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JmJm Question about study
Good morning Jim, Last week i posted about stopping tx at 16 weeks, und at 4week geno 2 and bad sides. You did mention a study when you ansered my post, it was about the success rates of svr. Do you happen to know where on the net i could find that study. When i went to my clinic yesterday my np thought i was going to stop at 12 weeks and i mentioned that I'm taking pegasays and i need to do the 16 weeks, she seemed confused...so needless to say i set up an appointment with the DR. I would like to be prepared with some stats when i go for my appointment, but i went back in the post and i can't find the study. Thanks so much
Do either of you know how long after stopping treatment, if there is a relapse when does it show up?
I saw my relapse within 3 weeks. I went from <5 IU/ml to 6.85 million IU/ml in less than 3 weeks. I don't know that many people get tested that soon after stopping but I am in a little different position so I got tested shortly after stopping. My guess is that with a sensitive test most relapsers would show within a few weeks if they tested - maybe not all but many would, in my opinion. I re-treated within 6 weeks but some people would argue against starting up again that soon. I haven't seen anything convincing pro or con to that approach but maybe someone has and can enlighten both of us. No one can know what you're going through but if it is bearable I would try to complete 24 weeks. While your liver is good now you'll still have to face some type of treatment at some time and I generally think the sooner you get it over with the better. Good luck with whatever you decide. Mike
I saw my relapse within 3 weeks. I went from <5 IU/ml to 6.85 million IU/ml in less than 3 weeks. I don't know that many people get tested that soon after stopping but I am in a little different position so I got tested shortly after stopping. My guess is that with a sensitive test most relapsers would show within a few weeks if they tested - maybe not all but many would, in my opinion. I re-treated within 6 weeks but some people would argue against starting up again that soon. I haven't seen anything convincing pro or con to that approach but maybe someone has and can enlighten both of us. No one can know what you're going through but if it is bearable I would try to complete 24 weeks. While your liver is good now you'll still have to face some type of treatment at some time and I generally think the sooner you get it over with the better. Good luck with whatever you decide. Mike
I am also Gen 2 and RVR at 4 week PCR. My GI also said that I could only go 12 weeks. I mentioned that with being on Pegasys that the shortest I had heard about was 16 weeks. He still felt that 12 weeks would be good if sx get to bad. He is worried as I am 65 yrs old, I will be starting procrit this week as my hemo dropped just below 10 (six shots done). There is no way that I will stop at 12 weeks after reading the info above. I will not stop at 16 unless I have to. What about lowering riba dose for last 8 weeks. I am on 1000 / day right now. What about going to 800. I know that lots of 2s and 3s only do a fixed 800 for entire treatment. I have also read that max riba is most important in early part of tx.
This is confusing as it would be hard not to want to stop early. Especially if your doc tells you to.
This is confusing as it would be hard not to want to stop early. Especially if your doc tells you to.
I wish you all the best in your tx. My DR would prefer i do the 24 weeks also, but the decision is mine. Like i said the sx are very bad for me and i'm not a whinner. I don't think i have ever spent more than a day in bed in my life. Now that I'm tx i'm lucky to get to the couch and to my appointments. I also have 2 kids still at home the youngest being 7. I just think that if i relapes i'm only 45 with no liver damage.... i do still have time. I respect whatever decision people make and i'm still scared but i don't want to get to the point that i end up with big problems.
Are you having many sx? How is tx going for you?
Best of luck.
Are you having many sx? How is tx going for you?
Best of luck.
So far SXs are mainly fatique, insomnia, headaches, concentration problems, and starting to get depressed. I don't feel like doing much and have to force myself to take on any task. Hopefully procrit will help with the fatique. I am 65 yrs old and my doc feels that things may get tough for me. I have only done 6 shots so far and from what I read on the forums, the SXs get worse as you get farther into tx.
Luckily my wife takes care of me and we have no little ones to deal with. Also, so far my appetite has been good and I have not lost any weight.
