2nd treatment

[bren189]

2 years ago I was treated for Hep C with interferon injections wkly and riboviron 2 x per day for 6 months.  I was undetectable after 4 months but relapsed soon after the treatment ended.  Now I just learned that I have developed cirrhosis and my doctor wants me to do the exact treatment as before but for one year this time.  Does anyone know what the chances are that this will work.  I hear about the new treatments coming out but although I researched them i am not sure they applicable for me.  Genotype 3  viral load 1.5 mil  belirubin and criatine  levels are currently normal and Dr. says my liver is compensated and my meld score is 7  Thank you  

[Dee1956]

Hi there...ABN has given you some excellent advice.  I would try to wait for the new drugs if I were you.
I have read that doing the same thing does not always work.  If I were you i would want to wait for the newer drugs that are having excellent results.

Good luck
Dee

[ActingBrandNew]

Based on unacceptably high relapse rates, a shortened treatment duration is not recommended in genotype 3-infected patients with high baseline HCV RNA (>600,000 IU/ml), METAVIR 3 or 4 fibrosis, obesity, metabolic risk factors or viral co-infections (6, 16) .

Data of a retrospective pooled analysis of registration studies in non-RVR patients showed superior treatment outcome with weight based ribavirin and up to 48 weeks of therapy (17) . The role of treatment beyond 24 weeks has been evaluated only in a single prospective study (9) . Treatment up to 36 weeks in genotype 3-infected patients without RVR resulted in a small but statistically insignificant, improvement in SVR as compared to treatment with 24 weeks (62% and 51%, respectively).

The decision to retreat a patient with genotype 2 or 3 infection should take into account prior treatment regimen, duration, and response. Several trials have examined retreatment of genotype 2 and 3 infection, with SVR rates ranging from 53-63% with 48 weeks of therapy (18, 19, 20, 21) . EPIC 3 enrolled 367 genotype 2- and 3-infected treatment-experienced patients and reported SVR rates of 59% (genotype 2) and 55% (genotype 3), respectively. Relapsers had an SVR rate of 61%, whereas nonresponders had an SVR rate of 46%. Favorable predictors of retreatment response were: genotype (2 or 3 versus 1), low fibrosis score, previous treatment type, low viral load (<600,000 IU/ml), and previous response (relapser versus non-responder) (21) .

Recommendations for treatment-naive and -experienced patients with genotype 2 or 3 infection:

    Treatment-naive patients should be treated with peginterferon-ribavirin for 24 weeks (Class I, Level A).
    For patients with low viral load (HCV RNA 600,000 IU/ml), steatosis or advanced fibrosis, treatment beyond 24 weeks may improve response (Class I, Level B).
    Retreatment duration is 48 weeks (Class I, Level A).

http://www.hepatitis.va.gov/provider/guidelines/2012HCV-supplement.asp

[ActingBrandNew]

I am a genotype 3 as well and finished treatment in April of this year. I dont know much about cirrhosis so I wont address that but I will comment on your question about treating with Interferon and Riba again for a year. Genotype 3's have a high relapse rate. There are other genotype 3's on this forum who relapsed in the same scenario where there doc had them go for 48 weeks.

"I was undetectable after 4 months but relapsed soon after the treatment ended. "

If Im understanding you correctly, you first became UND at 4 months? What was your baseline VL last time you treated? It sounds like you should have stopped treatment if you were still detectable all the way up to 4 months. Are you treating with the same doctor now? If so, I would recommend you seeing a different one as it seems like the protocol may have been ignored and you treated 2 additional months for nothing.

Like I said, Im not familiar with the Cirrhosis aspect of your situation however the new meds do apply to you and if all goes well should hopefully be available soon. If it were me, Id definitely consider waiting for the new meds.

FOSTER CITY, Calif.--(BUSINESS WIRE)--Jun. 7, 2013-- Gilead Sciences, Inc. (Nasdaq: GILD) today announced that the U.S. Food and Drug Administration (FDA) has granted priority review to the company’s New Drug Application (NDA) for sofosbuvir, a once-daily oral nucleotide analogue inhibitor for the treatment of chronic hepatitis C virus (HCV) infection. The FDA grants priority review status to drug candidates that may offer major advances in treatment over existing options. Gilead filed the NDA for sofosbuvir on April 8, 2013, and FDA has set a target review date under the Prescription Drug User Fee Act (PDUFA) of December 8, 2013.

The data submitted in this NDA support the use of sofosbuvir and ribavirin (RBV) as an all-oral therapy for patients with genotype 2 and 3 HCV infection, and for sofosbuvir in combination with RBV and pegylated interferon (peg-IFN) for treatment-naïve patients with genotype 1, 4, 5 and 6 HCV infection.

Sofosbuvir is an investigational product and its safety and efficacy have not yet been established.

http://www.gilead.com/news/press-releases/2013/6/gilead-announces-us-fda-priority-review-designation-for-sofosbuvir-for-the-treatment-of-hepatitis-c