more than 72 weeks for SLVR

[drofi]

Suitable Treatment Period in Patients with Virological Response during Combination Therapy of Peginterferon and Ribavirin for Chronic Hepatitis C.
(Arase, Y. et al., Inter Med 47: 1301-1307, 2008)

Link fulltext:
http://www.jstage.jst.go.jp/article/internalmedicine/47/14/1301/_pdf
or  http://tinyurl.com/5efhmy


Objective:
The aim of this study was to determine the suitable treatment period in patients who achieve virological response during combination therapy of peginterferon and ribavirin for chronic hepatitis C virus infection.

Methods
Inclusion criteria were HCV-genotype 1b, serum HCV RNA level of 􀀀100 KIU/ml before treatment, and negativity of serum HCV RNA during treatment. The 366 patients were enrolled in this retrospective cohort study. Patients were classified into four groups according to difference of response: rapidvirological response (RVR) at week 4 after the initiation of treatment (n=37), early-virological response (EVR) at week 5-12 (n=161), late-virological response (LVR) at week 13-24 (n=131), and superlatevirological response (SLVR) at week 25-48 (n=37). A non-relapse in patients with undetectable HCV RNA during therapy was defined as clearance of HCV RNA 6 month after the cessation of therapy.

Results:
Of the 366 patients, 241 had non-relapse and the non-relapse rate in each group was 89% (33/37) in RVR, 79% (127/161) in EVR, 54% (71/131) in LVR, and 27% (10/37) in SLVR. In RVR, 26 of 27 patients with continuance of negative HCV RNA of >30 weeks during treatment had non-relapse. In EVR, patients with period of negative HCV RNA of >40 weeks had non-relapse rate of 90% (71/79). In LVR and
SLVR, all nine patients with continuance of negative HCV RNA of >60 weeks had non-relapse.

Conclusion:
A suitable treatment period of combination therapy for chronic hepatitis C should be determined based on the time of attainment of negative HCV RNA.

[frijole]

So they are saying the patients in the study how cleared between weeks 25 - 48 attained SVR if they treated over 60 weeks after attaining negative RNA.

That is a long time, but I think anyone who clears really late needs to read this study.
Thanks for posting it.
frijole

[nygirl7]

Just going to show exactly what we already know ... treatment NEEDS to be tailormade per the individual and their response criteria. I wish more doctors would read these important findings, imagine there are a whole bunch that don't even KNOW what the latest studies say. Unbelievable when they are SO super-important to achieving SVR.

[smaug48]

Sobering but very important news for slow responders - people who become undetected between weeks 13-48 need to be undetected for 60 weeks for best chance of SVR.

Now I'm looking at joining Bill1954, sldb and Tallahassee in doing 90+ weeks.  Yuck.

Assuming that this was high-quality study, it proves that extending treatment changes the game in terms of when someone has to get to undetected.  

24 weeks is NOT the cutoff for getting to undetected if one is going to extend treatment (and is tolerating treatment well).

drofi, thank you so much for posting this.

smaug

[merryBe]

thanks for posting this...the best news I've read all year!!!

Orginal odds they ave me were 3%....then research showed 20%...but my doc doesn't beleive it.
Now this study give me 54% odds.....

It ups all our chances and I'm definitely printing it up for my Hepatologist.

Perhaps making beleivers of our doctors will save many who are being cut off treatment prematurely.!!!!!!!!

MB

[zazza]

I became UND somewhere between week 13 and 15, which means that I was UND 57 to 59 weeks. At first I thought Thank God I did not read that study when I was treating! but when I think of it it would not have made that much difference to me. What is another 3 weeks on interferon when you have already done 72, say?

[zazza]

Which week are you in now? Are you going for 24 + 60?

[Rockerforlife]

I plan on doing 72 weeks this time around....starting this Friday.

[moahunter]

Very interesting study. It shows that 66%, or 2/3rds of 1b patients can be cured, with good management of SOC. Those odds are pretty good.

[IAmTheWalrus]

Wow! Very relevant news, there. I was planning on 48 weeks of UND TX, but now it looks more like I should do 60 weeks.  I am REALLY bummed that my 24 week PCR ended up being at about 26 weeks due to a bad test. I could have cleared at week 13, or not until week 26. It could save me some extra foggy weeks.

In for a penny, in for a pound, I guess.

Thanks for the information, (so you're a Chippendale's dancer and a speedboat racer, too? What a coincidence!)  ;)

[merryBe]

I think it's pretty much the standard now to go out to 72 in LVRs..

the trick is going to be convincing doc and ins. to do the 90 for the SLVR

If I was in that group, I think it would be wisdom to get this information to your doctor ASAP as it sometimes take them time to change their minds, and work to get insurance to go along.  So the sooner you all bring the information to your providers the soooner SOC will change to reflect it.
Unfortunately right now it will be a real fight to get ins. to go 90 wks.
I'd be tempted to suggest starting the process of that approval well in advance of needing it, so that if they refuse you'll still have some months to appeal the ruling, before your year and a half (the max now) runs out.

Please keep us posted, those who try to do this as to your success and outcomes.

[eureka254]

Thanks for the post!  It's great to see current research breaching that elusive 50% barrier of cure for geno 1s.  It's due time for more options, better success rates, and encouragement -- especially  for those who are still detectable at week 12.  Great info.
~eureka