Aa
Stopping tx 12-16 weeks
My Hepatologist feels I could probably stop at 12-16 weeks. I am a geno2 ...had the disease for 33 yrs. If I am UND at 4 weeks this is the plan.
Do you think it's wise to stop that soon? Why do most 2's do the 24 week tx?
Julia
Do you think it's wise to stop that soon? Why do most 2's do the 24 week tx?
Julia
The studies have showed results for 16 weeks in lieu of the 24 weeks for your genotype. Providing EVR by week 4, the SVR rates showed really no difference in the studies as well with the 16 weeks. I would take into consideration the degree of liver damage also. Stage 3 or 4 damage might want to go the full 24 weeks. Fatty liver amount should be taken into account as well.
I do not believe that this has caught on here in the States much unless the patients have done their homework and works with their doc to treat in this specific approach. Otherwise the patient just follows what the doctor tells them and I believe this plays a part for geno's 2 treating for 24 full months. I believe in individualized approach for treatment anyway.
I do not believe that this has caught on here in the States much unless the patients have done their homework and works with their doc to treat in this specific approach. Otherwise the patient just follows what the doctor tells them and I believe this plays a part for geno's 2 treating for 24 full months. I believe in individualized approach for treatment anyway.
If you're taking Pegasys and are UND at week 4, 16 weeks seem to be acceptable. If Peg-Intron, 12 weeks might be okay. But to play it safe, go the whole 24. The odds are slightly better with the full duration of treatment. OTOH, if your sides are unbearable, shortened tx is definitely an option. My doctor pulled me off Peg-Intron after only 13 weeks. I was UND 4 weeks after quitting, and next week will get the results of a 4 month post PCR. Just got some of the other numbers from that blood test yesterday, and my ALT remains normal, which is an excellent sign. I'm praying. But if I could have, I wouuld have completed the 24 week course.
There have been several studies for geno 2 and 3 on treatment duration where some of of these studies lean towards stopping early if you are UND at wek 4 while the other studies recommend going the distance OF 24 Weeks
I am geno 10a=3 and I am on week 20/24.. I was UND at week 4 and could have had the option to stop earlier,but as my sides have been managable I have decided to go the distance
Having said that....even if my sides were less managable than they are now....I would have tried to finish 24 weeks by Gods grace rather than face a higher possibility of a relapse...this is my personal opinion
But I guess it all comes down to how bad your sides are affecting you
Please find a link below advocates that longer treatment is better for hep C
Longer Hepatitis C Treatment Best?
Cure Rates Are Higher With Longer Treatment Of 6 Months, Research Suggests
(WebMD) Shortening treatment to less than six months does not appear to be a good strategy for patients with the most curable types of hepatitis C virus infection, new research suggests.
Patients with hepatitis C genotypes 2 and 3 who were treated for four months had lower cure rates and higher relapse rates than those treated for six months.
The study, which appears in Thursday's New England Journal of Medicine, shows that longer treatment benefits even those with highly treatable hepatitis C, researcher Mitchell L. Shiffman, MD, tells WebMD.
"I tell patients if they can tolerate treatment and can stay on it for 24 weeks, they have a better chance of achieving the best possible outcome, which is a cure," he says.
Hepatitis C Treatment Strategies
Long-term infection with hepatitis C virus (HCV) is a leading cause of cirrhosis, liver cancer, and liver transplants in the United States. As many as 4 million Americans are infected, but most don't know it, experts say.
About 70 percent of infected Americans carry the genotype 1 form of hepatitis C, which tends to be less responsive to treatment than genotypes 2 and 3.
With aggressive treatment, nearly 80 percent of people with genotypes 2 or 3 achieve complete and sustained viral eradication, or cures, compared with about 40 percent to 45 percent of people carrying genotype 1 virus.
These days, most patients are treated with a long-acting version of the injected drug interferon along with the antiviral drug ribavirin.
The standard course of treatment for patients with the more treatable types of hepatitis C infection is half that of patients with genotype 1 hepatitis C — 24 weeks compared with 48 weeks.