I guess I have to take it one shot at a time. Stopping early would be nice as I want to get on with whats left of my life, but I'm afraid of not getting to SVR. I don't know if I could ever do this again.
Try and hang in there. Hopefully you have support with your kids. This forum is a great source of info and support.
Thanks for asking about me.
Luckily my wife takes care of me and we have no little ones to deal with. Also, so far my appetite has been good and I have not lost any weight.
I guess I have to take it one shot at a time. Stopping early would be nice as I want to get on with whats left of my life, but I'm afraid of not getting to SVR. I don't know if I could ever do this again.
Try and hang in there. Hopefully you have support with your kids. This forum is a great source of info and support.
Thanks for asking about me.
65 is not that old. It's great to hear that your Wife is very supportive. I don't know what i would do without my husband. He is a firefighter so he has a lot of time at home and he takes care of everything right now. I think i really made my choice about stopping at 16 weeks because last Sunday night i spent in the hospital i had fever and so much pain and then they stuck me in isolation and scared the **** out of me because of my white blood cell count and neutriphils being so bad. I just looked at my husband and said i don't want this to kill me. I wonder some times how much the body can take. I have lost almost 20lbs in 8weeks so now i'm just over 100lbs. I can't affoard to loose 20 more lbs. I'm sorry about going on and on but it is very tough. I wish i could feel confident enough to make it to the 24 weeks, but the way things are going i know i will be lucky to make it to 16 weeks. You hang in there ok....some people have said thier sx get better with tx. I think it's all a **** shoot and we just have to keep fighting until we are done.
Your NP is probably basing the 12 weeks on the Manglia study here. Note that this study used Peg Intron, not Pegasys:
http://content.nejm.org/cgi/content/abstract/352/25/2609 (12 week Manglia)
There were a few similar studies that used Pegasys but this is the only one I could find. Note that this study is for 16 weeks.
http://www.hivandhepatitis.com/hep_c/news/2006/092906_a.html
Also, keep in mind there is even a newer study that suggests you might have something like a ten per cent better chance of going the full 24 weeks but also adds that a shorter course can make sense if your're experiencing bad sides since the odds still are quite good. I flagged Mike Simon on this because I believe he was the first one to post that study and I couldn't put my finger on it. If I find it, I'll post later.
Hope this helps some.
-- Jim
http://content.nejm.org/cgi/content/abstract/352/25/2609 (12 week Manglia)
There were a few similar studies that used Pegasys but this is the only one I could find. Note that this study is for 16 weeks.
http://www.hivandhepatitis.com/hep_c/news/2006/092906_a.html
Also, keep in mind there is even a newer study that suggests you might have something like a ten per cent better chance of going the full 24 weeks but also adds that a shorter course can make sense if your're experiencing bad sides since the odds still are quite good. I flagged Mike Simon on this because I believe he was the first one to post that study and I couldn't put my finger on it. If I find it, I'll post later.
Hope this helps some.
-- Jim
Wow, that is good to know. I'm suree the pharmacuetical companys love it when researchers find this stuff. I know i'm willing to take a small risk in stopping at 16 weeks. If this treatment does not do me in first. Thanks again.
From:
http://clinicaloptions.com/Hepatitis/Conference%20Coverage/Boston%202006
"This slide shows the results of this subset analysis. On the left-hand panel are patients who achieved RVR and were HCV RNA undetectable 4 weeks into treatment. Overall for patients with genotypes 2 and 3, even if they achieved RVR, the SVR was significantly lower after 16 weeks of therapy compared with 24 weeks (82% vs 90%, respectively). For patients with HCV genotype 2, SVR dropped from 91% to 80% when comparing 24 and 16 weeks, respectively. For patients with genotype 3, a nonsignificant decline in SVR rates from 89% down to 84% was observed with a shortened duration of therapy. Therefore, based on these data, it is suggested that patients with genotype 2/3 receive 24 weeks of treatment to achieve the maximal chance of SVR, even for patients with RVR. However, these data also suggest that for patients with RVR, treatment for 16 weeks will result in SVR rates of 80% to 84%. Therefore, patients who have trouble staying on therapy for 24 weeks still have a significant chance of achieving SVR with 16 weeks of treatment. Additionally, these data suggest that relapse following 16 weeks of treatment can result in favorable virologic outcomes with retreatment for 24 weeks.
