Aa
A ? For HR Pleasae
HR, what is your opinion or knowledge about whether a person can develop a resistance to interferon with multiple tries at clearing the virus? Say a person who may have cleared had they been able to finish treatment, but because of side effects they were taken off SOC and did not clear? If they try again and again can they develop resistance?
yeah, I hope hr gets a chance to comment on this, it's something I've wondered about for a while...
The following recent small study out of Mayo indicates fairly dismal outlook for simply spinning the roulette wheel again:
http://www.ncbi.nlm.nih.gov/pubmed/17253142
it closes with:
"In conclusion, HCV patients who fail PEG plus RBV may represent a highly resistant group of patients who need more effective treatment strategies, preferably with multidrug combinations. Retreatment of these patients with another course of PEG IFN plus RBV after they have not responded to an initial course of PEG IFN plus RBV is of marginal benefit. "
all were on 2b for round 1 and 2a for round 2 confirming once again that that's not one of the variables worth varying. On the other hand, tx duration for 1s seems to play a more critical role if you're lucky enough to sail past the w12,w24 and breakthrough shoals:
"An important point regarding the 2 patients who did achieve SVR is that they were treated for >48 weeks. They were treated for a total of 68 and 72 weeks (for 48 weeks after HCV RNA became negative) during the second course of PEG IFN plus RBV. These patients were treated for a longer period of time because they demonstrated fluctuating levels of viremia, including positive HCV RNA following periods of undetectable RNA. This finding suggests that the standard 48-week treatment is insufficient and that an extended course of treatment may be necessary. "
The following recent small study out of Mayo indicates fairly dismal outlook for simply spinning the roulette wheel again:
http://www.ncbi.nlm.nih.gov/pubmed/17253142
it closes with:
"In conclusion, HCV patients who fail PEG plus RBV may represent a highly resistant group of patients who need more effective treatment strategies, preferably with multidrug combinations. Retreatment of these patients with another course of PEG IFN plus RBV after they have not responded to an initial course of PEG IFN plus RBV is of marginal benefit. "
all were on 2b for round 1 and 2a for round 2 confirming once again that that's not one of the variables worth varying. On the other hand, tx duration for 1s seems to play a more critical role if you're lucky enough to sail past the w12,w24 and breakthrough shoals:
"An important point regarding the 2 patients who did achieve SVR is that they were treated for >48 weeks. They were treated for a total of 68 and 72 weeks (for 48 weeks after HCV RNA became negative) during the second course of PEG IFN plus RBV. These patients were treated for a longer period of time because they demonstrated fluctuating levels of viremia, including positive HCV RNA following periods of undetectable RNA. This finding suggests that the standard 48-week treatment is insufficient and that an extended course of treatment may be necessary. "
You are absolutely right. I used the wrong word. I used response instead of SVR. Sorry, I need to be more careful. I forget that people can't read my mind.
Yes jmjm, making the treatment longer duration or higher dose sometimes helps enough to get that person over the hump to an SVR.
Yes jmjm, making the treatment longer duration or higher dose sometimes helps enough to get that person over the hump to an SVR.
Susie:
I'm surprised that you say many here have responded to the same interferon on the second try. Makes me wonder if they complied better
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Assuming a viral response the first time (>2 log drop in 12 weeks for geno 1's), in many cases they simply treated longer with the same Peg. Say 72 weeks for geno 1's or 48 weeks for geno 2's.
That's not to say that doctors sometimes don't change the Peg, or even up the doses (double-dosing for example) on retreatment. Lots of retreatment strategies as you can see right in this discussion group.
Also, if non-compliance was an issue the first time, that has to be dealt with. Perhaps using epo if non-compliance had to do with anemia. Or maybe prescribing ADs if non-compliance was due to depression, etc, etc.
I'm surprised that you say many here have responded to the same interferon on the second try. Makes me wonder if they complied better
-----------------
Assuming a viral response the first time (>2 log drop in 12 weeks for geno 1's), in many cases they simply treated longer with the same Peg. Say 72 weeks for geno 1's or 48 weeks for geno 2's.
That's not to say that doctors sometimes don't change the Peg, or even up the doses (double-dosing for example) on retreatment. Lots of retreatment strategies as you can see right in this discussion group.
Also, if non-compliance was an issue the first time, that has to be dealt with. Perhaps using epo if non-compliance had to do with anemia. Or maybe prescribing ADs if non-compliance was due to depression, etc, etc.
""I'm surprised that you say many here have responded to the same interferon on the second try. Makes me wonder if they complied better.""
Responding to the same treatment has nothing to do with "complied better" most will get the same response but will not get the big SVR!!!!!!!! And as a side note I responded to both peg intron and pegasys but did not get the gold!!!!!!!!
Have a great day!!!!!!!!!!!!!!
Responding to the same treatment has nothing to do with "complied better" most will get the same response but will not get the big SVR!!!!!!!! And as a side note I responded to both peg intron and pegasys but did not get the gold!!!!!!!!
Have a great day!!!!!!!!!!!!!!
""I'm surprised that you say many here have responded to the same interferon on the second try. Makes me wonder if they complied better.""
Responding to the same treatment has nothing to do with "complied better" most will get the same response but will not get the big SVR!!!!!!!! And as a side note I responded to both peg intron and pegasys but did not get the gold!!!!!!!!
Have a great day!!!!!!!!!!!!!!
Responding to the same treatment has nothing to do with "complied better" most will get the same response but will not get the big SVR!!!!!!!! And as a side note I responded to both peg intron and pegasys but did not get the gold!!!!!!!!
Have a great day!!!!!!!!!!!!!!
Technical is the last thing I need.......lol. This old brainfogged mind can't take too much technical any more. Thanks for your explanation. It was simple enough for me to understand.
I'm surprised that you say many here have responded to the same interferon on the second try. Makes me wonder if they complied better. We have way less than 10% doing that on their second tries on my board. And we've never had anyone respond to the other interferon after failing one. Of course there aren't enough people on the boards for a good sample, I wouldn't think.
I'm surprised that you say many here have responded to the same interferon on the second try. Makes me wonder if they complied better. We have way less than 10% doing that on their second tries on my board. And we've never had anyone respond to the other interferon after failing one. Of course there aren't enough people on the boards for a good sample, I wouldn't think.
I think studies have shown that if you respond to a particular interferon once, than you will likely respond to that same interferon again. Also, anecdotally, we see so many here who have failed treatment at least once, only to suceed using the same Peg perhaps for a longer time.
I think the difference is in part that interferon -- unlike the PPI's like Telaprevir -- work in an indirect fashion, i.e. on the immune system -- while the PPI's work directly on the virus itself. When a PPI works on the virus, a resistant strain to the particular PPI may survive and thrive, making it in theory more difficult to fight that strain in the future with the same PPI. But since the Peg works on the entire immune system, this specific. situation doesn't exist. I'm sure HR or someone else will come up with a more technical explanation.
-- Jim
-- Jim
I think the difference is in part that interferon -- unlike the PPI's like Telaprevir -- work in an indirect fashion, i.e. on the immune system -- while the PPI's work directly on the virus itself. When a PPI works on the virus, a resistant strain to the particular PPI may survive and thrive, making it in theory more difficult to fight that strain in the future with the same PPI. But since the Peg works on the entire immune system, this specific. situation doesn't exist. I'm sure HR or someone else will come up with a more technical explanation.
-- Jim
-- Jim
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