A few questions...

[pKinCA]

Hi Everyone... So after a few days of reading posts, etc. I have a few questions:  

1)  What is difference between Copegus and Copegasys?

2)  My doctor prescribed Copegus, but the pharmacy sent generic ribavirin -- he said that was fine... Any feedback to the contrary?

3)  Do you have strict ribavirin-taking schedules?  I calculated that the doses should be taken 12 hours apart for maximum coverage...  Sometimes it's difficult to take at these times because I just don't feel like eating (i.e. take with food...)

4)  Which has more pronounced side effects, the interferon or the ribavirin?

(PS  I am 2b; 24 weeks; 180 mcg Pegasys and 800 ribavirin...)

Any and all answers are appreciated!

[IAmTheWalrus]

My doc says that he uses 1000 mg/day for mass 75kg. Maybe 800 mg is a little low even though it seems right for your weight. Ask your doc.

Note: while the european studies indicate very good success with geno 2 & 3 with only 12 weeks of treatment, the SRV rate is still a little higher with 24 weeks (I believe it is 80% SVR versus 90% SRV for those with RVR). For those who do not achieve an RVR (clear at 4 weeks) there is similar SVR improvement for those who treat for 48 weeks versus 24 weeks. The key factor to consider is whether or not RVR is achieved.

wish I had geno 2 :)

Brent

[sfbaygirl]

You are about 120, right? How much Riba did you take?  I guess all I was saying is that they are finding that 2's and 3's need to be on weight based....I sure would be as some have relapsed with only 800mg.  Perhaps at this weight of 120, 800 is about right. I was on 1000 at 140, so that is probably weight based at 800. I am now 120lbs, but as you said you want to get that first 12 weeks with as much as you can! Iknow you did!  

Linda

[pKinCA]

My weight = 120 lbs = 55 kgs.  55 kgs x 15 mg = 825 mg ribavirin.

Is this correct?  

If yes, then I think my doctor's orders of 800 mg ribavirin per day is good -- I will for sure ask him about this though at my next appointment.

My doctor, by the way, gave me a similar "talking to" as you nygirl :-)  He is a VERY caring doctor and I know you all care too... thank you for your concern and input!!  Trust me, I want to get this scourge out of my body and will do everything I can to do it!  I just hope I can tolerate the drugs for as long as it takes...

[medicmommy]

Well, here's what i found...If you are 150 lbs (75 kg?) or under, the weight based tx is recommended but, as of now anyway, weights over that respond well to the 180 mcg Copegsys and 800 mg ribavirin...Most 3a s are at a 0 vl at 12 weeks, but tx is strongly recommended for the entire 24 weeks...There are a few who have cleared the virus at 9 weeks and had to stop (I have a friend who is one of them) and are still clear years later...Also, if your weight drops to that point, or if you haven't at least come close to 0 at 12 weeks, the riba dose can be raised or lowered...Same is true if the sides are too much...If I am able, I will do the entire 24 weeks...This stupid disease has interrupted my life enough and, if I clear, I want the best odds of never getting it back!

[nygirl7]

I posted somewhere else about studies being done in Europe where 2's and 3's are having high percentages of SVR after only 12 to 16 weeks of treatment...
------------------

The goal of treatment is to achieve SVR - not break a speed record to see how quickly you can do it.  There are PLENTY of geno 2 and 3s on our forum here who have relapsed after treatment and they have done the entire course of 24 weeks. Now they are in a spot to have to do 48 weeks.

If you are not having any serious problems with side effects it is completely worth going the entire distance and not cutting out early.  It's human nature to want to get done as quickly as you can but please please try to do the entire route. Every week you do after you become undetctible gives you more chance at getting the virus that is not showing up in your bloodstream. Remember being UND does not necessarily mean you truly have "no" virons left inside you anywhere - and all the people on here who have relapsed can attest to that.

Having enough ribavirin in your blood stream is CRUCIAL to a successful course of treatment.  It is especially crucial in the first 12 weeks but if you don't have enough in there and skimp a little bit that virus that is left can come back and begin replicating in no time at all.

It's better to have too much rather than have too little.

When in doubt it seems to me - take the harder route and not the short cut.  Short cuts have been known for getting people lost and you don't want that you want SUCCESS.

[IAmTheWalrus]

Most of the recommendations for weight-based Ribavirin dosing indicated 15 grams/KG. But in practice, I think docs limit the topside to 1200 mg (mine did, even though I am around 100KG). There is a inverse correlation between body mass and successful treatment.

I don't know if I would be tryig to reduce the dosages recommended as the studies only show results for the dosages tested. When you reduce the dosage you get in uncharted territories and if TX is not successful, one would wonder if it was the 200 mg Ribavirin reduction.

[pKinCA]

...mind if I call you "mm" ??  :-)

What drugs are you gonna take and how much of each -- do you know yet?

[medicmommy]

hello!
Hmmm...Now I'm curious too...I weigh about 180 lbs and am a 3a...I'll get back to you...going to hep central for some answers...

