3a Riba dosage?

[GoodByeHepC]

Hi Everyone,

I'm wondering what the Riba dosage is for other 3a's and how you are tolerating it.

I'm a 3a and started treatment 2 months ago.
My Dr. put me on Peginteron (.4 on the redipen) and 1000 mg of Riba per day. He said that my Geno would normally be prescribed 800 mg per day but he felt that the extra pill per day would increase my chances for success.

But I feel like it may have increased my side fx as well.

Things have gone better than I expected so far but I have one side effect in particular that is alarming me. If I exert myself in any way my heart rate goes way up and I often feel like I'll pass out or have a heart attack. I was in good shape before tx and I'm a 47 year old male 167 lbs.

At Week 4 my viral load went from 700,000 down to 16,300. and my hemo was around 11.7. My Dr said that although I'm not technically a "rapid" responder it was still good.

Any other 3a's out there think that it would help reduce my side fx if I went to 800 per day on the riba. My Dr wouldn't give me a straight answer and said that I had to make the decision myself. He said that he didn't have any hard data as to whether or not reducing Riba by 200 mg per day would make a big dif in my side fx.

Thanks!

[zazza]

Regarding dosage:
I gained weight during treatment so I asked my doc if my doses of ribavirin and PegIntron ought to be increased. My doc checked my bloodcounts, especially my neutrophil and white blood cell count, and then said if I hit 76 kilo I would go from 100 mcg which I was currently on to 120 mcg. 120 mcg is the standard dosing for 76 - 85 kilo.

So weighing 76 kilo I dosed 120 mcg/0.5 ml from week 41 to 72. No significant differences in side effects, no differences in blood counts. I never heard of bumping just one tick, didn't think they did that. I thought it was 120 mcg/0.5 ml or 120 mcg/0.4 ml. But I did see the extra mark at 0.45 ml though.

I like that your doctor wants to give you Procrit instead of reducing riba. Good thinking!

Have you talked to him about extending to 48 weeks since you were not UND at week 4?

"I've learned significantly more on this website than I have from my own Dr." So have I.

Good luck and hoping you get to UND real soon!

[CockSparrow]

Comeagain-G3s who dont RVR have lousy SVR rates
Do you call 76% lousy thats with the higher doses 48w acc to that study

I should have said with 24 weeks.
You would expect better results with 48 weeks

CS

[GoodByeHepC]

Thanks Zazza & FIGuy,

My hemo was at 11.9 at 4 weeks.
I just did my 8 week and my hemo is still going down. It's at 10.4
I think he is trying to keep it from getting dangerously low. I've complained about very high heart rate and I'm sure he doesn't want to take any chances. So I may be on Procrit for a while if my insurance aproves it. He wants to avoide reducing Riba (as everyone here agreed)

RE my interferon dosage:
I asked him why my peginteron was set to .4ml and he seemed quite sure that it was the right dosage for my body weight (76 kg).
He called back later after checking my records and said that my body weight is right on the cusp of the dosage recommendations (As FIGuy pointed out) Meaning that I probably could have bumped it up to .45.
I'm sure he is trying to balance sx with results.
I asked him if my chances of being UND at week 4 would have been better if my dosage was slightly higher and he insisted that it would not have made a difference. I don't buy that.
I've decided to bump my dosage to .45 for the next two weeks 11 & 12 in the hopes that I'll be UND for my 12 week tests.

I don't know what my neutrophil count is. My conversation with Dr was over the phone and was mainly about the Procrit.

I agree with you about the miss-information that is circulating about g3s.
I've learned significantly more on this website than I have from my own Dr.

Thanks very much for your insight.
It's Truly appreciated.

[comeagain]

I didn´t mean they have unpresice testes because of missinformation ( or maybee they do) no I think its cheepnes. I meant that some people get overtrilled over 4w result and later find theme selfes in a chock of dissapointment.

[comeagain]

I think its odd when i lock at many studies so small nr of people involved.

And not enough thoroughly facts like for instance when they say RVR 4 w responder.
were they acctually 2w responders they mented, them who made it all the way,you dont know couse they did´t  tock any 1w or 2w vl testes.
And SVR rate among so called RVR wasn`t 100% it could have been them who was UND after w 2 that didn`t made it.  I think many peoble shout halleluja a little bit to early when they get their 4w testes.  Some have even not precice enough testes, and thats couse they missinformed due to not thoroughly studies.
That test cost 250 dollars in Sweden to get. With all the new tecknik data I think its a shame they hasn`t come up with much more presice figures long time agoo.
My hepdoc use to say you can allways find a study that contradict another.

