Aa
GP7852/Glen
Glenn, I feel terrible. You are not a candidate for Viekira Pak as you have used sovaldi. One of the Abbvie drugs is contraindicated (paritaprevir) for the use of Viekira Pak if you have used sovaldi. There must be a resistance issue, at least for now.
I know you live not too far from Philly and Baltimore. Is there any chance you can see a hep doc at Johns Hopkins in Baltimore(Dr. Sulkowski)? Or at NIH in Bethesda, MD? They may have some trials where you don't have to worry about insurance issues. And they may have some things up their sleeves that are not public information. Also, you would be under the care of some of the top hep docs in the country.
Try to find out if there is anything going on with daclatasvir. It was studied with sovaldi and did great (100% SVR) until Gilead decided not to let it go on because they were working on ledispravir and didn't want to share.
You keep saying you have very late stage disease? Are you considered to be decompensating? If you are, please discuss this with your doctor and make sure it is ok to use harvoni outside of a clinical trial. I find the information on using it in decompensated patients very confusing. Is your treating doc a hepatologist?
Again, I am sorry for my part in getting your hopes up. If I hear anything that I think could help you, I will let you know. Another resource for information for you would be Help4Hep ((877‑435‑7443) and ask for Andrew. He works the late shift most days. He is extremely knowledgable about the different drugs.
I know you live not too far from Philly and Baltimore. Is there any chance you can see a hep doc at Johns Hopkins in Baltimore(Dr. Sulkowski)? Or at NIH in Bethesda, MD? They may have some trials where you don't have to worry about insurance issues. And they may have some things up their sleeves that are not public information. Also, you would be under the care of some of the top hep docs in the country.
Try to find out if there is anything going on with daclatasvir. It was studied with sovaldi and did great (100% SVR) until Gilead decided not to let it go on because they were working on ledispravir and didn't want to share.
You keep saying you have very late stage disease? Are you considered to be decompensating? If you are, please discuss this with your doctor and make sure it is ok to use harvoni outside of a clinical trial. I find the information on using it in decompensated patients very confusing. Is your treating doc a hepatologist?
Again, I am sorry for my part in getting your hopes up. If I hear anything that I think could help you, I will let you know. Another resource for information for you would be Help4Hep ((877‑435‑7443) and ask for Andrew. He works the late shift most days. He is extremely knowledgable about the different drugs.
Glen, Andrew is not scheduled for Help4hep this week. But, Bruce is on at 4:00 Eastern Time tomorrow. He is just as great as Andrew. I sent him a heads-up to watch for your call.
Thanks Dee and Glen for your support. At some point I told Glen he should consider AbbVie. That is wrong for him if he has taken Incivek, Victrelis or Olysio. I also said sovaldi is a PI and it is not. But I really appreciate your kind words and understanding.
I got my SVR near the end of 2013. I enjoyed that for a few months and then the proverbial sh*t hit the fan. Both of our daughters were diagnosed within two weeks of each other with breast cancer. 2014 has been a nightmare of bilateral mastectomies, chemo, radiation, and trying to be there for them and our young grandkids. I guess I didn't realize how exhausted and stressed I still am.
Thanks again for being so kind.
I got my SVR near the end of 2013. I enjoyed that for a few months and then the proverbial sh*t hit the fan. Both of our daughters were diagnosed within two weeks of each other with breast cancer. 2014 has been a nightmare of bilateral mastectomies, chemo, radiation, and trying to be there for them and our young grandkids. I guess I didn't realize how exhausted and stressed I still am.
Thanks again for being so kind.
Hi there, I just wanted to say you did not do anything wrong.
Glen asked if he should do the Abbie V or Harvoni, you said Harvoni with Ribavirin.
We are all human.
It appears that even Glenn's doctor did not know so please don't kick yourself. I think you have been very helpful here on the forum
Thank you
Dee
Glen asked if he should do the Abbie V or Harvoni, you said Harvoni with Ribavirin.
We are all human.
It appears that even Glenn's doctor did not know so please don't kick yourself. I think you have been very helpful here on the forum
Thank you
Dee
Thanks again for everything mom-in addition to all the calls I will be making on Monday I will also be calling Andrew at help4hep.Sounds like a guy who can really guide me in the right direction.
Glen
Glen
Thank you for the information. I am going to copy this. It has gotten so confusing since we treated with Incivek. Or...I may be more confused since Invicek. Thanks again, Dee
What would we do without you? I guess I got confused with PI and thought it meant sovaldi. i think I need to step away from here for a bit. As you can probably tell from my logon name, I have had a very stressful year. And I see it is taking a toll on my ability to think, remember, and be helpful. I apologize to you all, but especially Glen. I will send him a PM telling him to ignore my posts. Sorry.
Sovaldi is not the problem with the Abbvie drugs. Sovaldi is not a PI. It is past treatment with the PI drugs that is the problem, due to resistance issues. The Abbvie regimen contains Paritaprevir, which is a PI, so those who have failed in the past with a PI (Telaprevir, Boceprevir, Olysio) should not treat with the Abbvie drugs.
