FibroSure and biopsy

[MarkFly1]

Last summer or thereabouts, I had a Fibrosure test which indicated a score of F3 which was quite high compared to previous assessments of my liver.  My doc then decided we should do a liver biopsy which showed a fibrosis score of 0-1.  We decided to do another Fibrosure test 2 weeks ago which I discovered yesterday was F4 Cirrhosis.  Yikes.  Well, I did a little further digging and discovered that the Fibrosure test requires 10-12 hours of fasting ... no one had told me this and in both cases I had eaten regular meals.  Would digesting food skew the results so dramatically?
Because of this last test, my doc wants to start me on Telaprevir+PegIfn+Ribavirin.  Only prior treatments were with regular Interferon and Ribavirin.  I have the IL28B allele CC.  Should I go ahead and do the TPR treatment or wait for Sofosbuvir or do another Fibrosure test this time after fasting?

[MarkFly1]

Well, had my third Fibrosure blood draw this morning, this time with Quest instead of LabCorp and also after fasting.  Been taking zinc, vitamin D and no B-complex.  Seeing my hepatologist on Monday who went to Amsterdam for the liver conf.  Should be an interesting visit.  I'm wondering if there is a way to get a Fibroscan done, just recently approved by the FDA.  Other than the last Fibrosure tests, my blood numbers are seemingly ok except for somewhat elevated AST and ALT.  Well, hopefully this last Fibrosure will shed some light on the state of my liver.  Oh yeah, I will make sure the doc palpates my liver on Monday!

Mark

[MarkFly1]

Wow, you are lucky.  I wasn't able to get into that trial because of my prior interferon experience.  They either want treatment naive or those who have failed pegylated interferon.  I'm neither.  Well, thanks for your response and good luck.  I'm seeing my hepatologist on the 6th.  This time I'm going to make sure we're communicating very clearly!

Best,
Mark

[Willy50]

Mark, it sounds to me as though you want to try to treat.  You are correct there will be other forms of treatment coming up in the future.  You'll get there one way or another.  I can see you prefer to get it done sooner.  There is nothing wrong with that and my first doctor said he always preferred to try to cure people over waiting.

So far I have only been successful in getting into a trial with Sofosbuvir (7977) and Ledipasvir (5885) with riba.  I am in the 24 week arm. It appears to me that 12 weeks seems to be pretty effective in G-1 naives.
This may become the first approved interferon free treatment, but who knows?  Abbvie is also very close as well.  At one time they thought they might be first.

Good luck in whatever you should decide.

willy

[MarkFly1]

Willy, my doc isn't weighing the tests (biopsy, Fibrosure) equally.  I have just been worried about the two results.  What treatment are you on?  Maybe I should just go ahead and start triple therapy knowing that within a year or so I can be 'rescued' if need be by more recent approvals?
Glad to hear your treatment is going well so far.  Keep me posted.  I'm rootin for ya!

Mark

[MarkFly1]

Just wanted to let you know I appreciated your post a few weeks ago.  Really glad you were able to successfully get through the treatment.  I'm still waiting to see if I should give it a go or wait until Sofosbuvir is approved.  These last Fibrosures really scared me and I don't think I have as much luxury for waiting as I thought.

Best,
Mark

[Willy50]

Both myself and boceprevirgal reported f-4 findings with fibrosure which were disputed with a biopsy showing stage 2.  I'm not aware of anybody who would weight the fibrosure tests as equal to biopsy and my results show why.  My platelets are mid range by the way; 236 and confirmed in numerous tests.

I am bewildered by the notion of taking a 3rd fibrosure test.  Your tests have already shown the sampling error; one a stage 3, one a stage 4.  I got my fibrosure this summer and was counseled that they (the trial center) don't put much stock in them.  Part of my deal of getting into the trial was my staging had to be assessed; a fibrotest was the cheapest, fastest, least invasive.  It also proved to possibly be the least accurate, since looking at my platelets one might assume a non cirrhotic score, as well as my regular physical.  Both of my biopsies have been by world class doctors who also co-authored some of the studies presented at liver conferences.  I am more confident of the biopsy results than the fibrotest.

My study is going well. I am on my 12th day and I have no dicernable sides yet.  At times I imagine the riba is affecting me if I push myself, I may feel a little more winded or if I post and seem a little more opinionated.  : )  I ran a 5 K last weekend but that was only 5 days in.  I probably would today, as I feel no different but I am swamped with work.  I'm sure at some point I will feel the riba.

Bottom line is I am not aware of anyone who would weigh the blood tests near equal for your biopsy score.  You have your staging. The question is what to do with it?

You ask for feedback; mine would be wait, based on your biopsy score.
Your past treatment have demonstrated you are a lesser responder to IFN in spite of you being a CC.  You have results which prove that from what I understood. (possibly due to insulin resistance)

If you were to wait a few months for the approval of the new drugs you would face treatments with higher chances of success, a lower side effect profile and a possibly lower exposure to IFN in duration.

If I had your biopsy score I would wait even longer.  Frankly, I did wait longer. I was a stage 1 five years ago and declined treating until now.

Good luck.

willy

PS..... as a hypothetical...... imagine that I clear in 2 more weeks.  Imagine that my ALT drops to 20, down from 150.  Now imagine I get a fibrosure test.  Ask yourself what score the blood test would present?  It could show a decrease from cirrhosis to stage 1 or 2 in a matter of 2 months.  Do we believe those results?  

I have nothing to gain in trying to explain my viewpoint to you.  I'm actually explaining it to anyone who chooses to read this.