The graph on the right shows striking data on SVR rates in patients not achieving a RVR. Only 49% of patients with genotypes 2 and 3 achieved SVR if they did not achieve RVR. Furthermore, reducing the duration of therapy to only 16 weeks significantly dropped the SVR rate from 49% to 27%. Clearly, patients who do not achieve RVR cannot possibly have a shortened duration of therapy. The question is, do these patients actually need an extended duration of therapy of more than 24 weeks? The ACCELERATE trial was not designed to address this, but additional studies looking at this population of patients with genotypes 2 and 3 who do not achieve RVR would be of interest to the field."
Mike
http://clinicaloptions.com/Hepatitis/Conference%20Coverage/Boston%202006
"This slide shows the results of this subset analysis. On the left-hand panel are patients who achieved RVR and were HCV RNA undetectable 4 weeks into treatment. Overall for patients with genotypes 2 and 3, even if they achieved RVR, the SVR was significantly lower after 16 weeks of therapy compared with 24 weeks (82% vs 90%, respectively). For patients with HCV genotype 2, SVR dropped from 91% to 80% when comparing 24 and 16 weeks, respectively. For patients with genotype 3, a nonsignificant decline in SVR rates from 89% down to 84% was observed with a shortened duration of therapy. Therefore, based on these data, it is suggested that patients with genotype 2/3 receive 24 weeks of treatment to achieve the maximal chance of SVR, even for patients with RVR. However, these data also suggest that for patients with RVR, treatment for 16 weeks will result in SVR rates of 80% to 84%. Therefore, patients who have trouble staying on therapy for 24 weeks still have a significant chance of achieving SVR with 16 weeks of treatment. Additionally, these data suggest that relapse following 16 weeks of treatment can result in favorable virologic outcomes with retreatment for 24 weeks.
The graph on the right shows striking data on SVR rates in patients not achieving a RVR. Only 49% of patients with genotypes 2 and 3 achieved SVR if they did not achieve RVR. Furthermore, reducing the duration of therapy to only 16 weeks significantly dropped the SVR rate from 49% to 27%. Clearly, patients who do not achieve RVR cannot possibly have a shortened duration of therapy. The question is, do these patients actually need an extended duration of therapy of more than 24 weeks? The ACCELERATE trial was not designed to address this, but additional studies looking at this population of patients with genotypes 2 and 3 who do not achieve RVR would be of interest to the field."
Mike
Yup that's it. Thanks for posting. Wish we could find the exact study instead of the presentation but it's probably referenced in there somewhere. In short, an 82 per cent chance of SVR for geno 2's if you take the shorter course versus 90 per cent if you go the full 24 weeks. The conclusion seems to be to go full course unless have bad sides then go short course since the odds (82 per cent) still are pretty good. Geno 3's seem to fair better on shorter course which is suprisingly in light of reports that geno 3's have a more difficult time clearing.
"For patients with HCV genotype 2, SVR dropped from 91% to 80% when comparing 24 and 16 weeks, respectively."
From the same site posted above.
Mike
From the same site posted above.
Mike
Thanks so much for all the info..... I guess i'm kinda playing the lottery here, I'm scared of stopping at 16 weeks but I think I'm more afraid of not stopping. Just got my latest labs faxed to me and things are moving all over the place again. I did shot #8 last night feels like my brain is going to explode, can't seem to too much of anything. I'm so scared of the damage tx is doing to me. Do either of you know how long after stopping treatment, if there is a relapse when does it show up, and how long you have to wait to treat again? I'm not a negative person, i have to believe i will be in that 80% other wise i would kill myself doing this tx. Thank God i have no liver damage and i still have time. I know a lot of people are not in that position and i don't know how they do it. Thanks Again
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