Aa
12 weeks tx for Genotypes 2&3
There is an exciting study printed on the janus7 site under genotypes 2008 that flatly states the for genotypes 2 and 3 if a person with a BMI under 27 is RVR after 4 weeks "almost all may be cured after 12 weeks of standard treatment" Considering this is without Alinia, without teleprevir this might actually be improved in the future. Also if Albuferon hits the market soon with injections every two or four weeks instead of every week, that would mean a total of 3-6 shots TOTAL. That would HAVE to make the tx easier to take. By the way the study was in the New England Journal of Medicine and the date on this was April of this year.
Barry
Barry
I think the issue of creating super resistant strains would be my concern.
Sure people want shorter treatment, and sure the insurance companies love that...
but every relaspe means someone having to retreat, with a potentially more virulent drug resistant virus, AND the possibility of spreading it.
I think if the relapse rates were no different we'd all be on board..but that is not the case.
My question is, who is being served by shorter less successful treatments...it surely is not the patients.
maryB
Sure people want shorter treatment, and sure the insurance companies love that...
but every relaspe means someone having to retreat, with a potentially more virulent drug resistant virus, AND the possibility of spreading it.
I think if the relapse rates were no different we'd all be on board..but that is not the case.
My question is, who is being served by shorter less successful treatments...it surely is not the patients.
maryB
my doc said something about this...because i was und at 4 weeks in still undecided dont know if i want to chance it ....
Here is some data related to treatment duration an SVR...
Understanding HCV Nonresponse and Identifying Candidates for Retreatment
Source: New Management Strategies for HCV Nonresponders and Relapsers
By: Mitchell L. Shiffman, MD
"Several small studies have suggested that patients with HCV genotype 2 or 3 who achieve an RVR can be treated for a shorter duration (12-16 vs 24 weeks) without any significant decrease in the number of patients achieving SVR.[16-18] In addition, a single retrospective analysis has evaluated the impact of reducing the duration of therapy from 48 weeks to 24 weeks in patients with genotype 1 who achieved an RVR.[19]
Unfortunately, in each of these studies, reducing the duration of therapy was associated with approximately a doubling in the relapse rate. In addition, a large, randomized controlled trial in patients with genotypes 2 and 3 demonstrated that SVR was significantly reduced in patients with RVR—from 90% to 82%—when the duration of therapy was shortened from 24 to 16 weeks.[3]Based on these observations, it is apparent that patients who achieve an RVR are highly sensitive to the duration of interferon-based therapy. Taken together, these studies also suggest that patients with genotype 2/3 with RVR should be treated for 24 weeks and those with genotype 1/4 for 48 weeks and that doing so is associated with high rates of SVR. As a result, the management strategy for patients with RVR who develop adverse events should be to consider reduction of the doses of ribavirin and/or peginterferon alfa so that these patients have a better chance to complete the current standard-of-care duration of therapy."
3. Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa 2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2007;357:124 134.
16. von Wagner M, Huber M, Berg T, et al. Peginterferon alpha 2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology. 2005;129:522 527.
18. Mangia A, Santoro R, Minerva N, et al. Peginterferon alfa 2b and ribavirin for 12 vs 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2005;352:2609 2617.
19. Jensen DM, Morgan TR, Marcellin P, et al. Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon alpha 2a (40 kd)/ribavirin therapy. Hepatology. 2006;43:954 960.
Hope this helps.
Hector
Understanding HCV Nonresponse and Identifying Candidates for Retreatment
Source: New Management Strategies for HCV Nonresponders and Relapsers
By: Mitchell L. Shiffman, MD
"Several small studies have suggested that patients with HCV genotype 2 or 3 who achieve an RVR can be treated for a shorter duration (12-16 vs 24 weeks) without any significant decrease in the number of patients achieving SVR.[16-18] In addition, a single retrospective analysis has evaluated the impact of reducing the duration of therapy from 48 weeks to 24 weeks in patients with genotype 1 who achieved an RVR.[19]
Unfortunately, in each of these studies, reducing the duration of therapy was associated with approximately a doubling in the relapse rate. In addition, a large, randomized controlled trial in patients with genotypes 2 and 3 demonstrated that SVR was significantly reduced in patients with RVR—from 90% to 82%—when the duration of therapy was shortened from 24 to 16 weeks.[3]Based on these observations, it is apparent that patients who achieve an RVR are highly sensitive to the duration of interferon-based therapy. Taken together, these studies also suggest that patients with genotype 2/3 with RVR should be treated for 24 weeks and those with genotype 1/4 for 48 weeks and that doing so is associated with high rates of SVR. As a result, the management strategy for patients with RVR who develop adverse events should be to consider reduction of the doses of ribavirin and/or peginterferon alfa so that these patients have a better chance to complete the current standard-of-care duration of therapy."
3. Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa 2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2007;357:124 134.
16. von Wagner M, Huber M, Berg T, et al. Peginterferon alpha 2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology. 2005;129:522 527.
18. Mangia A, Santoro R, Minerva N, et al. Peginterferon alfa 2b and ribavirin for 12 vs 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2005;352:2609 2617.
19. Jensen DM, Morgan TR, Marcellin P, et al. Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon alpha 2a (40 kd)/ribavirin therapy. Hepatology. 2006;43:954 960.
Hope this helps.
Hector
Sorry! -I didn't mean to alarm anyone!...I'll post the study as soon as I find the link again...Shouldn't take me long...sorry again for the sloppy post... ~Melinda
P.S. Did you know that the Hep C virus can live for 3 months in a dried blood drop, outside of the body? That makes me wonder how long it can live in the body even when it isn't replicating anymore..
Nah i didnt. I thought it was for no more than 4 days.
CS
Nah i didnt. I thought it was for no more than 4 days.
CS
I didn´t mean to be rude its just that I think thats quite some alarming facts there. If you can refer to any study or articel about it would be most appriciated.
take care !
comeagain
take care !
comeagain
I should learn to spell check
this line
If you are a G3 with any negative predicts especially HVL and F3 or F3 and maybe even F2.
Should say
If you are a G3 with any negative predicts especially HVL and F3 or F4 and maybe even F2.
The other spelling mistakes can stay.
this line
If you are a G3 with any negative predicts especially HVL and F3 or F3 and maybe even F2.
Should say
If you are a G3 with any negative predicts especially HVL and F3 or F4 and maybe even F2.
The other spelling mistakes can stay.
I did'nt find the study all that interesting myself. It showed what all the short cource studies have shown. The relapse rates are higher with a short course.
What was interesting about it was that they made an attempt to see who was likely to benefit from the shorter cource and this is about time.
But hionestlky couldnt that have been workout from the original short cource studies anyway if they re looked at the data.
Its clear that many of us G2 & G3s can get by with less.
Working out who is the difficult bit.
If you are a G3 with any negative predicts especially HVL and F3 or F3 and maybe even F2 I wouldnt even consider contemplateing the shorter Tx duraation unless you were prepared to go again for 24 weeks then 48 if you relapsed.
The study used Low platelets rather than F3-F4 which might be a better way of loking at this negative.
Of patients with EOT response, 14% relapsed off-therapy.
Factors predictive of relapse were age older than 45 yrs , BMI > 27 Kg/m2, platelets counts <140.000 mm3
In the subset of patients without these unfavourable predictors, relapse rate was only 7%.
Really what did we learn.
CS
What was interesting about it was that they made an attempt to see who was likely to benefit from the shorter cource and this is about time.
But hionestlky couldnt that have been workout from the original short cource studies anyway if they re looked at the data.
Its clear that many of us G2 & G3s can get by with less.
Working out who is the difficult bit.
If you are a G3 with any negative predicts especially HVL and F3 or F3 and maybe even F2 I wouldnt even consider contemplateing the shorter Tx duraation unless you were prepared to go again for 24 weeks then 48 if you relapsed.
The study used Low platelets rather than F3-F4 which might be a better way of loking at this negative.
Of patients with EOT response, 14% relapsed off-therapy.
Factors predictive of relapse were age older than 45 yrs , BMI > 27 Kg/m2, platelets counts <140.000 mm3
In the subset of patients without these unfavourable predictors, relapse rate was only 7%.
Really what did we learn.
CS
If you gonna state such info you better back it up!! Thinking about the brain and lung tumors and blood drop isssues.
That is really cool news! -I hadn't seen it yet...Personally, if I were to recommend anything, I'd say to do what is proven to work...So many of our friends on here have been trial guinea pigs, and found out, years later, that there was something horribly wrong with the trial meds...for example, there was a trial just stopped last month because it was found to cause liver, lung and brain tumors to grow! For now, I'll stick with the Pegsys and Ribavirin...the sides may suck, but at least you know what to expect...and, 24 weeks doesn't seem so long when you are 80% sure you will attain SVR...~Melinda
P.S. Did you know that the Hep C virus can live for 3 months in a dried blood drop, outside of the body? That makes me wonder how long it can live in the body even when it isn't replicating anymore...
P.S. Did you know that the Hep C virus can live for 3 months in a dried blood drop, outside of the body? That makes me wonder how long it can live in the body even when it isn't replicating anymore...
Who is everyone else who is fat @ses ?
I only see me , everyone else is just a big frecking grey mass!!
I only see me , everyone else is just a big frecking grey mass!!
Forgot to add that this pertains only to genotype 2. Current studies indicate that geno 3 is definitely more difficult to cure and that in some cases 48 weeks might be the safest protocol.