Treating with Harvoni is the AASLD recommended way to go.
The AASLD guidelines for those who failed with a PI are copied and pasted below. Go towards the bottom and you will see that the AASLD does NOT recommend the Abbvie drug regimen for those who failed with another PI. The thinking behind this is that, before we ever started treatment with any PI, even before we treated with Incivek, we already had the resistant strains of HCV in our bodies. When we treated, the wild type virus was eliminated and this made room for the resistant strains to multiply. After TX, those who failed Tx, gradually returned to their "normal: levels of viral strains, with the wild type virus taking over again as the dominant strain. However, even though the resistant strains decrease in number, they are not totally gone. So there is nothing to prevent them from multiplying again once the wild type strain is eliminated. If you treat with the Abbvie drug regimen, you will, in effect, be treating with only part of the regimen because the feeling is that the PI included in the regimen will not work against the resistant strains that you already have in your body. So you would not have the benefit of the entire drug regimen and you would be more likely to fail treatment.
If I were you, I would go to a Hepatologist who thoroughly understand all of the aspects of treating people who have failed with the PIs in the past. According to the AASLD guidelines, you should be treating with Harvoni, NOT the Abbvie regimen.
According to the new AASLD guidlines, the Abbvie regimen is NOT recommended for those who failed the PIs.
Recommended regimen for patients without cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) for 12 weeks is recommended for retreatment of patients without cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Rating: Class I, Level A
Two options with similar efficacy in general are recommended for patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and an HCV protease inhibitor regimen has failed.
Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) for 24 weeks is recommended for retreatment of patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Rating: Class I, Level A
Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) plus weight-based RBV (1000 mg [75 kg]) for 12 weeks is recommended for retreatment of patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Rating: Class IIa, Level B
The following regimens are NOT recommended for patients with HCV genotype 1 infection, in whom prior treatment that included an HCV protease inhibitor has failed.
Any regimen containing PEG-IFN, including
Simeprevir, PEG-IFN, and RBV
Sofosbuvir, PEG-IFN, and RBV
Telaprevir or boceprevir, PEG-IFN, and RBV
PEG-IFN and RBV alone
Rating: Class IIb Level A
Monotherapy with PEG-IFN, RBV, or a direct-acting antiviral
Rating: Class III, Level A
Any interferon-free regimen containing an HCV protease inhibitor
Simeprevir
Paritaprevir
Rating: Class IIb, Level A
http://hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed
Treating with Harvoni is the AASLD recommended way to go.
The AASLD guidelines for those who failed with a PI are copied and pasted below. Go towards the bottom and you will see that the AASLD does NOT recommend the Abbvie drug regimen for those who failed with another PI. The thinking behind this is that, before we ever started treatment with any PI, even before we treated with Incivek, we already had the resistant strains of HCV in our bodies. When we treated, the wild type virus was eliminated and this made room for the resistant strains to multiply. After TX, those who failed Tx, gradually returned to their "normal: levels of viral strains, with the wild type virus taking over again as the dominant strain. However, even though the resistant strains decrease in number, they are not totally gone. So there is nothing to prevent them from multiplying again once the wild type strain is eliminated. If you treat with the Abbvie drug regimen, you will, in effect, be treating with only part of the regimen because the feeling is that the PI included in the regimen will not work against the resistant strains that you already have in your body. So you would not have the benefit of the entire drug regimen and you would be more likely to fail treatment.
If I were you, I would go to a Hepatologist who thoroughly understand all of the aspects of treating people who have failed with the PIs in the past. According to the AASLD guidelines, you should be treating with Harvoni, NOT the Abbvie regimen.
According to the new AASLD guidlines, the Abbvie regimen is NOT recommended for those who failed the PIs.
Recommended regimen for patients without cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) for 12 weeks is recommended for retreatment of patients without cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Rating: Class I, Level A
Two options with similar efficacy in general are recommended for patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and an HCV protease inhibitor regimen has failed.
Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) for 24 weeks is recommended for retreatment of patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Rating: Class I, Level A
Daily fixed-dose combination ledipasvir (90 mg)/sofosbuvir (400 mg) plus weight-based RBV (1000 mg [75 kg]) for 12 weeks is recommended for retreatment of patients with cirrhosis who have HCV genotype 1 infection, regardless of subtype, in whom a prior PEG-IFN, RBV, and HCV protease inhibitor regimen has failed.
Rating: Class IIa, Level B
The following regimens are NOT recommended for patients with HCV genotype 1 infection, in whom prior treatment that included an HCV protease inhibitor has failed.
Any regimen containing PEG-IFN, including
Simeprevir, PEG-IFN, and RBV
Sofosbuvir, PEG-IFN, and RBV
Telaprevir or boceprevir, PEG-IFN, and RBV
PEG-IFN and RBV alone
Rating: Class IIb Level A
Monotherapy with PEG-IFN, RBV, or a direct-acting antiviral
Rating: Class III, Level A
Any interferon-free regimen containing an HCV protease inhibitor
Simeprevir
Paritaprevir
Rating: Class IIb, Level A
http://hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed
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