another 72 weeks question

I was und at 16 weeks.  I have compensated cirrhosis, platelets @ 77, 000.  Meds = peg 180 1 x wk, riba 1000xday and procrit 1 x every 2 weeks.  Hemoglobulin is 10.3 from 10.6 at last vl test.    I am at week 48 and was extended to 72 weeks when I became und at week 16..  Could I go off treatment now?  I have less and less energy and get extremely restless at night. could restlessness be r/t dementia?

[can-do-man]

Us cirrhotic people odds are very low with reaching SVR, being you didn't clear till week 16 your best bet is to extend to 72 weeks. It does increase your odds on clearing. Have you seen if you could up your procrit to weekly? I was on 40,000 once a week and it did help.

Not sure on the dementia but i also suffered from restlessness at night time. In what ever you decide i wish you the very best.

can

[GrandmaBRZ]

Thank you for your response.  

I have been thinking about asking to up it to 1xw.  It is covered by a foundation aand i am waiting to see if they will extend the grant for my renewal.  If they do, I will ask for a procrit increase to 1xw.  

Take care and the very best to you as well.

jen aka grandma brz

[HectorSF]

Hi. Glad to hear that you did become undetectable! You made it to 48 weeks. You have to be tough. Congratulations!!! I know the side effects are brutal. And it is very difficult. I had trouble also with sleeping and fuctioning while awake. I also have cirrhosis. The odds of the treatment working are low to begin with. That you have been able to keep the virus clear for this amount of time is fantastic. I would hate to see all you have gained if you should relapse by stopping treatment too soon.

My personal advice to to go to 72 weeks. (Easy for me to say). It will give you the best chance of clearing the virus. You can improve your odds by 30% by going to 72 weeks!!! "the relapse rate was reduced from more than 50% to less than 20%." according to 3 studies. (see below).

This data may help you understand how important it is to treat for 72 weeks. Even patients who don't have cirrhosis, need to treat for 72 week. All the more important for us cirrhotics with such low chances of SVR.

"Understanding HCV Nonresponse and Identifying Candidates for Retreatment"
Source: New Management Strategies for HCV Nonresponders and Relapsers
By: Mitchell L. Shiffman, MD

http://clinicaloptions.com/Hepatitis/Treatment Updates/HCV Nonresponders/Module/Shiffman.aspx

"Another 15% of genotype 1 patients achieve undetectable HCV RNA between Week 12 and 24 of treatment and have been referred to as “slow to respond.”

"It is critically important to recognize the point at which a patient achieves undetectable HCV RNA during treatment as this is directly related to the likelihood of achieving a SVR (Figure 5).[7] In other words, the later a patient achieves undetectable HCV RNA during treatment, the higher the likelihood that the patient will relapse after treatment is discontinued following the standard duration of therapy (24 weeks for genotypes 2/3 and 48 weeks for genotype 1).[7] Three recent studies have now demonstrated that relapse can be significantly reduced in slow-to-respond genotype 1 patients—those who achieve undetectable HCV RNA after Week 12—by extending the duration of treatment from 48 to 72 weeks.[8-10,20] In each of these studies, the relapse rate was reduced from more than 50% to less than 20%."

7. Ferenci P, Fried MW, Shiffman ML, et al. Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa 2a (40 KD)/ribavirin. J Hepatol. 2005;43:425-433.
8. Sanchez Tapias JM, Diago M, Escartìin P, et al. Peginterferon alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology. 2006;131:451 460.
9. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon alfa 2a plus ribavirin. Gastroenterology. 2006;130:1086 1097.
10. Sanchez-Tapias JM, Ferenci P, Diago M, et al. How can we identify HCV genotype 1 patients who may benefit from an extended treatment duration with peginterferon alfa-2a (40KD) plus RBV? Program and abstracts of the 42nd Annual Meeting of the European Association for the Study of the Liver; April 11-15, 2007; Barcelona, Spain. Abstract 641.
20. Ferenci P, Laferl H, Scherzer TM, et al. Customizing treatment with peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) in patients with HCV genotype 1 or 4 infection: interim results of a prospective randomized trial. Program and abstracts of the 2006 Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, Massachusetts. Abstract 390

Of course it is your decision.
Best of luck!
Your doing great so far.
Hector

[GrandmaBRZ]

Thanks for the stats.  It will make a huge difference, i know, if i finish the 72.  I will stick it out.

Stay well, jenn aka grandmaBRZ.