[comeagain]

Cocksparrow-G3s who dont RVR have lousy SVR rates
dhttp://www.natap.org/2007/DDW/DDW_01.htmo Do you call 76% lousy thats with the higher doses 48w acc to that study
BTW is it over with pinkeye

[CockSparrow]

Comeagain - Why are geno 1a more difficult to treat the 1b, 3 more then 2.
And if a g1 have 80% chance SVR  with 48 w tx why shouldnt a geno 3.
That hasen´t been checked up yet I´m in a study for that at the precent.

Yes it has. Study 5 (NV15942) in the pegasys insert.
http://www.natap.org/2007/DDW/DDW_01.htm

Now this this the study that recommended 24 weeks even for Pegintron.
Now the SVR rates were not that different regardless of the arm you were in.
The relapse rates were lower in the 48 wk WBR arm.

Pegintron has never been had multinational studies comparing 24 wks v 48wks for G2/3.
Win-R doesnt count as it was a clinical trial Only dione in the US and had really high drop out rates.
http://www.natap.org/2006/DDW/DDW_24.htm
The was a similar study done in Canada.

There have been several G3 studies that have tXed for 48 weeks but these tended to be for specific reasons such as steatosis..
This is changing with several studies using either Peg looking at comparing 48 wks with 24 wks including the one you are in.

G3s who dont RVR have lousy SVR rates.
G3s who RVR are dead easy to treat and have excellent SVR rates.
But all genos have excellent SVR rates when RVR.

CS

[zazza]

A geno 1 RVR has better odds of SVR than a geno 3 non-RVR. Interesting, hey?

I am a geno 1. Having a low baseline viral load I was going to tx for only 24 weeks if RVR, which is becoming the norm in Europe for LVL. If I had been UND by week 12, I would have tx'ed 48 weeks. Since I was a slow responder, UND between week 12 and 24, I tx'ed 72 weeks.

Why are geno 3's not given the same chance as I got? They are taken off treatment if detectable at week 12.

[zazza]

With your weight of 76 kilo you would be dosed with 120 mcg PegIntron, i e the entire Redipen 120 mcg/0.5 ml, if you were a geno 1. What is your neutrophil count (ANC)? This is what may be affected by raising the interferon.

I agree with CockSparrow: "At the risk of giving medical advice I would set the dial to max, so long as my whites were not too low."

Why would your doctor put you on Procrit if your hemoglobin is 11.9? Or has your hgb become lower still? I was of the impression that Procrit is usually not used until 10, or at least 11.

[comeagain]

We are all in away labrats still, particullary g 2, 3.
Acc to zazza and I´m sure she have studies to back that up with geno 1 that are UND at week 12 has 80% chanses of SVR.  How much can you trust a study  was some of them UND earlier weeks and what other parameters like weight time of infection lengt of infec. rase , sex iron in the blood did they had and of cource vl, grade and state of liver damage and all the other aspect not even thought of so much of yet like lifestile digestivsytem how well its functioning etc.
Theres been a big differens last 10 years in curing HCV.
Why are geno 1a more difficult to treat the 1b, 3 more then 2.
And if a g1 have 80% chance SVR  with 48 w tx why shouldnt a geno 3.
That hasen´t been checked up yet I´m in a study for that at the precent.
It seems (my conclution) that the best for all Genos is to bee UND at weck 2 as the vertex paitent seems to be its an interesting subject though and we all have much more to learn.
And as I`ve sad in another tread I dont think its harmles for many to tx to long so shortening the treatment by hitting it fast and hard could be a goal to work after, just my thoughts I´m not a doc

[GoodByeHepC]

So which of thee two drugs actually eliminates the Virus?

It was my understanding that Interferon was the main drug and the Riba prevented the virus from reconstituting.

After reading this thread I'm thinking that my Dr. should have ticked up my peginteron one tick. (700,000 starting and 16,300 @ week 4)
My injections are set to .4 there are two more ticks - the max is .5
I can't help but think that if my dosage were one tick higher I would have been UND @ week 4.

I'll be speaking with him tomorrow. I think He's going to put me on Procrit due to the results of my last blood work.

thanks

[mar148]

I agree completely that once treatment begins you look at response and determine course of action.  But if a type 1 was not RVR that does not mean they would go 72 weeks verses 48, but look at how many logs they dropped and look at their week 12 response, which hopefully is undetected.  So by type of genotype the week four response means different things and different courses of action.  So no, your reaction to treatment is a critical component in strategy while going through it, but even then it means different things by genotype and with different statistical outcomes of success by genotype.