In several recent studies, it was reported that shortening treatment to four months and even three months had no impact on cure rates in hepatitis C genotype 2 or 3 patients.
In an effort to test these findings, Shiffman and colleagues from Virginia Commonwealth University compared outcomes among genotype 2 or 3 patients treated for four months and six months.
They report that 31 percent of patients treated with the shorter course of therapy eventually relapsed, compared with 18% of patients who got the full six months of treatment. Relapse was defined as having detectable levels of virus in the blood at follow-up despite complete viral eradication at the end of treatment.
Overall, 62 percent of patients treated for four months achieved sustained viral responses, compared with 70 percent of patients treated for six months.
Among patients who achieved complete viral responses within a month of starting treatment, 79 percent of those treated for four months achieved complete, sustained responses, compared to 85 percent of the patients treated for six months.
Individualized Hepatitis C Treatment
Shiffman understands the desire of patients and doctors to shorten treatment. The drugs used to treat hepatitis C are very expensive and they can cause severe fatigue, fever, depression, and other hard-to-tolerate side effects.
But he says a better strategy than shortening treatment is lowering drug dosage in patients who have trouble tolerating hepatitis C treatments.
He adds that rapid response to treatment has become as important as viral genotype for predicting response to treatment.
Patients who show no signs of hepatitis C infection within a month of beginning treatment have a 90 percent cure rate, regardless of genotype, he says.
"We are learning that the optimal way to treat hepatitis C is to monitor the virus during treatment, no matter what the genotype, and adjust treatment duration based on response."
T. Jake Liang, MD, of the National Institutes of Health, says this individualized approach to hepatitis C treatment will become more common as more is learned about the virus.
Liang is chief of the liver disease branch of the National Institute of Diabetes and Digestive and idney Diseases.
"As our technology improves we will be more able to identify patients who will benefit from a shorter course of treatment," he tells WebMD. "For now,
though, genotype 2 and 3 patients who can tolerate the treatment should remain on it for a full six months."
Heres the link below
http://www.cbsnews. com/stories/ 2007/07/11/ health/webmd/ main3047056. shtml
Wishin you the best in whatever you decide
I am geno 10a=3 and I am on week 20/24.. I was UND at week 4 and could have had the option to stop earlier,but as my sides have been managable I have decided to go the distance
Having said that....even if my sides were less managable than they are now....I would have tried to finish 24 weeks by Gods grace rather than face a higher possibility of a relapse...this is my personal opinion
But I guess it all comes down to how bad your sides are affecting you
Please find a link below advocates that longer treatment is better for hep C
Longer Hepatitis C Treatment Best?
Cure Rates Are Higher With Longer Treatment Of 6 Months, Research Suggests
(WebMD) Shortening treatment to less than six months does not appear to be a good strategy for patients with the most curable types of hepatitis C virus infection, new research suggests.
Patients with hepatitis C genotypes 2 and 3 who were treated for four months had lower cure rates and higher relapse rates than those treated for six months.
The study, which appears in Thursday's New England Journal of Medicine, shows that longer treatment benefits even those with highly treatable hepatitis C, researcher Mitchell L. Shiffman, MD, tells WebMD.
"I tell patients if they can tolerate treatment and can stay on it for 24 weeks, they have a better chance of achieving the best possible outcome, which is a cure," he says.
Hepatitis C Treatment Strategies
Long-term infection with hepatitis C virus (HCV) is a leading cause of cirrhosis, liver cancer, and liver transplants in the United States. As many as 4 million Americans are infected, but most don't know it, experts say.
About 70 percent of infected Americans carry the genotype 1 form of hepatitis C, which tends to be less responsive to treatment than genotypes 2 and 3.
With aggressive treatment, nearly 80 percent of people with genotypes 2 or 3 achieve complete and sustained viral eradication, or cures, compared with about 40 percent to 45 percent of people carrying genotype 1 virus.
These days, most patients are treated with a long-acting version of the injected drug interferon along with the antiviral drug ribavirin.