[pKinCA]

Oh, that is interesting about my ribavirin dosage.  I weigh about 120 lbs.  Does anyone know the current recommended dose for that weight?  (Thank god this is "anonymous" -- I never tell anyone my age or weight :-))  

I think it was mas1961 who is also Genotype 2b and who is taking exactly the same meds as me...  I think Lady Lauri is also 2b, but I don't think I know what she is taking... (I'm really sorry if I'm mixing up people with stats, I'm new and it's a little difficult to keep track of all of the info!)

I did read somewhere online (you never know how accurate things are that are on internet, right?) that Genotype 2b is thee easiest of all genotypes to treat...  Maybe that has something to do with it...

I posted somewhere else about studies being done in Europe where 2's and 3's are having high percentages of SVR after only 12 to 16 weeks of treatment...  I mentioned these to my doctor (well, begged him...) and he said forget it -- he wants me to do 24 weeks, until if and when it becomes standard protocol here in US...

I'm the patient that tries to finagle the LEAST amount of drugs and least amount of time out of my doctor -- maybe he gave in on the ribavirin??  Uh oh...

Thanks for your help!!

PS  What is your genotype?

[sfbaygirl]

You may want to rethink the 800 Ribavarin. Weight based Ribavarin is a better way to tx all genotypes.  Not sure what your weight is, but if you post it I am sure someone will give you the answer. 800mg of Ribavarin has been found to not be enough for some 2's and 3's. I may be wrong, but it is kind of an outdated study.  Don't want to worry you. For instance I was on 1200 Ribavarin at 140 lbs.  A bit more than needed, but you sure don't want to do tx twice!  

Linda

[pKinCA]

Thank you both for the great answers!  Off for the day... Be back later tonight :-)

[medicmommy]

Hello!
K...Copegus(ribavirin)= the virus suppressing pills that you take every day, 12 hrs apart (and I've been told preferably with some high fat food to maximize absorption)
Pegsys (peglated interferon)= the injection used 1x per week that suddenly boosts your interferon (body's bug fighter system)(equal to being jet-launched off an aircraft carrier) for a few days (the pegalation is a treatment that makes the interferon last a bit longer in your system)
I don't know about the generic riba..
I've been told the shot will initially kick your butt but the body gets used to it after a couple weeks..The pills have a slow onset...they dehydrate you and watch out for anemia starting the second week...Irriability from thew fatigue you may get can usually be lessened by a midafternoon nap...
log value drop...You would go from 6,000,000 to 600,000 to 60,000 (2 log drop)..(I think I have that right!lol It's been a while since trigonometry!) I just had all these q's answered yesterday and have also uncovered them in LOADS of reading...I hope this helps! Good luck! I'm not far behind you! :)

[Bill1954]

Good questions.

1)  What is difference between Copegus and Copegasys?
a) Roche Pharmaceuticals manufactures their HCV combo, which includes the interferon ‘Pegasys’ along with the oral antiviral ‘Copegus’ (ribavirin).

2)  My doctor prescribed Copegus, but the pharmacy sent generic ribavirin -- he said that was fine... Any feedback to the contrary?
a) This is typical. If there is any concern, a letter of bioequivalence should be available from the manufacturer. This is predicated by insurance, and shouldn’t affect treatment outcome.

3) 3)  Do you have strict ribavirin-taking schedules?  I calculated that the doses should be taken 12 hours apart for maximum coverage...  Sometimes it's difficult to take at these times because I just don't feel like eating (i.e. take with food...)
a) I doubt if it matters much if you’re off a few hours with your ribavirin dosing. I imagine the original trials were conducted 12/12 hours, but ribavirin has an extremely long serum half-life; once serum concentration is established (CMAX) it “sticks to your ribs” :o); a few hours either way shouldn’t make too much difference. More important, perhaps, to take it when you won’t forget a dose; and take with food if possible. Studies show that riba taken with dietary fat increase the availability of the drug, but I unaware if there is info that correlates this with SVR odds.

4)  Which has more pronounced side effects, the interferon or the ribavirin?
a) Very difficult question to answer. Because virtually all of us take them both simultaneously, it’s very difficult to determine which side effect can be attributed to either drug.

5)  How do you calculate a "2-log drop" in viral load?  (i.e. mine is currently 6,000,000 what would a 2-log drop be?)
a) To calculate a two log-10 drop in viral load, simply move the decimal point to the left twice. Using your VL for an example:

Baseline VL = 6,000,000
1 log drop = 600,000
2 log drop = 60,000
3 log drop = 6,000
4 log drop = 600
Etc.

Log drop = logarithm. Any scientific calculator will have a log function; you should have one in your PC if you can find it :o). Just enter your numerical viral load and hit the “log” key to translate into log expression.

Good luck and take care,

Bill

[pKinCA]

oops... one more :-)

5)  How do you calculate a "2-log drop" in viral load?  (i.e. mine is currently 6,000,000 what would a 2-log drop be?)

Thanks!