Boceprevir or Teleprevir.. I need to choose which one.

[cieritaqt]

Well, my start date for treatment is set for September 16th. I can choose between Boceprevir and ribivirin with interfuron, or Teleprevir with  ribivirin with interfuron. Since I am genotype 1b, I gotta choose one or the other. Teleprevir is only 12 weeks, but can cause a rash, and anal burning and hemroids. The Boceprevir is 20 weeks (basically all three drugs during the whole TX), but has more chance of loosing morew WBC's causing more anemia vs. Teleprevir. I think I am going to do the Bocevir. Any thoughts or suggestions will be greatly appreciated. Thanks! Peace and love to you all!

C

[willbb]

Congrats on getting started soon. As far as what to treat with ,it is obvoiusly a personal desicion one made with the advice of a knowledgeable doctor in the treatment of HCV.

The two P.I."s if you look at them are fairly close in their efficacy in trials. As you know the protocols for dosing are somewhat different as you state  and some sides are more prevalent with each,,but your facts may be a touch off as far as length of time

This is for treatment naives  without cirrhosis:

Incivek is taken for 12 weeks with INF/RIBa  and if UND.at weeks 4 and 12 then you would do the INF./Riba only for an additional 12 and be finished at Wk.24

If you have VL 1000 at Wk. 4  or 12 then you stop(as their is little chance of success, and possible resistance build up according to the drug co.)


With Vic: You do a lead of   Inf./Riba for 4 weeks  and then start Vic(if you have had at least a 1 log drop in the first 4 weeks)

If you are UND. at Wk.8and 24 then you continue on  triple till week 28 ..then you are done.

If you are Det. at Wk.8  but UND. at Wk. 24 then you do triple  till Wk 36  and then do just Inf/Riba for an additional 12  for a total of 48.

if you have VL>100 at Wk.12   or any virus at all at Wk.24(you stop all treatment as there is little chance of success)

Hope this isn't too confusing ..there seems to be some  confusion for some on the protocols for both.( see below)

http://www.accessdata.fda.http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/201

917lbl.pdfgov/drugsatfda_docs/label/2011/201917lbl.pdf


As far as the side effects by trial data..they really weren't that much different it terms of anemia:

Vic: showed approx. 20% more patients had anemia issues than with InF. /Riba alone  and

Incivek: showed approx. the same increase  approx. 20% more patients had anemia issues than INF/Riba alone ..... so not much different,other than I believe the data shows that with Vic the degree of anemia was somewhat more severe.

The other differences  that showed up significantly in trials is: With  VIc. approx. 35% (total patients complained of  bad taste in their mouth ).....   and with Inci    20% more complained of itching. than with Inf. /Riba alone  ...also aprrox. 12% complained of hemmroids and anal discomfort w/Inci  whereas this did not seem prevalent with Vic.

Again..I know there are a number of folks undecided on which to take .. hope this may help and not made it even more confusing(but decisions should always be made according to a doctors advice obviously)

Will

..

[CaughtOffGuard]

I personally chose Incivek (Teleprevir) for the 24 week treatment time.  
I have just started week 2 of treatment.  I have the rash that you are talking about.  So far, it's mildly irritating......Gold bond cream, applied every four hours, is doing a great job for me.

Good luck with everything.

christina

[willbb]

meant to add in the Incivek protocol      If you  have DET virus of 1000 or less at Wk 4 or 12  then you continue on past the week 12 for 36 weeks with Inf/Riba alone for a total of 48 weeks(as long as you are UND. at week 24

[cieritaqt]

Hey Will! Thanks for all the info, you're on it. The stuff you wrote above reflects the flow charts the doctor showed me yesterday to compare Incivek vs. Vic. I am a little confused though. If I choose Victrelis (Boceprevir), does that mean my chances of the treatment lasting up to 48 weeks, are greater than if I choose Incivek? Obviously, I am looking to shorten the duration of treatment.

Also, my viral load is under 1/2 a million. Does this mean the dosage strength prescribed to me will most likely be less than if I were older and had a viral load of 3 or 4 million, for example? I am 29 years old... Thank you so much!

[cieritaqt]

Thank you for your input. Hang in there. May I ask why you chose Incivek over the Victrelis? I am with Kaiser, and the Incivek is not available in the pharmacy yet, I will need to wait until mid October if I choose Incivek. I just want my treatment to start sooner, that way it will end sooner. Also, don't hesitate to reach out to me if you need any support.

[willbb]

The shortest amount of time you would do on Inci (depending on good results ) is 24 weeks   and on Vic (depending on good results)  is 28 weeks...so obvoiusly 4 more on Vic.

Are your chances of having to do 48 greater on either?? given that they are saying efficy is very comparable  for both ...I would say not as a naive

Your Vl  and age  have no bearing on dose.

Good luck with what you choose....

Will.

[dixiechicdana]

My viral load went from 14,900,000 to 43 at week 4 so your chances are very good. :)

[newyorker719]

im on week 5 w/ incivek..no rash...side effects arent bad at all..just have low wbc..may have to do neulasta..havent gotten sick at all...feel pretty good! im young too..had viral load of 500,000 starting...dont know if that makes a difference as far as the side effects u get. good luck!

[beeblessed]

Hi there.  I agree with Will.  Good info.  
I am starting on Vic soon.  Initially my doc wanted me on Incivek but after speaking with colleagues about how their patients were doing, she decided to switch me to Victrelis.  She said they had reports that more and more people were having anal pain and/or bleeding, and "firey" bowels, on Incivek.  But check out the many posts from folks on both sides.  Some have very few side effects, while others are worse and struggle to get through, while still others have used rescue drugs or other remedies and come through with flying colors.