The standard course of treatment for patients with the more treatable types of hepatitis C infection is half that of patients with genotype 1 hepatitis C — 24 weeks compared with 48 weeks.
In several recent studies, it was reported that shortening treatment to four months and even three months had no impact on cure rates in hepatitis C genotype 2 or 3 patients.
In an effort to test these findings, Shiffman and colleagues from Virginia Commonwealth University compared outcomes among genotype 2 or 3 patients treated for four months and six months.
They report that 31 percent of patients treated with the shorter course of therapy eventually relapsed, compared with 18% of patients who got the full six months of treatment. Relapse was defined as having detectable levels of virus in the blood at follow-up despite complete viral eradication at the end of treatment.
Overall, 62 percent of patients treated for four months achieved sustained viral responses, compared with 70 percent of patients treated for six months.
Among patients who achieved complete viral responses within a month of starting treatment, 79 percent of those treated for four months achieved complete, sustained responses, compared to 85 percent of the patients treated for six months.
Individualized Hepatitis C Treatment
Shiffman understands the desire of patients and doctors to shorten treatment. The drugs used to treat hepatitis C are very expensive and they can cause severe fatigue, fever, depression, and other hard-to-tolerate side effects.
But he says a better strategy than shortening treatment is lowering drug dosage in patients who have trouble tolerating hepatitis C treatments.
He adds that rapid response to treatment has become as important as viral genotype for predicting response to treatment.
Patients who show no signs of hepatitis C infection within a month of beginning treatment have a 90 percent cure rate, regardless of genotype, he says.
"We are learning that the optimal way to treat hepatitis C is to monitor the virus during treatment, no matter what the genotype, and adjust treatment duration based on response."
T. Jake Liang, MD, of the National Institutes of Health, says this individualized approach to hepatitis C treatment will become more common as more is learned about the virus.
Liang is chief of the liver disease branch of the National Institute of Diabetes and Digestive and idney Diseases.
"As our technology improves we will be more able to identify patients who will benefit from a shorter course of treatment," he tells WebMD. "For now,
though, genotype 2 and 3 patients who can tolerate the treatment should remain on it for a full six months."
Heres the link below
http://www.cbsnews. com/stories/ 2007/07/11/ health/webmd/ main3047056. shtml
Wishin you the best in whatever you decide
Following is the actual clinical review of Schering's application for PEG-Intron to The Center of Biologics Evaluation and Research (CBER), the division of the FDA that regulates these types of drugs. In other words, it is the highest authority's (CBER) review of PEG-Intron, as studied by the very people who most wanted it to be approved (Schering). It reads like an admission, an admission that the drug is neither safe nor effective, but "hey, it's all we've got". It may shock you. It may only confirm what you already know.
§ PEG-Intron is the Same Drug as Interferon Only Worse
§ PEG-Intron is NOT Safe
§ PEG-Intron is NOT Effective
You need only read one paragraph into the study to learn that PEG-Intron is the same drug as Interferon, only modified to stay in your system longer (Thereby killing you more consistently) ."PEG-lntronTM, peg-interferon alfa-2b, is a covalent conjugate of recombinant interferon alfa-2b with monomethoxy polyethylene glycol product. The biological activity of peg-interferon alfa-2b is derived from its interferon alfa-2b moiety."
compared to interferon alfa-2b treatment.Time to response to treatment and time to relapse were not superior with peg-interferon alfa-2b treatment compared to interferon alfa-2b treatment. Health-Related Quality of Life Scores were not improved in any of the interferon treatment groups either during or after treatment."
After reading 43 pages of evidence, in Schering's own words, that PEG-Intron is not effective and not safe.
Dr. Russell Blaylock, a board-certified neurosurgeon and author of the books Health and Nutrition Secrets That Can Save your Life and Natural Strategies for Cancer Patients, contributed this outstanding article about interferons, which are used widely for the treatment of multiple sclerosis (MS), hepatitis, cancer and more. If you, or someone you know, are taking these drugs, this article will help you decide if the benefits outweigh the many risks.
