Does Smoking effect Treatment?

[Trinity4]

Yes, I smoke about 1 pk every 4 days.  I know it's a nasty, vile habit.  I've smoked since I was 25 years old so that's over 25 years of smoking.  I've never been a heavy smoker and quit with both pregnancies and a couple of times through out the years. Never smoke in my house, car, or at work.  It's after dinner, and during the evening hours.  As a matter of fact, I had quit for a year prior to dx of hepc. Cold turkey - no patches, no pills.  The logic is why am I even bothering with tx when the smoking is going to kill me anyway?  True that, and I know every reason in the world why I should quit right now, this minute.  I've mentioned coping mechanisms in the past that help us to keep ourselves in check when the sx get overwhelming.  I've tried AD's before - the sx from them are worse for me than the actual depression.  I don't get the benefit from them that most do and I really gave it an honest try.  So, when I get to the boiling point, I smoke a nasty cig and life becomes tolerable again for a while.  My question is, does smoking effect the chances of SVR?  If I was not a smoker, would I have possibly gotten UND at 12 wks instead of the 793 IU/ml?  I haven't seen any studies on this but I haven't made a great effort to find any either.  What are your thoughts on this -  BTW -  I already know what a knucklehead I am for smoking so please don't give me to much grief about that.  :)
Trin  

[CoWriter]

The smokers in the Egyptian study smoked >30 cigarettes/day.  The "Heavy smoking and liver" article referred to people who smoked ≥ 40 cigarettes/day.  The WIN-R study didn't specify.  

But obviously they're talking about heavy smokers.  

[gauf]

I smoke. I hate it. Been at it for 35 years. It is my last vice and plan to quit "again", after tox. The reason? COST!  The smoking itself doesn't seem to slow me down much, but after 35 years how would I know?

[fretboard]

If I were you I would just continue on with your smoking and tx.  Actually you don't smoke that much, 1 pk in 4 days is a minimal amount.  I agree with rita on this one, if you feel like you want to quit, take care of that idea after tx.  Yes, I am a smoker and I also go out of my way, as to being respectful when I smoke around others.  Also, as far as the studies go, I don't think you need those to decide that the cigs actually help you with your sx's, but it was a nice gesture for CS to post them for you.  What I mean is I'm sure that's part of the reason you smoke already or continue to.  God Bless  

[GSDgirl]

I also smoke.  I was und at 12 weeks and und after TX.  I don't get my next blood work until Sept.  Now I am nervous and have been and will be until Oct when I get my results.  I quit alcohol, I quit coke (snorting & smoking) I quit meth 20 years ago and it was nothing like what I am hearing it is today.  Never did like pills except the soma I take for the muscle pain.  Have pot here but haven't smoked in over 20 years, got some from my bro "just in case" LOL.  BUT my cigs, I get crazy nervous just thinking about quiting.

Also I had 5 phlebotomies prior to TX because of PCT .

Denise

[CockSparrow]

Dont try Pot. Its just as bad as tobacco. Just eat broccoli and brussel sprouts. They activate 1A2 as well.
But they probably dont make Broccoli Ice cream. Its all i ate on Tx

CS

[CockSparrow]

Hi CoWriter
You can think the data is flawed all you like.
Me i would like to see more studies done on it.

From Smoking is not associated with nonalcoholic fatty liver disease

Smoking is a well-studied risk factor for many malignant neoplasms, cardiovascular diseases, chronic obstructive pulmonary diseases and other important diseases. However, it was recently shown that smoking is associated with many of the risk factors for NAFLD, particularly obesity, IR, diabetes and dyslipidemia.
Basic and clinical research demonstrates that smoking alters enzymatic and inflammatory pathways in liver physiology, and is considered to be a risk factor for liver neoplasm, and affects the prognosis of chronic liver diseases.

Just letting you know I am aware of what smoking can cause and its relationship with liver disease.

What studies have been done on Smoking and SVR. Answer not many.
Heres one from natap
Smoking Cigarettes Reduced SVR Rates in Peg/RBV Study

The Influence of Cigarette Smoking on Response to Treatment With Pegylated Interferon alfa-2b and Ribavirin in Patients With Chronic Hepatitis C

".....Cigarette smokers with genotype 2 and 3 had lower SVR than nonsmokers.
This difference was not seen in the patients with HCV genotype 1.

Pity I am a G3.

Heres one from Egypt.
Impact of cigarette smoking on response to interferon therapy in
chronic hepatitis C Egyptian patients
CONCLUSION: Smokers suffering from chronic hepatitis C tend to have a lower response rate to interferon-α compared to non-smokers.
Therapeutic phlebotomy improves the response rate to interferon-α therapy among this group.

Tend to have lower response. Either they do or they dont.
In other words the response was lower but it didn’t hit statistical significance.

How the hell does phlebotomy improve response rate.
Unless smoking raises your iron level that is.


Come the evidence isn’t exactly overwhelming is it. Most of the ones you picked show that smoking is associated with many of the predictors of non response. But where are the ones that directly compare svr rates.
And I still say there haven’t been many studies done on it.

Yes I know it was a High Dose IFN study. 10 MU IFN alpha 2b a day to be precise. It was even injected for part of it. So I can spot the differences between it and how we use IFN.
From the study  
Differential Effect of IFN_-2b on the Cytochrome P450 Enzyme System:
A Potential Basis of IFN Toxicity and Its Modulation by Other Drugs1

The CYP enzymes are a superfamily of heme-containing enzymes distributed widely throughout the body that are involved in the synthesis and metabolism of endogenous substrates including steroid hormones, fatty acids, and lipids, as well as the metabolism of exogenous substrates such as drugs and environmental chemicals. IFNs have been shown to decrease the expression and activity of CYP enzymes in animal models.
Human data are less extensive and primarily limited to patients with hepatitis being treated with comparatively low-dose IFNs (12–15), but the available data indicate a detrimental effect on drug metabolism.

Now this comes from the Pegasys Product Info sheet
Drugs Metabolized by Cytochrome P450
There was no effect on the pharmacokinetics of representative drugs metabolized by CYP107 2C9, CYP 2C19, CYP 2D6 or CYP 3A4.
Treatment with PEGASYS once weekly for 4 weeks in healthy subjects was associated
with an inhibition of P450 1A2 and a 25% increase in theophylline AUC (see
PRECAUTIONS: Drug Interactions).

Now the High Dose study suggested that Inhibition of 1A2 was associated with neurological toxicities, and that 2D6 was associated with Flu Like symptoms and Fever

OK the Pegasys PI states that there was no inhibition of CYP2D6, but they were only treated for 4 weeks.

I don’t know about you but this is the first time I have seen anything that gives any indication of why some of us go thru Tx without any sides while others suffer them severely.

One of the things that intrigues me about this is that giving up smoking which is a good thing may and I repeat may cause you to have more sides than you otherwise would have as tobacco activates 1A2, and even Pegasys suppresses it.

Now will I smoke during my next Tx. Not a chance, wont start till I stop. But this has more to do with it MAY impact Tx and I am getting rid of all the mays, its not that this is proven.
I will let you know what I have sides this time.

CS