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Harvoni + Ribavirin works for previous failed treatment patents?
I have failed treatment for HEPC three times in the past; Interferon, Interferon + Ribavirin, and Interferon+Ribavirin+Tepavier. I also have compensated cirrhosis. I've had HEPC for over 50 years. Currently I'm on week 4 of Havoni + Ribavirin (1200 mg a day + 1 Harvoni). I read that the recommended duration for we hard-to-treat previous non-responders is 24 weeks, but my clinician is insisting 12 weeks will be good enough and there is no difference in the outcomes for 12 weeks vs 24 weeks. Is this correct data?
Harvoni with RBV 12 weeks is still one of the recommended regimens for patients with HCV genotype 1a or 1b infection who have compensated cirrhosis, in whom prior PEG-IFN and RBV treatment has failed.
But
Recommended regimen for patients without advanced fibrosis, in whom a previous sofosbuvir-containing regimen has failed.
Either wait Rating: Class IIb, Level C
or Harvoni plus RBV for 24 weeks. Rating : Class IIa, Level C
Per the hcvguidlines link posted earlier today.
As of today only a medical professional can advise otherwise or if a future update to hcvguidlines recommends differently. Otherwise it's our non medical opinion.
But
Recommended regimen for patients without advanced fibrosis, in whom a previous sofosbuvir-containing regimen has failed.
Either wait Rating: Class IIb, Level C
or Harvoni plus RBV for 24 weeks. Rating : Class IIa, Level C
Per the hcvguidlines link posted earlier today.
As of today only a medical professional can advise otherwise or if a future update to hcvguidlines recommends differently. Otherwise it's our non medical opinion.
Recommended regimen for patients without advanced fibrosis, in whom a previous sofosbuvir-containing regimen has failed.
wait
With advanced fibrosis - Harvoni with or without RBV for 24 weeks.
wait
With advanced fibrosis - Harvoni with or without RBV for 24 weeks.
Railroad when you said this..." It seems from all the reading that for difficult-to-treat people with cirrhosis who have had the virus for decades the protocol should be combined Harvoni + Ribivrin for 24 weeks to achieve the highest chance of success. I'll be arguing that point with the Kaiser clinicians."
I agree 100% with that. Your a three time treatment failure that is cirrhotic and type 1. This BS about with or without and 12 vs 24 is just nonsense. Time and treating is running out you need to give it your all this time. I wouldn't risk shortcuts if I were in your shoes. People take "trial" results as gospel and their not.
Wishing you the best, give them h&ll.
I agree 100% with that. Your a three time treatment failure that is cirrhotic and type 1. This BS about with or without and 12 vs 24 is just nonsense. Time and treating is running out you need to give it your all this time. I wouldn't risk shortcuts if I were in your shoes. People take "trial" results as gospel and their not.
Wishing you the best, give them h&ll.
I agree with you and Can-do-man about treating for 24 weeks.
You need to throw everything, including the kitchen sink, at this. As Can-do said, 3 times treatment failure, GT1, and Cirrhosis, plus a 50 year history of HCV, is not a good combination. You cannot afford to fail this treatment.
The real world never has the same results as the trials. The SVR rates are always lower in the real world.
If it was me, I would do 24 weeks with the Riba.
My friend, who has Cirrhosis and failed Triple Tx with the PIs, is starting Harvoni and Riba soon and she will be doing 24 weeks of Harvoni and Riba, ordered by her very knowledgeable and competent Hepatologist.
Wishing you the very best.
You need to throw everything, including the kitchen sink, at this. As Can-do said, 3 times treatment failure, GT1, and Cirrhosis, plus a 50 year history of HCV, is not a good combination. You cannot afford to fail this treatment.
The real world never has the same results as the trials. The SVR rates are always lower in the real world.
If it was me, I would do 24 weeks with the Riba.
My friend, who has Cirrhosis and failed Triple Tx with the PIs, is starting Harvoni and Riba soon and she will be doing 24 weeks of Harvoni and Riba, ordered by her very knowledgeable and competent Hepatologist.
Wishing you the very best.
can-do-man and pooh55811 provide some good arguments to try and get treatment extended to 24 weeks.
You can gather as much information as possible to present to doctor and insurance. You can ask your doctor to check with experts for their opinion with your specific situation. Get a second opinion.
Mostly my personal opinion.
First priority is to focus on treatment and not get overwhelmed with worry and anxiety. You can try again if denied maybe there will be more supporting info before you finish tx Hopefully some members can provide links to professional recommendations to help you.
It can take a month, months or even longer before certain guidelines are updated. The review panel has to discuss,review statistics and come to an agreement. Then the recommendations have to published on the website. Some doctors may be privy to new information before published. Great if your doctor knows anyone that unofficially has more info.
Actually since you treated with telaprevir the correct hcvguidlines (link in prior post accessed February 10, 2015)
"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."
abbreviated
Harvoni 24 weeks Rating: Class I, Level A
Harvoni plus RBV 12 weeks Rating: Class IIa, Level B
"Based on data from the SIRIUS study, patients with cirrhosis in whom a prior protease inhibitor containing regimen failed may also receive ledipasvir/sofosbuvir plus weight-based RBV for 12 weeks."
So even if unsuccessful getting tx extended you still have a very good chance of achieving SVR
My best wishes.
You can gather as much information as possible to present to doctor and insurance. You can ask your doctor to check with experts for their opinion with your specific situation. Get a second opinion.
Mostly my personal opinion.
First priority is to focus on treatment and not get overwhelmed with worry and anxiety. You can try again if denied maybe there will be more supporting info before you finish tx Hopefully some members can provide links to professional recommendations to help you.
It can take a month, months or even longer before certain guidelines are updated. The review panel has to discuss,review statistics and come to an agreement. Then the recommendations have to published on the website. Some doctors may be privy to new information before published. Great if your doctor knows anyone that unofficially has more info.
Actually since you treated with telaprevir the correct hcvguidlines (link in prior post accessed February 10, 2015)
"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."
abbreviated
Harvoni 24 weeks Rating: Class I, Level A
Harvoni plus RBV 12 weeks Rating: Class IIa, Level B
"Based on data from the SIRIUS study, patients with cirrhosis in whom a prior protease inhibitor containing regimen failed may also receive ledipasvir/sofosbuvir plus weight-based RBV for 12 weeks."
So even if unsuccessful getting tx extended you still have a very good chance of achieving SVR
My best wishes.
Gotta agree 100% that you go for 24 weeks with Harvoni and Riba. If I were in your shoes I would insist until they agreed. You must remember that with these clinical trials the participants were "Cherry Picked" so that the best possible outcome would occur. This does not translate to the Real World.
In my opinion your life depends on it! You can not afford to relapse at this stage of the game. Your instincts and observations are spot on. Do not let them deter you from the goal and stand your ground.
My best to you as well
.......Kim
In my opinion your life depends on it! You can not afford to relapse at this stage of the game. Your instincts and observations are spot on. Do not let them deter you from the goal and stand your ground.
My best to you as well
.......Kim
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