By Russell L. Blaylock, M.D.
http://www.russellblaylockmd.com/
How Interferon Ruins Your Brain:
The mechanism of this injury to the brain appears to involve the brain's special immune cell called the microglia. Normally, these cells remain dormant in the brain. That is, they are sleeping. Microglia cells can be activated by numerous factors, including mercury, aluminum, iron, overvaccination, and brain trauma, strokes, infections (viruses, bacteria, rickettsia) and cytokines such as interferons.
Once activated, microglia can move about the brain secreting very toxic compounds, which include two excitotoxins (glutamate and quinolinic acid). These excitotoxins dramatically increase free radical generation in the brain as well as oxidation of lipids (called lipid peroxidation). These radicals damage synaptic connections, interfere with neurotransmitters and can even kill neurons. In addition, these activated microglia generate other toxic compounds such as prostaglandins (PGE2), which increase brain inflammation.
If the microglia activation is short lived, the damage to the brain is minimal and recovery takes place. Yet, should the activation continue, which would occur with high-dose and long-term use of interferons, the damage could be substantial and irreversible.
§ PEG-Intron is the Same Drug as Interferon Only Worse
§ PEG-Intron is NOT Safe
§ PEG-Intron is NOT Effective
You need only read one paragraph into the study to learn that PEG-Intron is the same drug as Interferon, only modified to stay in your system longer (Thereby killing you more consistently) ."PEG-lntronTM, peg-interferon alfa-2b, is a covalent conjugate of recombinant interferon alfa-2b with monomethoxy polyethylene glycol product. The biological activity of peg-interferon alfa-2b is derived from its interferon alfa-2b moiety."
compared to interferon alfa-2b treatment.Time to response to treatment and time to relapse were not superior with peg-interferon alfa-2b treatment compared to interferon alfa-2b treatment. Health-Related Quality of Life Scores were not improved in any of the interferon treatment groups either during or after treatment."
After reading 43 pages of evidence, in Schering's own words, that PEG-Intron is not effective and not safe.
Dr. Russell Blaylock, a board-certified neurosurgeon and author of the books Health and Nutrition Secrets That Can Save your Life and Natural Strategies for Cancer Patients, contributed this outstanding article about interferons, which are used widely for the treatment of multiple sclerosis (MS), hepatitis, cancer and more. If you, or someone you know, are taking these drugs, this article will help you decide if the benefits outweigh the many risks.
By Russell L. Blaylock, M.D.
http://www.russellblaylockmd.com/
How Interferon Ruins Your Brain:
The mechanism of this injury to the brain appears to involve the brain's special immune cell called the microglia. Normally, these cells remain dormant in the brain. That is, they are sleeping. Microglia cells can be activated by numerous factors, including mercury, aluminum, iron, overvaccination, and brain trauma, strokes, infections (viruses, bacteria, rickettsia) and cytokines such as interferons.
Once activated, microglia can move about the brain secreting very toxic compounds, which include two excitotoxins (glutamate and quinolinic acid). These excitotoxins dramatically increase free radical generation in the brain as well as oxidation of lipids (called lipid peroxidation). These radicals damage synaptic connections, interfere with neurotransmitters and can even kill neurons. In addition, these activated microglia generate other toxic compounds such as prostaglandins (PGE2), which increase brain inflammation.
If the microglia activation is short lived, the damage to the brain is minimal and recovery takes place. Yet, should the activation continue, which would occur with high-dose and long-term use of interferons, the damage could be substantial and irreversible.
brown_eyed_grl
Being a G2 RVR doing the short course will give you an excellent chance of SVR. However doing 24 weeks gives you a slightly higher chance of SVR. If you were LVL the short course is worth considering, otherwise do the full 24 weeks. Relapse sux.
Me I’d do 24 weeks just to make sure you kill the all little buggers.
Shastri
G2s and G3s should not be lumped together. G2s have a higher SVR rates than G3s. G3s also have higher relapse rates, even though they have similar RVR rates.
The Studies don’t break things down enough.