Treatment is part science, part art and knowledge of the disease factprs (VL, age, race... weight) treatment response and genotype.

[zazza]

The reason is that geno 2's and 3's who are not RVR are usually undertreated because of their genotype. By looking at time of response rather than genotype these non-RVR's would get at least the same chance as geno 1's.

It does not mean we should in fact ignore genotype, since genotype as you say tells us a lot about the probability of RVR, of fatty liver, etc. But once tx'ing, the on-tx response tells us more.

[mar148]

From what I read the genotypes are very different to how they replicate  and react to interferon/riba type medication.  To ignore genotype would be ignoring an important part of the treatment strategy.  Genotypes do have very different treatment outcomes and their reaction to medication and what is means to treatment success varies greatly.   While we all might have/had hepc on this website, the genotype makes it a little different for each of us in terms of treatment and the reaction the body has to the disease.  (i.e., type 3 has more fatty liver, type 2 some say have slower liver disease progression.....)

I am not sure why someone want to ignore genotype?  Is there are reason you would want to interpret the facts that way that I am missing?

[meki]

"I believe we should be Txed based on our response rather than by our Geno.
This would make no difference to the way most are treated but would catch slow responders of any geno. "

Agreed.

[mar148]

There is a higher SVR outcome for 2 but 3 is not far behind.  It is still the second best genotype to have in terms of SVR outcome than 2, not quite as good but still pretty good by any disease standard.

[BelB64]

I wonder what the numbers would have been like if everything was equal between the 2s and 3s. Since the 3s had on average higher VLs and more fibrosis and cirrhosis than the 2s, wouldn't it make sense that there was a higher SVR outcome for the 2s?  

If I'm reading this correctly the 3s had 5% more HVL patients and 7% more liver damaged patients than the 2s and ended up with 7% less SVRs.

It also appears that low viral load is the best predictor as again if I'm reading this correctly 81% of those under 400,000 RNA and 70% of those between 400000 and 800000 got to SVR.  66% overall is not as high as we'd like but still MUCH better than 1's. Hopefully when teleprevir and alinia become available they will increase the percentages of svrs dramatically

[CockSparrow]

Here are couple of links on HALT-C.
It used Pegasys but Conventional IFN will make no difference.

http://www.nih.gov/news/pr/nov2007/niddk-06.htm
http://www.hivandhepatitis.com/2007icr/aasld/docs/111607_a.html

CS

[CockSparrow]

Its called maintenance therapy and the studies done on it surprised everyone by proving that lowering your ALTs did not stop disease progression. In other words it doesnt work.

So I wouldnt do it. In your shoes and i kinda am, i would be looking at lowering hepatic iron and trying to work out the reason for your slow response.

Then I would hit it with everything I could throw at it. NPIA could well be a part of that approach.

Long term Interferon use carries certain risks.
You could end up with any number of AI issues.

Question your Docs make and sure you understand what they are trying to achieve.

All the Best
CS

[dranurag]

I understand it was riba and that is why they have stopped it. Now they want me to take standard interferon 3 miu 3 times aweek for many many years --may be life long. Any comments?

[CockSparrow]

It'll be back
It wasnt the Peg that raised your iron.
Actually it may have a bit not sure what liver cells do when then they die as far as releasing any stored iron goes.

I had high iron too Tx btw
CS

[dranurag]

I have become UND again with just standard interferon without anything else. Now I am stopping it after 6 months. Let us see if and when the virus comes back. My iron levels came back to normal after stopping peg and riba and are still normal.

[Lady Lauri]

CS, your awesome on those studies! Helped me  alot during tx!

Goodbye....didn't see it above, but have you had EKG, etc. before tx? Probably should have them do that to be on the safe side.
2b  & also had shortness of breath bad (1st side to leave me tho and I smoke!) and a LOT of heart palpitaions. As Gauf said, scares you. But with the check up before hand, helped me to not worry as much.

Be well, LL

[CockSparrow]

I would not be doing what you are. Non Peg IFN TIW has next to no chance of working and if its being used as maintenance that dont work either.

I would be looking at how to reduce my iron levels then Tx-ing again, but much harder.

I cant see where your docs are going with your Tx.
CS