Stop tx or extend to 72 or more weeks?

Hi Dr D,

Thank you very much for taking the time to help people on this forum, like myself.

I am geno 1a, "at least" stage 3 (difficult to say for sure because one core was completely fibrous), white male, age 45, received hep c through a transfusion in 1981.  I am on tx currently, 180 Pegasys and 1400 ribavirin - I will take shot #30 tomorrow.  Besides liver enzymes, I had no hep c symptoms pre-tx.

Pre-tx VL - 718,581
week 4 - 193,000
week 8 - 30,000
week 13 - 1180
week 20 - 194
week 22 - 99
week 24 - <10 but detected
week 26 - <10 but detected
week 28 - Negative (=60 weeks after und - 100% (2/2)

The results from this study lead me to believe I should extend my treatment to 88 weeks.

So, am I a late responder or a super late responder?  Should I stop treatment or extend treatment?  If I extend treatment, how long should I extend?  Your opinion would be deeply appreciated, thanks!

smaug

[Douglas Dieterich, MD]

As long as you get to < 10 and stay there I would generally treat for 48-52 weeks ( a year is what I tell my patients) after they become undetectable. I dont think you have to go to 88 weeks 72 should be plenty, but I would go at least that long because of the slow response and the fibrosis on the liver biopsy.  Good luck, that should work and then the fibrosis should reverse some too! DTD

[smaug48]

Dr. D,

Somehow some of my original question was cut. After my VL stats should be the following:

I keep hearing that people who are not undetected by week 24 have a 2% chance of SVR even when extending to 72 weeks (although I have not seen the study(ies) yet).  Are you familiar with this statistic?

There is a new study out from Japan:

jstage.jst.go.jp/article/internalmedicine/47/14/1301/_pdf    (add www to the beginning)

that states that LVRs (undetected between weeks 13-24) should tx 60 weeks beyond becoming undetected, and offered the following results for super late responders (undetected between weeks 25-48):

Continuing tx for:
20-29 weeks after und - 18% (2 out of 11 people)
30-39 weeks after und - 20% (1/5)
40-49 weeks after und - 40% (4/10)
50-59 weeks after und - ND  (couldn't find in the study what this stands for)
>=60 weeks after und - 100% (2/2)

The results from this study lead me to believe I should extend my treatment to 88 weeks.

So, am I a late responder or a super late responder?  Should I stop treatment or extend treatment?  If I extend treatment, how long should I extend?

[smaug48]

Bumping to top

[Proactive]

Double Bump..I'd like to hear the doc's response as well...

[albany]

i am very interested in the reply to this question, as i mention more in detail (where Dr D is mentioned as an expert in this field) http://www.medhelp.org/posts/show/590259

[Pam09]

A related discussion, VL was started.