G2 LVL RVRs have over 90% SVR in both the short course and the Full course.
CS
Being a G2 RVR doing the short course will give you an excellent chance of SVR. However doing 24 weeks gives you a slightly higher chance of SVR. If you were LVL the short course is worth considering, otherwise do the full 24 weeks. Relapse sux.
Me I’d do 24 weeks just to make sure you kill the all little buggers.
Shastri
G2s and G3s should not be lumped together. G2s have a higher SVR rates than G3s. G3s also have higher relapse rates, even though they have similar RVR rates.
The Studies don’t break things down enough.
G2 LVL RVRs have over 90% SVR in both the short course and the Full course.
CS
G2s have a higher SVR rate and lower relapse rates than G3s..Accepted but I was not zeroing in on that, My point was that irrespective of being a G2 or G3, we should try to go the distance and finsh 24 weeks,sides permitting. By doing this there is a higher chance of SVR and lower probability of relapse,even though it might be marginal
Take care
Take care
hey how are your shrunken testicles? did you think by changing your screen name we wouldn't know it was you? your just a walking commercial for that quack blalock. nice try pal.
Depending on which study you look at, there's either no difference, or around 6-8% difference in SVR rates for those geno 2's and 3's who are non-detectible by week 4. But even in the studies that show a difference, your odds are still excellent -- around 80% if I remember correctly -- if you do the shorter course. Where I take issue with Shiffman's analysis of "tolerating" treatment is doesn't appear to factor in the potential damage additional weeks of interferon can do in the long term, which of course there are no studies. If it were me, I'd do short term unless I had stage 3 or 4 liver damage, and then do the full course.
-- Jim
-- Jim
I dont know what stage my liver is in. Last bx was in '98. My team didnt feel it was necessary to do another one b/c of my chances to achieve SVR.
Jim, why would you chose to stop tx at 12-16 weeks? Wouldnt you be concerned you might relapse?
Jim, why would you chose to stop tx at 12-16 weeks? Wouldnt you be concerned you might relapse?
Shas: G2s have a higher SVR rate and lower relapse rates than G3s..
------------------------------------------------------------------------------------------------
My understanding is that SVR and relapse rates for geno 2's and 3's are identical. Or perhaps you're referring to the relapse rates in the shorter course studies that I don't have handy? In any event, could you post a study(s) to support your position. Thanks.
-- Jim
-- Jim
------------------------------------------------------------------------------------------------
My understanding is that SVR and relapse rates for geno 2's and 3's are identical. Or perhaps you're referring to the relapse rates in the shorter course studies that I don't have handy? In any event, could you post a study(s) to support your position. Thanks.
-- Jim
-- Jim
Don't have time to find the study right now, but will try to find it later. The first study I read about g2/g3 short course put g2 SVR almost identical with 12 weeks (+or- 5%) while g3 dropped from 80-85% down to 67%. This was a study from over a year ago, I think.
Thank you so much for that info. I think I may do the full 24 weeks. Better to air on the safe side.
Julia
Julia
Probably for the same reason your doctor is suggesting you stop.
As mentioned above, depending on the study you look at, the odds are either identical (short vs longer course) or around 6-8% difference. In any case, your odds are still excellent -- around 80% -- even by the studies that do show a difference. (Please double-check all figures against orginal study data as this is by memory). So, the reason I'd stop is to spare myself the potential longer term effects of the interferon after weighing the risks and rewards of each approach. Again, assuming I was not a stage 3 or 4. That said, good arguments based on the same data can be made for the longer course, and Shiffman has made one. No right or wrong here, just different takes. As to concern of relapse, that's always a concern, but no guarantees that 24 weeks won't result in relapse either. I suggest you take your time and think it over. If you end up disagreeing with your doctor's recommendation for the shorter course, I'm sure he'll let you continue on to 24-weeks if that's what you want. And if he doesn't, I'm sure you can find a good doctor who will.
