Tracey:
You did have a very significant response to the medications. It's true that you didn't become undetectable by week 12, but you came quite close. Although there are no guarantees, you are on a likely path to clear the virus before week 24. Thus your chances of beating the virus are significant – not great but substantial.
The article you cite concerns 48 vs 72 week treatment regimens. I think most people on this board are advocating that you fight to maintain your treatment dosages and maintain 48 weeks of uninterrupted treatment. The question of whether you would continue past 48 weeks is a separate question, and one that only your treating physician could answer. According to the article you mentioned, there are a higher drop out rate for those treating for 72 weeks, which makes sense, since it doesn't necessarily get much easier.
Thanks for your input but the specific url that antman posted discussed who could be called an evr - his contention was that i was not an early responder (the EVR was actually a 4 week number in this study) I was telling him that i thought i was an evr based on the 100 fold decline. did you read the url he posted? It would be cool if you did that way i would know if i am reading correctly.
I have another question - everyone is telling me that i need to fight fight fight for longer tx but then here is this study from just a week ago???
http://www.medicalnewstoday.com/articles/148570.php
Extended Treatment Duration in Chronic Hepatitis C Genotype 1-Infected Slow Responders: Final Results of the SUCCESS Study(2)
The primary objective of the SUCCESS study was to evaluate the effect of extending treatment duration to 72 weeks with PEGINTRON and REBETOL(R) (ribavirin, USP) combination therapy in genotype 1-infected patients who have slow response to therapy, defined as having detectable virus (HCV RNA) with at least a 2 log10 reduction in viral load at treatment week 12 and undetectable virus at treatment week 24. In this large, prospective, randomized, multinational clinical trial, slow responders were randomized at treatment week 36 to receive PEGINTRON combination therapy for a total of 48 weeks (n=86) (standard approved duration) or 72 weeks (n=73). Patients with undetectable virus at week 12 (complete early virologic response), received treatment for 48 weeks (n=816), whereas patients who did not respond to treatment (less than a 2 log10 reduction in viral load at week 12) were discontinued from the study. In total, 1,419 patients were treated.
In this study, sustained virologic response (SVR)(3) with 72-week treatment was not statistically superior to the 48-week treatment in slow responders (47.9 percent (35/73) vs. 43.0 percent (37/86), respectively), the primary endpoint of the study. Relapse rates between these two arms also were not significantly different (32.7 percent (16/49) vs. 47.1 percent (32/68), respectively) and adverse events were similar among treatment groups (secondary endpoints). Early discontinuation rates were higher in the 72-week arm compared to the 48-week arm (23.3 percent (17/73) vs. 9.3 percent (8/86), respectively).
"The absence of an early virologic response [EVR] at week 12, defined as undetectable HCV RNA ( 2-log decrease in HCV RNA at week 12 who have not become HCV RNA negative by week 24."
You started with a viral load of 700,000. A 2 log drop means you remove the last two zeros.....a decrease down to 7,000 at week 12 would be a two log drop. And your results were 99 so you got more than a 2 log drop.
Co
Thanks for your input - I read the info on the Url that you posted and it said that EVR defined as undetectable or greater than 100-fold decline in HCV RNA by week 12 have a 70% chance of svr whereas those who do not have less than 3%. With my numbers going from 700,000 down to 3,000 and then down to 99 by week 12 my reduction was a 100 fold right?
More confused Tracy
Hey everyone - I was searching for the Berg study that someone referred me to and came accross this - it is from the Hepatitis Association from April 2009 - fairly recent and I think the number that they quote is 98%. I have included the URL and the paragraph where i got the stat from - any thoughts on this?
http://www.hepcassoc.org/news/article183.html
Stopping Treatment in Likely Nonresponders
The absence of an early virologic response [EVR] at week 12, defined as undetectable HCV RNA ( 2-log decrease in HCV RNA at week 12 who have not become HCV RNA negative by week 24. Recent studies show that this information can be used to individualize the duration of therapy.
The HCV RNA status at week 4 also provides useful prognostic information that can be used to individualize the duration of therapy in genotype 1 patients (4,5). Normalization of ALT on treatment is an indicator of a therapeutic response but lacks specificity, and, thus cannot be used in place of serum HCV RNA determinations.
http://www.liverfoundation.org/downloads/alf_download_321.pdf
BTW- the stat for SVR at 12 weeks is <3% if not clear according to this article. you NP said 1% right? not too far off.