what now

Just finished being treated with Peg/interferon .  It didn't work for me .  What do I do now?  I have geno type a.  Started treatment with 8 million load down to 300,000 and now rising .

[Bill1954]

Hi there,

Sorry to hear things didn’t work out that time. I assume you’re genotype 1? Maybe 1a is what you meant?

As was probably explained to you when you began, only around 45% of genotype 1 patients will undergo treatment successfully using the pegylated interferon and ribavirin.

Have you had a biopsy performed in the last few years? The results of a liver biopsy can determine how critical it is to retreat soon; if you have little to no fibrosis, a case could be made to postpone re-treatment in favor of more efficient drugs that are now in clinical trials.

These drugs, known as ‘polymerase inhibitor’ class pharmaceuticals will be used in conjunction with the current treatment, but increase the efficacy from roughly 45
% to about 75%. And, for some patients, might shorten therapy to 24-28 weeks, reducing the exposure to interferon.

If for some reason it’s important to get with the program right now, it might be possible to simply change the brand of interferon, and do it again. I had a poor initial response to treatment the first time. Second time around, I changed from Pegasys to Pegintron, extended the treatment time, and was finally successful ion the end.

Welcome to the forum; and good luck—

Bill

[copyman]

I agree with what bill said about waiting for the new drugs with minimal damage.

I think bill meant to say the new drugs set to come out first are "protease" inhibitors not polymerase. The two new drugs coming out first are Telaprevir (most likely a shorter course of therapy) and Boceprevir.

Polymerase are still being studied but look promising

Best of luck

[Bill1954]

Uh, yeah… protease inhibitors initially; my booboo…

[willing]

for a good overview of what's coming down the road you might want to look at presentations from HEP DART'09 an hcv drug development conference attended by many of the major names in the field.
http://ihlpress.com/gaj_hepdart2009.html
See in particular the three 'Crystal Ball' presentations by Pawlotsky, Nelson and DiBisceglie outlining therapy strategies for 2009-12, 12-15 and beyond 15.

It all depends on how long you believe you can wait. The longer you put it off the better the drugs and the less you'll need to rely on Ifn/rbv - but the more damage you'll sustain in the interim. Depending on your sense of urgency you could

(a) start as soon as next Jan and add either Boceprevir or Telaprevir after approval but before your  eot

(b) start standard triple tx in the middle of next year (which is what many relapsers will choose)

(c) wait for ns3a approval(s) and join a polymerase clinical trial (assuming the control arm is using triple tx this would likely give you the benefit of quad tx  - ifn/rbv/ns3a/ns5b)

(d) wait for both n3a (protease) and ns5b (polymerase) approval - which would push the wait out to 2014/15.

All the best!

[jepperone]

Good to see you post,

Thanks for posting the up dates on the Crystal Ball presentations of the new drugs in the pipe line. Quite a few posters have been inquiring about them here lately in their decision making process as to when to treat.

jep

[vik97]

I was in the same position as you a year ago, geno 1a, baseline viral load 7.8 million and the peginterferon/ribavirin didn't work.  The important thing is to not get discouraged.  As other members have said, you have many options.

Vik

[Diamond_Lil]

Hi Dianarose,

Sorry your treatment failed and I wish you the best going forward.

I don't know what degree of liver damage you have or if you have time to wait for the new drugs but since you did ask "what next" there is another option for relapsers. It's called Infergen (concensus interferon) and it consists of daily shots of Interferon Alfacon-l plus weight based ribavirin.  Very tough treatment but there are success stories for those who have undergone treatment with Infergen.

Diamond_Lil

[banarep]

Am just finishein up in the realize study and my study doc tells me telaprevir will be out this time next year, so if you can wait, wait.  At present since you are either a nonresponder or a relapser, your treatment will still be 48 weeks, but you have a much better chance of clearing the virus.  

[willing]

yeah - I think that collection of presentations is among the best currently available and would recommend it to anyone contemplating tx over the next few years.  I regularly sift through all the aasld/ddw/easld abstracts but the summaries there seem much more on point. Pawlotski's includes a lot of good information about optimizing soc (IR/length/adherence etc.)

Of course the one point they don't address is my personal $64K question - how to add both ns3a and ns5b inhibitors without waiting 5 more years (which I can't do)?