continuation of my request

[Premananda]

It has been detected that the genotype of my patient is genotype III, as per advice from the concern Doctor patient will go for 4 months dose of Titaferon 80mcg along with rivavirin.
Plz suggest if anything left from our end.

[flyinlynn]

Hi

You have responded to an old post in the Hepatitis C community.

We are not doctors here and cannot give medical advice you should see your doctor for this type of question.

I see you are asking about TITAFERON which is Peg Interferon I believe the name used in India for this medicine.

I am not aware of any dose adjustment for interferon based on body weight.

Also you may want to know this is very old treatment for Hep C there are newer more effective treatments recently approved in the US and may be already available in India if that is where you are. I don't know what names they have overseas but here in the US there are Sovaldi, Olysio & Harvoni.

You should ask your doctor about any new medicines available to you.

Again your best resource for dosing information is your personal physician who prescribed the medication for you.

As this is an old post the best way to get your question noticed would be to post your own new question. Go to the top of the page right side and select the green "Post a Question" link and ask away. Others on the forumn are very knowledgable an may have additional suggestions

Good Luck
Lynn

[gurdeepak]

Can Anyone Suggest me the Dosage related to body weight in case of TITAFERON ALFA 2b ...Geno 3, Viral Load 244000.

Does TITAFERON comes in 150 dosage...?? if not can we give a combined dosage of 100 and 50 of titaferon alfa 2b if body weight is higher than 95kg.??  

[hepcat1954]

If you've lost faith in your doctor, you should get a 2nd opinion from a qualified GASTROENTEROLOGIST!

We're not qualified here to give medical advice on stopping/adjusting HCV treatment.  You need a professional.

[Premananda]

It is in connection with my HCV patient which has been detected HCV with viral load 3,72,000 IU /ML, Genotype III. During the treatment, after the completion of 1month, HCV Quantitaive (HCV VIRAL LOAD BY TAQ MAN)
shows <15 IU/ML which was found effective. But, unfortunately  patient get admitted recently in a private Hospital nearby and found having anemia, 2 units of blood has been given to the patient.
Now my patient is in improving condition, coming Saturday dose of interferon will complete his three months course.

Patient is suffering in another sense after having the interferon dose. Shall we stop or else take opinion from the concern Doctor? Doctor advice was to have interferon dose for continuous 4 months. Plz suggest as soon as possible.

Regards,
Premananda  

[Premananda]

My patient is taking peginterferon alfa 2b ( once a week)+ Ribavarin 800mg (daily), as you suggested I will go for 6 months.

Thanking you,
Premananda

[ActingBrandNew]

If you only do 4 months (16 weeks) of treatment, you have a higher chance of relapsing. Talk to your doctor about doing at least 24 weeks.
___________________________________________________________
Individualizing Treatment Duration in Hepatitis C Virus Genotype 2/3-infected Patients

"The Accelerate study enrolled a large number of patients of different ethnicity and showed that the efficacy of treatment may be compromised when patients are treated for <24 weeks as the relapse is unacceptably high.[6] Although it has been shown that the occurrence of relapse after short therapy did not impact negatively on the outcome of a repeat 24-week course,[9] the challenge we are facing now is to better refine features of patients with a lower likelihood of relapse after a short course of treatment. In our protocol, evaluating so far 496 individuals who were treated with PEG-IFN α2b (1.5 μg/kg) and weight-based ribavirin for 12 weeks after RVR, 96% attained an end-of-treatment response, but 14% relapsed after the end of treatment.[9] This rate of relapse, lower than the rate reported in the Accelerate, can also be considered unacceptable when compared with the 2–7% rates observed after 24 weeks of treatment.[2,4,6]"

http://www.medscape.com/viewarticle/739955

[willbb]

Just to add to the excellent info given by Shyrlgame above,another article pertaining to Geno type 3.

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02715.x/full

Treatment with PEG-IFN and weight-based RBV for 16 weeks in patients a with rapid virological response (RVR) resulted in an SVR of 76.3% and 86.4% with 24 weeks of treatment, unlike genotype 2 which was 83.8% and 89.3% respectively. This was because of increased relapse rates in patients with genotype 3. Manns et al. [17] showed that the relapse rate was 26% after 16 weeks of treatment and 18% after 24 weeks in genotype 3 patients. The increased relapse rates could be because of steatosis, and as already mentioned, the increased rate of fibrosis in thes patients. In a cohort of 932 treatment-naïve patients, investigators of the ACHIEVE-2/3 trial [18] showed that hepatic steatosis significantly increases the risk of relapse independent of HCV RNA levels in patients with genotype 3 who achieve an RVR with IFN-based regimens. This may be because of altered IFN-α signalling, increased intrahepatic RNA levels or increased quasispecies diversity.
Other known risk factors for relapse are male gender, black race, age over > 40, increased viral load, presence of fibrosis, body weight > 85 kgs and presence of diabetes mellitus.

Also ,,if avail. you may want to discuss with the patientr haveing the "Il28B gene test as this is a good predictor of response as the above article states

best to you

Will

[Shyrlgame]

The current standard of care for G3, is usually for 6 months or more, with peginterferon and weight based Ribavirin (800 - 1400 mg per day in two doses, within 10 hours with food)

Hope this helps, some basics:


http://www.hepmag.com/articles/2512_18756.shtml

    

What treatments are available?

