Studies on Extending Treatment for Geno 3 detectable at week 4

[LindyK]

I have not been able to come up with any studies related to a better chance of SVR by extending to 48 weeks and increasing Riba for Geno 3 who did not experience RVR.

The only recent study was from the Boston Conference in October.  It did not say anything about extending - still says 24 weeks.  It did say that if one is RVR then 87%-93% chance of SVR but if EVR only 59% chance.  I am really getting bummed.

Kalio1, Jim, anyone have any data on this.  I've got to make an informed decision about what to do.

Thanks!

[Cindy10]

I too am gt 3 week 13/24. I did not clear at week 4 (I was <615 but more >10) My doc wants me to extend to 48 weeks. I question it as well. I wish I had retested at 6  or 8 weeks to have a better idea if I cleared (and if so when), still dont know yet. So I would suggest retested in a couple weeks if you can. I wish I did! Wishing you best of luck!

[desrt]

No data, but I can tell you my gastro has always treated geno 3s for 48 weeks with 1000-1200 riba. It was my decision to decrease my riba and stop tx early. I'm glad I did, but it was a chance I chose to take with only a 12 week undetected to base my decision on.
Also with a lot less knowledge than what I've gained in the last 4 years.

[Cindy10]

How long did you treat and did you clear?

[desrt]

To be painfully honest - I threw in the towel after 23 shots(the first three weeks underdosed due to a nurses mistake) and 22 weeks riba(19 weeks at 1200 and the last 3 at 800). Undetected since week 12 of tx up to 3.5 yrs post-tx, last October. I know another 3e who had to quit at 16 weeks due to sx that Procrit and Neupogen couldn't control, and she was still undetected 6 months post.

[desrt]

Oh yeah, still undetected as far as I know - but don't have any plans to do any more PCRs. Didn't mean to make it sound as though I became detectible in Oct.

[ladybug52]

I would love to have that kind of stats. 'Threw in the towel' is downplaying what you went thru for 23 weeks, maybe you can think of it as finishing the marathon early!

[desrt]

You're very kind. Seeing the courage that everyone on these boards shows is a humbling experience.

[LindyK]

My Hep Doc wouldn't do a 4 week PCR so I had my PCP order it.  I see my PCP today and will have him oder a PCR for week 7 and 8.  If extending gives me more of a chance for SVR then I will do it.  As I posted before, I will have to change Hep Docs as mine will not extend - he is rigid and straight SOC.  If I am not UND at week 12 he will probably pull me from tx.  His words "If you are not UND at week 12, treatment will not work."  I just don't buy this.

[FlGuy]

I think there's a bit more to deciding to extend or not. Things like level of liver damage, you life on tx, how you're tolerating tx, amount of riba (weight-based or not). If you get a wk 7 pcr, and it's und, the pessimist in me would assume that I cleared no sooner than wk 7.  Although it's true that many doc tx g3 for 48, it could be ovekill - but you never really know.  In the category of 'if I knew then what i know now, as a g3 I would have gone with WB riba, earlier pcrs and extended some due to liver condition.  I would have gladly invested another 12, or so, weeks in addition to the 24 to avoid a second round of 48. You have a difficult decision.  If you get a new doc and have the intention to extend without interruption make sure you have several weeks lead time to allow insurance to process the rx's.  You don't want to get to week 25 and not have the meds on hands.

[Cindy10]

desrt - thats awesome it worked for you. I am very happy to hear that.

Linda- I have to agree if he wont extend at all you need a new doc. You need to have the option of extending even if not the full 48 weeks.

[NYgirl]

The only studies that have been done are for Geno 1s. This is something Dr. Jacobson talked to me about when I went to him. He REALLY didn't like this at all. He said that not only the high degree of relapse in 2s and 3s but ALSO that nobody is really studying makes them the UNlucky genotype regardless of what the old books say.

If I was you I'd try and treat my HCV (if I was a "3" not a 1A and 1B) with the same stuff from the Geno 1 studies.  Just because as you know I am nuts - but I want this stuff out of me BAD.

Of course a lot of people will think that I am way too proactive in my hepc killing but it's my opinion...why do it half assed if you're going to do it at all (that isn't really true because it ISNT half assed but you get what I mean).

[jmjm530]

There were studies that showed 24 weeks to be sufficient treatment (versus 48 weeks) for treatment naive (first time treaters) geno 2's and 3's. Also, there are no studies I'm aware of that suggest 48 weeks for treatment naive geno 3's who are detectible at week 4.

What you might want to take a look at are the studies that tested 12 and 16 weeks of treatment against 24 weeks in subjects who were UNdetectible. Then, maybe at least you will find your odds of SVR if you treat for 24 weeks by looking at the stats of the detectible group (at week 4), assuming you clear by week 12. You might also try the Clinical Options site and see if something's there.

Personally, I'd pose this question to one or two liver specialists (hepatologists). On one hand you don't want to under treat, but equally important, you don't want to expose yourself any longer than reasonably necessary to the treatment drugs. In other words, you don't want to do more harm than good.


All the best,

-- Jim