-- Jim
As mentioned above, depending on the study you look at, the odds are either identical (short vs longer course) or around 6-8% difference. In any case, your odds are still excellent -- around 80% -- even by the studies that do show a difference. (Please double-check all figures against orginal study data as this is by memory). So, the reason I'd stop is to spare myself the potential longer term effects of the interferon after weighing the risks and rewards of each approach. Again, assuming I was not a stage 3 or 4. That said, good arguments based on the same data can be made for the longer course, and Shiffman has made one. No right or wrong here, just different takes. As to concern of relapse, that's always a concern, but no guarantees that 24 weeks won't result in relapse either. I suggest you take your time and think it over. If you end up disagreeing with your doctor's recommendation for the shorter course, I'm sure he'll let you continue on to 24-weeks if that's what you want. And if he doesn't, I'm sure you can find a good doctor who will.
-- Jim
Does LVL mean low viral load? My VL was 1.42 aat start of tx. The Dr's still seem to think I can stop early. I mean they know best ...right?
Julia
Julia
If you aren't having too many big problems...go all the way to week 24. Make sure you get any stragglers left behind. Believe me - we've seen too many Geno 2's relapse, you don't want to come back and have to 48?
It's just not worth it to me since 16 is so close to only 24.
And one small study does not REALLY undo all the years of studies that have been done that suggest 24 weeks is OPTIMUM treatment for geno 2.
(Of course if you have minimal liver damage and not overweight and don't have fatty liver you could go for it. I personally just don't really think it's worth it).
But then again I'm the first wierdo that I found around that begged to go for 72 weeks - so take me with a grain of salt. I just don't want to have to do this again if I don't ever have to, you know?
Regardless - we wish you ALL of the best B.E.G.
It's just not worth it to me since 16 is so close to only 24.
And one small study does not REALLY undo all the years of studies that have been done that suggest 24 weeks is OPTIMUM treatment for geno 2.
(Of course if you have minimal liver damage and not overweight and don't have fatty liver you could go for it. I personally just don't really think it's worth it).
But then again I'm the first wierdo that I found around that begged to go for 72 weeks - so take me with a grain of salt. I just don't want to have to do this again if I don't ever have to, you know?
Regardless - we wish you ALL of the best B.E.G.
Ironically the same logic being used for the shorter-course treatments is identical to the logic being used for extended treatments. That logic is to treat the INDIVIDUALLY (not as a group), and more specificially to treat the individual's patient's viral repsonse. Lots written on this lately over at Clinical Options and Berg has published a nice article on individualized treatment that unfortunately we've only had snippets of due to the fact that it's written in German.
-- Jim
-- Jim
I definitely hear you NYgirl. Youve been thru so much and have so much experience, so I know what youre saying comes from the heart. I do not EVER want to go thru this again . If you remember when I first came around, I was a mess. SO now Im txing and moving one one week at a time. To stop early could be a huge mistake. No way I wanna do this again. 48 weeks? I DONT THINK SO!!
Julia
Julia
Hi Julia;
This just came through my inbox, and I thought I’d pass it along; it just posted today. From the site:
http://www.hivandhepatitis.com/hep_c/news/2007/072007_b.html
“In conclusion, the authors wrote, "Treatment with peginterferon and ribavirin for 16 weeks in patients infected with HCV genotype 2 or 3 results in a lower overall sustained virologic response rate than treatment with the standard 24-week regimen."
However, the results suggest that a 16-week course of therapy may be adequate for a carefully selected subgroup of patients”.
See the web page for full commentary by Liz Hyleman.
I’ll withhold personal comment; I honestly haven’t been following GT-2 or GT-3 treatment protocol, so my thoughts aren’t up-to-speed or even relevant. I’m just passing this on. Take good care, and good luck with your decisions.
Bill
This just came through my inbox, and I thought I’d pass it along; it just posted today. From the site:
http://www.hivandhepatitis.com/hep_c/news/2007/072007_b.html
“In conclusion, the authors wrote, "Treatment with peginterferon and ribavirin for 16 weeks in patients infected with HCV genotype 2 or 3 results in a lower overall sustained virologic response rate than treatment with the standard 24-week regimen."