The goal of HCV treatment is to cure the virus, which can be done by using a combination of drugs. The standard of care and duration of treatment for hepatitis C depends on the HCV genotype (or genetic structure of the virus), along with what happens during the initial months of therapy.

Remember the importance of knowing your HCV genotype discussed in the "How is it diagnosed, and what tests are used?" lesson? Well, it matters when it comes to treatment.

Hepatitis C genotype 1 is treated with three drugs: pegylated interferon, ribavirin, and a protease inhibitor.  Treatment can last for as long 48 weeks, and will results in a sustained virologic response (SVR) in up to 70 percent of people who have never been treated for HCV.

Genotypes 2 and 3 are treated with pegylated interferon and ribavirin (standard dose is 800 mg/day, but weight based dosing is also used in some cases).  Duration of treatment ranges from three to 12 months, depending on hepatitis C viral load, liver damage, insulin resistance, and early response to treatment. Most people are treated for six months because the risk for relapse is greater when treatment is shortened. SVR rates among first-time treatment takers can be over 90 percent for genotype 2, and are 65 percent or more in HCV genotype 3.

HCV genotype 4 is treated with 48 weeks of pegylated interferon and weight-based ribavirin; SVR rates in people living with HCV being treated for the first time are as high as 70 percent.

Here's more specific information on the approved HCV treatment options:


Pegylated interferon. Interferon is a protein made by the immune system, named because it interferes with viral reproduction. In addition, interferon signals the immune system to recognize and respond to microorganisms, including viral and bacterial infections. Infected cells release interferon to trigger the immune response. There are three types of interferon: alfa, beta and gamma. Interferon alfa is used to treat viral hepatitis and some types of cancer.

In the 1980s, researchers were able to create interferon alfa in a laboratory. Hepatitis C is treated with man-made interferon alfa that has a molecule attached to keep it in the body longer and make it more effective, called pegylated interferon.  There are two brands of pegylated interferon, Merck’s PegIntron, which is dosed according to weight, and Genentech’s Pegasys, which is given at a fixed dose (i.e., the same dose for everybody).

During HCV treatment, pegylated interferon is given by weekly injections, for up to 12 months, at a much higher dose than what the body produces, causing many side effects. These include flu-like symptoms, laboratory abnormalities such as anemia (abnormally low red blood cell count), neutropenia (a decrease in neutrophils, a type of white blood cells that fight bacterial infections) and thrombocytopenia (low platelets), as well as psychiatric problems (e.g., depression, irritability, insomnia, moodiness). The good news is that clinicians have had years of experience with side effects management.
Ribavirin: Ribavirin is a nucleoside analog. It comes as a pill, capsule or liquid. Ribavirin is taken twice daily, and dosing is based on weight. Although it is not effective against hepatitis C when used alone, ribavirin plays an important role in HCV combination treatment. Although scientists have not discovered exactly how it works, it is clear that adding ribavirin boosts cure rates and reduces the risk of relapse.

The major side effect of ribavirin is anemia, which is dose-dependent and can be managed with red blood cell growth factors, or by lowering the dose of ribavirin. Additional side effects include heart problems, depression, dry skin, itching, rash, headache, cough and sinus problems, fatigue, diarrhea, dizziness, appetite loss, nausea and vomiting.

Ribavirin causes birth defects in animals, so it cannot be used by pregnant or breastfeeding women and their male partners. Men and women who are having intercourse must use birth control during HCV treatment, and for the next six months afterwards, since ribavirin can remain in the bloodstream after people stop taking it.
Protease inhibitors: Two hepatitis C protease inhibitors, Merck’s Victrelis (boceprevir) and Vertex’s Incivek (telaprevir), have been approved to treat hepatitis C, genotype 1, in combination with pegylated interferon and ribavirin. These oral antiviral drugs are used three times per day, for 12 to 44 weeks.

Protease inhibitors block an important step in HCV replication. The hepatitis C virus uses its protease enzyme to cut, or cleave, long strands of virus into shorter pieces, so that they can be rearranged and reassembled to form new viruses. Protease inhibitors stop viral cleavage by binding to the protease enzyme so it cannot cut, similar to covering scissor blades with glue.

Side effects of HCV protease inhibitors may vary according to the particular drug.  Both cause anemia. Victrelis may also worsen neutropenia and thrombocytopenia, and causes dysgeusia (metallic or altered taste in the mouth), dry mouth, vomiting and diarrhea. Incivek can cause a mild to serious rash, itching, hemorrhoids, anal and rectal burning, elevations in bilirubin and uric acid, and gastrointestinal discomfort.
When hepatitis C treatment is working, the virus will become undetectable within four to 12 weeks, and it will remain that way throughout treatment, and for six months afterwards: an SVR.

Researchers are trying to cure HCV without pegylated interferon, by using a combination of oral drugs, called direct acting antivirals (DAAs) to suppress viral replication, a strategy that works for treating—but not curing—HIV.

Evidence of the possibility of curing HCV without pegylated interferon and ribavirin was reported at a conference in April 2013, when 100% of trial participants were cured after six months of treatment with two DAAs. Clinical trials are exploring drug combinations and treatment strategies to increase SVR rates, with and without pegylated interferon and ribavirin.  
  






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Last Revised: June 03, 2013

This content is written by the Hep editorial team.