided is probably the same as, or quite close to, the one JVH is publishing in full in it's April issue.

Thanks again, looks to be an interesting read.

[ladybug52]

Good for you, I'm beginning to draw that conclusion myself. There's a video out by Dr. D that is about whether or not a personshould start tx. Ihaven't seenit all yet, but it's sponsored by Roche so I'm not sure it's going to be completely objective.
Bug

[CrazyTrain]

No, I had no Bx because of the concern with bleeding.

Ask 10 Dr.'s you seem to get 10 different answers on Tx, etc. etc.

I used my own logic in continuing / discontinuing Tx. If RNA-PCR and Heptomax type HCV virus tests come back undetectable (which indicates <5 or 10) why would I want to continue Tx for another 40+ weeks ? As opposed to routine RNA-PCR testing to see if it was returning. Some will say the answer is - to make sure you kill the 5-10 that aren't being detected - but at what cost. The cure is almost worse than the disease.

I too have heard the statement that VL isn't that meaningful because of the tendency for it to fluctuate. In the same breath you're told that VL count must drop by log 2 to warrant Tx continuation. So it is meaningful when "they" want it to be. I'll leave it up to you as to who "they" are.

Has it become apparent I am disappointed (understatement) with medical profession, at least my experience with them. I refer to the diagnostic and related prescription Tx as "connect the dots" - Heck I dont need them to walk through a symptoms flowchart and end up at a box with recommended Tx.

[GrandOak]

Not having seen the full paper, just the abstract, I'm not sure what study it is based upon, so can not atest to it's age.  But it is from the April 2007 publication of the Journal of Viral Hepatitis so am guessing that it can not be that old.  It may also correlate to the trial I understand Roche is going to be undertaking to examine this same concept of short tx periods.

Like VX950, the goal these days seems to be aimed at shotned tx periods to increase the odds for those who can not weather the sx of SOC and give them a shot at treating.

For those insterest in the full abstract, see:

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2893.2006.00817.x

[jmjm530]

Should have said "24" weeks, not "48" weeks. Short course for geno 2's and 3's is either 12 or 16 weeks depending on which Peg is used. The "12" is for Peg Intron.

[ladybug52]

Where do they get these numbers? I know I sound naive, but how can they say 12, 16, 24, 48, 72 ? I am geno 2, stage 1, grade 2, peg-intron, riba 800 mg which is actually weight appropriate for me also. What are the statistics if I go for 20 weeks instead of 24? My first pcr at 3 weeks was und <50. (I don't know the name of the test). Then at week 4 I had the heptimax-UND, week 12 the <50 pcr UND and I just got another heptimax at week 15, morning of shot 16, yesterday. I have poor communication with my PA, poor monitoring of my labs. I stopped procrit on my own 4 weeks ago when I noticed my hgb had risen to 13.3. My pcp gave me a lab request for the blood work and ordered another heptimax. I figure if I'm still clear why not stop at week 20? I know I'm a weinie, just worried about the long term effects of all the meds. Clearing the virus is my number one priority, just can't see where they get the magic numbers that tell us when to stop.

[CrazyTrain]

Hep C Geno1a  Pegintron .5/wk Riba 1200/day - I stopped Tx in Oct 06 after only 7 wks and have been undetectable since then (RNA-PCR and Heptomax). However, VL baseline was only 8,500 and I cheated and went heavy on the PegIntron.

My guess is that VL baseline is a major factor in what you can get by with as far as length of treatment.

The bad news for me was that liver was damaged to the point of bleeding varices, so I must of had for 20+yrs.

[jmjm530]

That's a relatively old study in Hep C years. Newer studies show the short course still viable but with slightly worse odds than with 48 weeks. Which study is more accurate who knows.  Still, the more recent study recommend the shorter course to those who are having difficulty with treatment. Personally, I'd recommend it to anyone with little or no liver damage cause you still have around and 80 per cent or more chance of SVR with half the drug exposure.

[ladybug52]

Did you have a biopsy before tx? That's amazing that you were able to clear, and leads me to believe there is no majic number. There must be a lot of factors to consider. I've had this 30+ yrs, never had any signs or symptoms, just tested positive when I gave blood in '92. My viral load was much higher, but I've always heard that's a flucuating number and not all that important.
Thanks for the  info.

[jmjm530]

The projected length of treatment comes from analysis of study data as best they have them. The shorter course treatment for geno 2's on Peg Intron is 12-weeks for those non-detectible like yourself at week 4. This is based on I believe the "Manglia" study cited above. It showed that 12 weeks is just as effective as 24 in those geno 2's and 3's who were non-detectible by week 4. A couple of our members -- "Rifleman" comes to mind, did the shorter course and are now SVR. Then, as mentioned, a later study said the odds with the shorter course dropped from something like 90 per cent (24 weeks) to around 80 per cent (12 weeks). Those recommendations were for geno 2's to treat the full 24 weeks unless they ran into trouble with side effects since the odds are better. Not sure which study is correct but that's about what I know. Personally, I'd consider a shorter course (12 weeks) if I was a geno 2 with stage 1 damage. On the other hand, some have stated that they would blame themselves forever if they didn't go "the whole way" whatever that means, and with that mindset then I guess one should go "the whole way" even though "the whole way" is also inexact. The truth is you can clear with 12 weeks and/or relapse with 24 weeks. No guarantees.

Be well,

-- Jim

[jmjm530]

This appears to be the full, or at least 'fuller' article you posted. There was an earlier study by Mangia I cited as well as another study that suggested around 10 per cent better odds with longer course. Maybe this is the tie breaker for the shorter course, who knows.

http://www.natap.org/2007/HCV/021207_01.htm

[madbrad]

My prayer is that your SVR.....And free for the rest of your life.

[madbrad]

Good news......Lets pray this materializes into Truth.

[nick m]

Very encouraging for me (maybe prematurely, 'cause i don't know whether i've achieved this - but intuitively/logically suspect i have). Anyway, I'll know next thursday when i'm 'unblinded'. 12 weeks VX and Peg, geno 1b since '70's.
best wishes
nick m