However, the results suggest that a 16-week course of therapy may be adequate for a carefully selected subgroup of patients”.
See the web page for full commentary by Liz Hyleman.
I’ll withhold personal comment; I honestly haven’t been following GT-2 or GT-3 treatment protocol, so my thoughts aren’t up-to-speed or even relevant. I’m just passing this on. Take good care, and good luck with your decisions.
Bill
How long to treat, when to treat or whether to treat is an individual decision. If you ask here, all you are going to get is personal opinions.
"Believe me - we've seen too many Geno 2's relapse, you don't want to come back and have to 48?
I really don't know where Nygirl gets her data as I have not seen any geno type 2's who dosed correctly, were und early and yet relapsed. Perhaps she will post the large number she is referring to.
I am not SVR but was und early on and quit at 16 weeks. What you do with your life is your business, good luck.
Bug
"Believe me - we've seen too many Geno 2's relapse, you don't want to come back and have to 48?
I really don't know where Nygirl gets her data as I have not seen any geno type 2's who dosed correctly, were und early and yet relapsed. Perhaps she will post the large number she is referring to.
I am not SVR but was und early on and quit at 16 weeks. What you do with your life is your business, good luck.
Bug
Hi jim,please find the link below supporting G2s having a higher SVR rate and lower relapse rate than G3s....
http://www.hivandhepatitis.com/2006icr/ddw/docs/052306_b.html
And here are the results
Results
1829 G2/3 patients were enrolled and randomized to WBD (24 wks n=317, 48 wks n=602) or FD (24 wks n=322, 48 weeks n=588).
SVR rates were similar in the WBD and FD groups (62 vs 60%, respectively) and were higher in the 24-week group (68 vs. 65%) than the 48 weeks (60 vs. 58%, respectively) due to a higher dropout rate after 24 weeks of therapy with missing data in that group (SVR not known, treated as NR).
G2 had a higher SVR and lower relapse rate than G3 (72 vs. 63% with 24 weeks of WBD therapy and 5 vs. 10%, respectively).
G3 patients had higher SVR with WBD (57 vs. 52% in 24 week group) but this difference was not statistically significantly.
Relapse rates were highest in G3 high viral load patients treated for 24 weeks (16%).
Multivariate analyses revealed G2, less advanced fibrosis, and 24 weeks of therapy as significant predictors of SVR. Safety and rates of drug discontinuation were similar between the groups.
Based on these findings the authors conclude, “Compared to Genotype 1 patients, WBD ribavirin and 48 weeks of therapy offers less advantage to FD in combination with PEG-IFN alfa-2b, in patients with HCV genotype 2 and 3.”
“Compared to G2 patients, SVR rates are lower and relapse rates are higher for G3 patients. G3 patients may benefit from higher ribavirin dosing
Take care
http://www.hivandhepatitis.com/2006icr/ddw/docs/052306_b.html
And here are the results
Results
1829 G2/3 patients were enrolled and randomized to WBD (24 wks n=317, 48 wks n=602) or FD (24 wks n=322, 48 weeks n=588).
SVR rates were similar in the WBD and FD groups (62 vs 60%, respectively) and were higher in the 24-week group (68 vs. 65%) than the 48 weeks (60 vs. 58%, respectively) due to a higher dropout rate after 24 weeks of therapy with missing data in that group (SVR not known, treated as NR).
G2 had a higher SVR and lower relapse rate than G3 (72 vs. 63% with 24 weeks of WBD therapy and 5 vs. 10%, respectively).
G3 patients had higher SVR with WBD (57 vs. 52% in 24 week group) but this difference was not statistically significantly.
Relapse rates were highest in G3 high viral load patients treated for 24 weeks (16%).
Multivariate analyses revealed G2, less advanced fibrosis, and 24 weeks of therapy as significant predictors of SVR. Safety and rates of drug discontinuation were similar between the groups.