Lastly, I did like the draw of "less time" with Incivek (keeping the early UND requirements in mind), but for me the sides with Vic (other than Anemia) do not sound nearly as prevelant as with Incivek.

Good luck on your decision.

[screaming48]

I will be doing the incivek but will still have to treat the whole 48 weeks even if at 4 weeks I am undetected, doc said didn't want me to relapse so its 48 weeks.:( only 12 weeks on incivek thank God

[frijole]

I chose the VIC.  My doctor prefers the INC primarily because the patient starts with all 3 drugs and he thinks that is easier than adding another drug at week 4.  I decided on VIC because I don't want the rash or the anal burning but also because I have seen some pretty amazing successes on this forum with VIC in the trials.  Either way you go is fine.  This is just personal for me.  There is something really scary about taking something that is so strong you only have to do it for 12 weeks.  I actually prefer the extended time with teh VIC.  I was anemic and had low neutrophils last time, so I am expecting that - maybe just a few weeks sooner this time.

Good luck with your decision.  I think about 95% of people who has started since FDA approval (on this forum) are treating with INC.

Welcome to the forum.  I find it a very helpful and comfortable place to be.

frjiole

[Lifenet62]

Frijole you always nail it.....this forum is a helpful and a comfortable place to be.

Cieritaqt.....I was just approved for tx, and most likely will be on VIC.  
Dr also stated perianal problems with patients on INC....using Boudreaux's Butt Creme....no joke, and I hear it really works!  
So VIC it is if the can get the drugs, scripts being written on Monday...I am being assisted financially and this is a blessing.  Target Start date for tx is last week of Sept....It is wonderful that many of us will be starting treatment around the same time so we can go through it together.....this forum and site have given me hope, information and peace of mind, that I never thought I could find outside of therapy....I wish you the best and peace of mind....know I will be keeping you in my thoughts, new friend.

Willbb, thanks for the clear, concise info....much appreciated.....

[joemc34606]

Myself and my doc choose invevik for the shorter time and he mentioned to me less sides with incevik. He told me Vic had more dry mouth and sores, not sure? But I'm on week seven and und at 4, stopping incevik at 12. Only five more weeks seemed to go pretty quick. Joe

[indy531]

I'll be doing the 4 wk. lead in w/PegInterferon/Riba before adding Vic. for 12 weeks, then last 8 w/P. and R.. I wasn't offered the choice and to be honest, while this forum has been extreley informtive, my MD/hep's specialty is HCV and he attended UVA, an institution that I regard very highly. He has had extensive experience in HC treatment, but he is also open to my questions/concerns.

[MsEllie60]

thank you for all of the comments ans suggestions.  It's funny I havent even begun the treatment yet and I fill so involved.  One questions though that no one has taked about..... "family support".  I pray that I dont have "any" side effects because my husband is disabled and won't be of any help and my children live away.  I'm not wanting to be babied, but when you don't feel well you just don't feel well.  Any suggestions!!!!

[streamline569]

I think quite a few of us are doing this alone. I thought I wanted people to be there with me to help. Now that I'm on week 8. I''m glad I'm alone and try to avoid as many people as I can. You'll be able to do it alone. Don't worry.  

[frijole]

msellie - You are treatment naive?  You have the possibility of doing 24 or 28 weeks which should not be too bad.  My husband picked up the slack with meals - not that I cared much about what I ate first treatment.  Since your husband is disabled is there any chance you could get Meals on Wheels or any other meal program?  Mind you I cooked Christmas dinner for 20 at week 24.    Housecleaning -- let it go.  I worked full time and was glad to do that but cut out all other activies.   No one can tell you how you will react but it is worth a try.  Do you know what your liver damage is?

lifenet62 - How kind of you to say that.  This is a comfort zone.  Outsiders don't understand and frankly I don't tell anyone so really don't give them a chance.  So this is the place to be.

[MsEllie60]

I am supposed to start a 48 week session.  I have another illnesses that I am being watched for and just got over having both hands operated on for CTS.  Permanent nerve damage and a bad legiment in my left knee from a fall.  Cooking is ok but cleaning is out of the question.  I might end up hiring someone to clean up for me.......oh well,  gotta do what I gotta.  I think the anxiety of it all is getting to me!.  I stay in prayer!

[cieritaqt]

I am not sure yet, but I have heard of hep C suppost groups. Are there any in your area? Like meetings where people go and gather support from each other? I know there are some in Los Angeles.

[GINGERPAL]

I chose to do the Incivek instead of the victrelis ...it is just what i thought I would take.  I think both drugs can have the same SVR results...of course the side effects are different.  I guess I think I can handle a rash better than anemia....but I am sure I will get anemia anyway because I got it the last time I treated with SOC.  But I will only have to take the incevik for 12 weeks, so I think I preferred that.  I guess it is a personal decision which drug to take....whatever you decide will be the right decision for you.
I will be treating by myself....so Streamline I look to you for strength ;)
Good luck to everyone!  Ginger P

[cieritaqt]

Thank Ginger! Good luck, the Incivek is not available to me yet in Kaiser pharmacies, so I guess I will start with Victelis since it s available first. I have read up alot on this, but what do the acronyms stand for? SVR and SOC?

[hrsepwrguy]

SVR - sustained virological response

SOS - standard of care

[hrsepwrguy]

SOC not SOS sorry

[GINGERPAL]

In a non-technical way, the way I understand SVR is that it is  'sustained virolgical response' meaning that the virus is gone....and that it is gone 6 months after finishing tx...which should mean that it is gone for good !
SOC is  'standard of care'  and I understood that this was meant to be the standard of medical treatment...which was used for the dual treatment.  Now people have available  triple therapy which includes the new PI (Protease Inhibitor -> either incevik or vitrelis).