ribavarin dose with Teleprevir

[pcds]

I just received my med and saw the doc orders 600mg of rbavarin.  When I treated last time I used 1000.  I called the office he's out of town.  Did he make a mistake?  If so now I worry about his being sloppy .  If I hadn't treated before I would be in trouble.  Not a great way to start off with a new doc.

[Proactive]

Elpasolady, I'm certainly no doctor, but was a late responder(cleared at wk 14). My doc was not happy with my rate of viral decline after 1 month on tx and also saw my hgb levels weren't dropping much on 1200mg of ribavirin ( hgb was @16), so he countered with increasing riba dosing, 1400mg, then 1600mg @ wk 8. You won't find this approach in the books..The point is, here in the US, hgb levels are about the only way to gauge serum levels of riba, so they should be followed closely, IMO..

not giving advise, just my opinion and tx story....and times have changed since then

[flcyclist]

My comment was directed to the desrt's post regarding high dosing riba and the large proportion of study subjects needing transfusions.  

I agree completely with your well stated comments. :)

[elpasolady]

Are you saying that the goal is to make sure you get your hgb down between 10 -11?  If you don't, then you need more Riba?  Did I understand you correctly?
Anyone else concur with this?
thanks

[spectda]

I wasn't suggesting that someone high dose ribavirin. I was suggesting that they take the amount to start with that people used in the trials if they expect the same chance of SVR.

If someone was unsuccessful with a previous tx and had no or little hgb drop they might consider speaking to their doctor about increasing the riba dose this time. Just my two cents!
-Dave

[Proactive]

Telaprevir trial results "The relapse rate was 53 percent for the 24-week regimen that did not include ribavirin (arm three)"

http://investors.vrtx.com/releasedetail.cfm?releaseid=457359

[flcyclist]

All I could find regarding this high dosing with ribovirin by Dr. Lindahl was a small pilot study done in 2005.  There were only 10 people in this pilot study and 2 needed transfusions, both who were receiving doses as high as 4,000 mg daily.  If there is other data, please let us know, otherwise this reference to high dosing and needing transfusions might give people an unnecessary scare.

http://onlinelibrary.wiley.com/doi/10.1002/hep.20563/full

The primary goal of this small pilot study was to determine feasibility and safety of the treatment, and not virological outcome. However, in this difficult-to-treat patient population with genotype 1 and a high viral load, nine of ten patients were cured by standard definitions, which seems to be a better response than that found in studies using standard ribavirin doses.