repeat tx

[dranurag]

Are there any studies about repeat treatment being as effective or less effective as the first tx which was stopped due to some reason or the pt relapsed after completing tx. In brief, do you feel that repeated courses of SOC should be tried and at what interval?

[HectorSF]

Thanks for the clarification.

I've never heard of interferon monotherapy retreatment being effective. If you read one of the articles I sent a link to, you will see that person who took standard interferon monotherapy could be retreated with the current PEG-inerferon and Ribavirin and have a good chance of achiving SVR. But not the other way around. The older interferon monotherapy worked in very few people.

SVR rates following retreatment according to prior therapy:
interferon monotherapy - interferon + ribavirin =13-15%
interferon monotherapy - Peg +ribavirin = 25-40%

Relapsers
interferon monotherapy - Peg +ribavrin 32-50%

"Previous Treatment With Inferior Therapy
Many patients who have a nonresponse to treatment or who relapse following treatment may have been previously given standard interferon-based therapy. Peginterferon/ribavirin is more effective at achieving an SVR than treatment with standard interferon with or without ribavirin.[1,2] Patients who achieved a partial response to previous suboptimal therapy have a good probability of responding to retreatment with peginterferon/ribavirin therapy.[9,18]"

1. World Health Organization. Hepatitis C. Weekly Epidemiol Rec. 1997;72:65-69.
2. Centers for Disease Control and Prevention. Hepatitis surveillance report No 59.Atlanta, Ga: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.
9. Sethi A, Shiffman ML. Approach to the management of patients who failed to achieve sustained virologic response. Clin Liver Dis. 2005;9:453-471.
18. Shiffman ML. Re-treatment of patients with chronic hepatitis C. Hepatology. 2002;36(suppl 1):129-134.

Maybe someone else here has heard of this type of treatment and can enlighten both of us?

Best of luck.

Hector

[dranurag]

I took only standard interferon 3 miu twivcw weekly the second time and became UND at 12 weeks. This time Riba was not prescribed as I had lot of iron levels after  the first treatment and they were afraid my AST ALT were remaing high due to that. I ramained UND for quite some time but enzymes remained high always ---around 100

[HectorSF]

Hello

What genotype are you? Type 1? (Because you treated for 48 weeks 1st time).
You became undetectable when? At week 12.
This determines duration of treatment. 48 weeks.
During your first treatment after dropping 2 log + and becoming  UND if you remained UND during your entire treatment (and had VL measured during treatment) means that you "relapsed".

STOPPED AT 24 WEEKS?
Yes, you should have continued.
Who said to stop???
Your doctor is advising you to do this?
This is not in accordance with standard tx protocol.

If you did nothing different during treatment (same meds, compliant, etc....and relapsed after 48 weeks...
I wonder how could half of the treatment duration give you better results?

I'm sorry to say this but I believe you're going to have to start all over again.


I would suggest educating yourself more about tx before starting again. Treatment is not guaranteed to work, but you want to give yourself the best odds possible.

Google these articles to find the latest data on retreatment...
"Retreatment Strategies for Patients Failing First-Line Therapy
By: HoChong Gilles, RN, MS, FNP

"Understanding HCV Nonresponse and Identifying Candidates for Retreatment"
By: Mitchell L. Shiffman, MD

Best of luck.
Hector

[dranurag]

I txed first time for 1 yr and remained UND during tx but relapsed after stopping for 4 weeks. Don't know whether this is relapse or non response. While retreating became UND at 12 weeks and remained so. Now stopped at 6 months . Should I have continued?

[CockSparrow]

Its a bit iffy whether dranurag is a relapser. You could easily say he is a non responder based on the lenght he Tx-ed.
You relapsed, so your odds are good to begin with.
I should have made it clearer about the odds being poor with the same Tx length.

Apart from that you RVRed which wins no matter how poor your odds were before you started.

When retreating if not clear by week 12 your svr odds are close to zero.
CS

[comeagain]

HE is my doc

[comeagain]

I`m retreating with higher doses longer tx I´m a G 3. Went from 3.8 milj iuml to less than 15iuml in 4weeks, more then a 4 log drop.
He gave me more then 90% SVR chanses this time if I do the whole tx 48 w. But he also said there aint no warranties though, and  he was suprised I didn´t cleared first time, so I don´t now how much hope i can get from that statement.

[CockSparrow]

Yes there have been studies on ReTreating. They dont have a very high success rate.
Basically unless you change sonmthing i.e longer Tx , higher doses, add another anti-viral and what ever else you can think of. The success rate is quite low. Its not zero though. Relapsers have higher odds but even they arent that high.

They are a few of us in the same boat as you. Even some G3s who are having or about to have another attempt at it.

There is a chance of re treating working but thats all it is a chance.
You need to work out what went wrong last time a see if you can undo that.
Then hit it with everything.

Wish you Well
CS