I am one of the people who did just that (actually 12 weeks of riba and INF plus an extra week on the INF alone), and I SVR'd. However, this came from necessity, not choice. I had severe autoimmune reactions to tx, and the doctor consequently made me quit.
If you can possibly tolerate the full 24 week course, I would recommend completing it. I believe the odds of cure, with RVR and BMI under 27, are 82%% after 12 weeks, vs. 90% after 24. 8% is a sizable percentage and not something to disregard.
If you can possibly tolerate the full 24 week course, I would recommend completing it. I believe the odds of cure, with RVR and BMI under 27, are 82%% after 12 weeks, vs. 90% after 24. 8% is a sizable percentage and not something to disregard.
I Judge Myself by my intentions and everyone else by their actions. It works like this, I intend to loose weight, everyone else is a Fat @ss.
I wanna take that back about losing 20lbs, Im not gonna lose anything I`m gonna eath fat unhealthy food everyday if I want to.
Why do I say this ? beacause 5 minuts after I had write that i was gonna lose 20lbs i went out and bought a big bag og candies
Thats me in a nutshell as soon as i think I´m gonna stop with something its okey to do it!!
Because I´m gonna stop tomorrow anyway, if not tomorrow the day after tomorrow or next week or next month.
I know I´m gonna stop thats for sure,its not only ok it would be stupid not to do it I just have to since I´m gonna stop anyhow!!!!!!
BTW 8 of them lbs I´ve lost I did because i had the flue a week ago so what am I bragging about get a grip maan!!!!
Why do I say this ? beacause 5 minuts after I had write that i was gonna lose 20lbs i went out and bought a big bag og candies
Thats me in a nutshell as soon as i think I´m gonna stop with something its okey to do it!!
Because I´m gonna stop tomorrow anyway, if not tomorrow the day after tomorrow or next week or next month.
I know I´m gonna stop thats for sure,its not only ok it would be stupid not to do it I just have to since I´m gonna stop anyhow!!!!!!
BTW 8 of them lbs I´ve lost I did because i had the flue a week ago so what am I bragging about get a grip maan!!!!
Thats interesting I´m a g3 relapser. But 5 or six other people I know have cleared, some older, some heavy drinkers ( I´ve been sober for 21years) but everyone has been 20lbs or more lighter then me. i think its a crucial factor, my intuition says that.
Now I´m down 15lbs planing to be down 20lbs for the last 24w on this tx.
5lbs more 8w to make that.
I`m also gonna take lactoferrin in end of tx and a while after to strenghten my immunial system, bye doing so i think I´ve given it my best shot for now.
I dont think this soc is without risks so I welcome every shortening of treatment as long as it dont end up in being lengtening bye have to do it twice.
Just as nygirl pointed out.8 ( thats what I`m doing right now first tx 24 sec 48 )
Never heard anything about getting immun to soc though
Now I´m down 15lbs planing to be down 20lbs for the last 24w on this tx.
5lbs more 8w to make that.
I`m also gonna take lactoferrin in end of tx and a while after to strenghten my immunial system, bye doing so i think I´ve given it my best shot for now.
I dont think this soc is without risks so I welcome every shortening of treatment as long as it dont end up in being lengtening bye have to do it twice.
Just as nygirl pointed out.8 ( thats what I`m doing right now first tx 24 sec 48 )
Never heard anything about getting immun to soc though
There can be a study to prove just about everything that you want to with this disease. However - we've seen WAY too many relapses with Geno 2 and 3 to believe that trying the short course necessarily does work like magic.
If you are going to treat - go for the full dose and the full course. The first time you treat is the BEST shot you have at beating this disease. You do NOT want to amp up viral immunity to the meds and find you it didn't work. Take the full time to make sure your immune system has been well enough trainned to kill off any straglers that might be lounging around. REmember a blood test can look in your blood but nobody knows if there is other virus present anywhere.
Ask the geno 2 and 3s that haven't had success - if the additional weeks are worth it. if it doesn't work you are relegated to doing 48 weeks.
Good luck.
If you are going to treat - go for the full dose and the full course. The first time you treat is the BEST shot you have at beating this disease. You do NOT want to amp up viral immunity to the meds and find you it didn't work. Take the full time to make sure your immune system has been well enough trainned to kill off any straglers that might be lounging around. REmember a blood test can look in your blood but nobody knows if there is other virus present anywhere.
Ask the geno 2 and 3s that haven't had success - if the additional weeks are worth it. if it doesn't work you are relegated to doing 48 weeks.
Good luck.
For BMI do you mean body weight? So it would be good if you are type 2 like myself to be below that when I start treatment in July?
Have an Answer?
You are reading content posted in the Hepatitis A Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
