Hep C- Liver BX question

[SMN18]

I just went to my Hepatologist and that Dr has a different BX opinion than my local Dr- my local Dr ( GI ) says grade 1 - Hepatologist says grade 2-3 and suggest TX again- I am a nonresponder- any opinions as to what I should do now- thanks

[Kristina538]

My bx came back with 'stage 2' but 'dx limited by small specimen'.   My specialist advised I was stage 3 and possibly beyond because of the fibrotic nature of the sample and other factors mentioned on the bx.  The bx's are not always as black and white as we would hope.    

Once I investigated the 'small print' of what had been found on my bx, I was grateful for my specialist's opinion of 'worst case scenario';  it made me more vigilant about tx options etc. and pushed me to find out more from this site and others until I finally learnt a whole lot more about my liver and my options.  Good luck.

[fretboard]

Apparently it's not that uncommon to get a different reading from a bx even with just a short time span inbetween.  Two different doctors=two different view points.  I would go with the last biopsy results from the Hepatologist.  You still have time to wait to tx until you can give yourself a better chance at success with the new PI's.  good luck

[HectorSF]

Here are the stats for non responders adding Telaprevir to SOC meds-Study 107 trial.

Study 107 Design Open-label treatment of patients from control arms of PROVE1, PROVE2 and PROVE3 who met either on-treatment criteria for non-response or who relapsed after completion of 48 weeks of Peg-IFN + RBV. Patients who discontinued therapy because of adverse events (AEs) in the PROVE studies were not eligible for inclusion.

58% of null-responders (28/48) had <10 IU/ml (undetectable viral load) at week 12; 79% of partial responders had <10 Iu/mL at week 12; 73% of relapsers (16/22) had <10 Iu/mL at week 12.

At week 24, 43% of null-responders (n=42) achieved undetectable HCV viral load, 82% of partial responders did also (n=22), and 71% of relapsers (n=7) did as well.

Partial-responders have almost 2x the chance of UND vs.Null-responders at Week 24.
How many of these patients will achieve SVR? We won’t know until the trial is completed. But this is a major improvement for patient retreating for HCV. Null-responders have less than a 10% of SVR using SOC meds.

Cheers!
Hectorsf

[copyman]

wait for the new drugs. Vertex hopefully will get approval for their new drug to treat non-responders first. Even so if you watch your diet with no alcohol you should be ok for the regular approval in the next few years. good luck

[lalapple]

how would your local doc know?  who performed the biopsy?

[HectorSF]

I would trust the Hepatologist. The liver is their expertise. A primary doc has to know about every illness and is an expert in none but can point you in the right direction when you need a specialist. These Grades are from a biopsy, correct?

What type of non-responder?
There is a huge difference in your odds of SVR when retreating depending if you were a null-responder and partial responder.

Cheers!
HectorSF