Based on these findings the authors conclude, “Compared to Genotype 1 patients, WBD ribavirin and 48 weeks of therapy offers less advantage to FD in combination with PEG-IFN alfa-2b, in patients with HCV genotype 2 and 3.”
“Compared to G2 patients, SVR rates are lower and relapse rates are higher for G3 patients. G3 patients may benefit from higher ribavirin dosing
Take care
When we compare studies, we need to remember not only to separate out geno 2 from geno 3, but also to distinguish between those who are UND at 4 weeks and those who aren't. Not all studies make that differentiation, which can be confusinng.
The logic behind individualising Tx appeals to me. If you meet the right criteria then shorten Tx.
In you dont fit the criteria do 24 weeks. If you dont want to do this again do 24 weeks.
In some G2/3 cases 48 weeks is whats needed.
The risk of relapse is slightly higher with the short course. If your VL is measured in copies/ml then yes you are LVL <2,000,000/ml. However some studies suggest that 1.000,000 is the LVL cut off point. If it is in IUs you are HVL, in which case do the full course.
Jims point is valid though you still have an excellent chance of SVR with the shorter course. However as Shartri states the relapse rate is slightly higher. This risk is worth it if you were prepared to have another run at Tx then the SVR rate for relapsers of the short course is excellent.
Shastri - We dont really disagree. Its just that with G2s the risk of relapse is not that much greater with the short couse so long as you RVR, are LVL and your liver damage is <F3. In your case being 3k i would do 24 weeks. In fact if you were HVL I personally would want to do 48 weeks with WBR.
The relapse rates are lower. Be a little skeptical though the G3 studies are mostly for 3a.
Jim - G3s definately have higher relapse rates than G2s. If G3s dont RVR their SVR rate is <50%.
I have seen this as low as 38%. These rates are for both PegINFs.
G2s who dont RVR still have a 70% or so SVR rate.
G3s who dont RVR are NOT easy to treat. Tx has failed me twice and I am 3a.
pigeonca - We also need to consider HVL v LVL and degree of liver damage, otherwise spot on.
CS
In you dont fit the criteria do 24 weeks. If you dont want to do this again do 24 weeks.
In some G2/3 cases 48 weeks is whats needed.
The risk of relapse is slightly higher with the short course. If your VL is measured in copies/ml then yes you are LVL <2,000,000/ml. However some studies suggest that 1.000,000 is the LVL cut off point. If it is in IUs you are HVL, in which case do the full course.
Jims point is valid though you still have an excellent chance of SVR with the shorter course. However as Shartri states the relapse rate is slightly higher. This risk is worth it if you were prepared to have another run at Tx then the SVR rate for relapsers of the short course is excellent.
Shastri - We dont really disagree. Its just that with G2s the risk of relapse is not that much greater with the short couse so long as you RVR, are LVL and your liver damage is <F3. In your case being 3k i would do 24 weeks. In fact if you were HVL I personally would want to do 48 weeks with WBR.
The relapse rates are lower. Be a little skeptical though the G3 studies are mostly for 3a.
Jim - G3s definately have higher relapse rates than G2s. If G3s dont RVR their SVR rate is <50%.
I have seen this as low as 38%. These rates are for both PegINFs.
G2s who dont RVR still have a 70% or so SVR rate.
G3s who dont RVR are NOT easy to treat. Tx has failed me twice and I am 3a.
pigeonca - We also need to consider HVL v LVL and degree of liver damage, otherwise spot on.
CS
Messed my reply to you up a bit. so i'll do it again.
We dont really disagree. Its just that with G2s the risk of relapse is not that much greater with the short couse so long as you RVR, are LVL and your liver damage is <F3.
The relapse rates are lower with 24 weeks especially for G3s.
As you are 3k be a little skeptical of the studies though as the G3 studies are mostly for 3a.
We dont really disagree. Its just that with G2s the risk of relapse is not that much greater with the short couse so long as you RVR, are LVL and your liver damage is <F3.
The relapse rates are lower with 24 weeks especially for G3s.
As you are 3k be a little skeptical of the studies though as the G3 studies are mostly for 3a.
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
