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Hepatitis Researcher, Pre-Dosing Ribavirin
I am starting treatment with Infergen in 2 weeks and am planning on pre-dosing riba(1,600 daily) leading up to the start date. Do you feel this may give me an edge or would it be better to just add the extra riba to the daily intake once I start the Infergen?
almost everyone around here still seems to ignore the fact that soc just didnt work for you and the chances of it working this time around are slim. i challenge you to get a real estimate of success percentage from 4 top hep docs. again, i challenge you to get a real estimate of success percentage from 4 top hep docs. dont skip this vital step. my guess is they will say from 5% to 20%. what drives you to this desperation? why would it be so bad to wait a few years for fda release? the new drugs are your only realistic way out. this is not just my contrary opinion, this is recognized by the medical community. many studies say that retreating in your case is a bad idea. and we see these results all around us on this forum. if you fail three or four rounds, you are in the hepatitis black hole until new drugs arrive. whats so bad about taking a rest? maybe a year ago you would feel like you had no other choices but today
your salvation is in the wings and soon to be here. whats the rush to another
torture session with stone age drugs? statistically, it is a bad bet.
is another failed treatment really going to help you? you dont need to buy more time,
you have some. do another biopsy, ill bet you are down to stage one by now. maybe even stage 0. at some point this "treatment bandwagon" becomes a losing proposition and you have arrived at that point. yes, its true that no one knows what
the future holds but your chances with soc are all but meaningless. i think many hep doctors will agree with this. this is the first time ive seen you post a message with
this realistic concern. is it really worth it to totally destroy your life? up until now you have been barrelling towards more soc with blinders on your eyes.
all of life is a gamble, please look at the odds before betting your life savings.
you really do have other options. and good ones at that.
i guess if youve got your heart set on it, i would try 4 weeks. if you dont rvr,
forget it. even then i think it is a bad idea. rvr's fail too.
i see far to many people on the "soc treatment bandwagon" and in my opinion they shouldnt be.
im a borderline case in this department but the scales barely tip enough for me to
see this first round of 72 all the way through. if i fail, soc will not be part of my future as a dragon slayer.
dont trust your judgement any longer, find several other top hep docs who specialize in retreating tough cases who will give you a real estimated chance for success. i think your decision will be all but obvious at that point.
the old days of ridiculous carnage are all but gone, rejoice man!
youve got better options.
your salvation is in the wings and soon to be here. whats the rush to another
torture session with stone age drugs? statistically, it is a bad bet.
is another failed treatment really going to help you? you dont need to buy more time,
you have some. do another biopsy, ill bet you are down to stage one by now. maybe even stage 0. at some point this "treatment bandwagon" becomes a losing proposition and you have arrived at that point. yes, its true that no one knows what
the future holds but your chances with soc are all but meaningless. i think many hep doctors will agree with this. this is the first time ive seen you post a message with
this realistic concern. is it really worth it to totally destroy your life? up until now you have been barrelling towards more soc with blinders on your eyes.
all of life is a gamble, please look at the odds before betting your life savings.
you really do have other options. and good ones at that.
i guess if youve got your heart set on it, i would try 4 weeks. if you dont rvr,
forget it. even then i think it is a bad idea. rvr's fail too.
i see far to many people on the "soc treatment bandwagon" and in my opinion they shouldnt be.
im a borderline case in this department but the scales barely tip enough for me to
see this first round of 72 all the way through. if i fail, soc will not be part of my future as a dragon slayer.
dont trust your judgement any longer, find several other top hep docs who specialize in retreating tough cases who will give you a real estimated chance for success. i think your decision will be all but obvious at that point.
the old days of ridiculous carnage are all but gone, rejoice man!
youve got better options.
As long as you seem to be open to additions to SOC (other than PI's), another option is double-dosing the Peg until UND, as suggested, and as discussed on the clinical care options web site.
Another is phlebotomy (blood letting) depending on your iron levels/stores. Some recent studies on that.
And lastly, is your weight. If you're overweight, getting down to "fighting weight" would give you more chances.
But again, at the end of the day, the important thing is how your body reacts to whatever intevention(s) you choose. The best way to find out would be by weekly viral load tests from week one, and ideally using a lab that would return results within a week.
That way you can track what is happening and tweak things if necessary. It will also give you a realistic appraisal of whether or not you should really finish up what can be a very grueling course of 72 weeks of Infergen. If it turns out that the virus simply isn;t reacting to all this, then you can always stop and cut your losses. And again, if you RVR, then 72 weeks might not be even necessary.
Another key ingredient in all this would be a liver specialist on board who is willing to work with you on your plan and provide support, helper drugs, etc, if and when necessary.
BTW since you got close to 2000 mg/day of ribavirin last time treating, you should know that a recent study by Lindahl shows that riba is saturable. That means that only so much can be absorbed at any one time. For that reason, if you end up getting over 2000 mg/day,. you probably want to break up the doses and therefore dose three times a day, as opposed to the usual two doses.
-- Jim
Another is phlebotomy (blood letting) depending on your iron levels/stores. Some recent studies on that.
And lastly, is your weight. If you're overweight, getting down to "fighting weight" would give you more chances.
But again, at the end of the day, the important thing is how your body reacts to whatever intevention(s) you choose. The best way to find out would be by weekly viral load tests from week one, and ideally using a lab that would return results within a week.
That way you can track what is happening and tweak things if necessary. It will also give you a realistic appraisal of whether or not you should really finish up what can be a very grueling course of 72 weeks of Infergen. If it turns out that the virus simply isn;t reacting to all this, then you can always stop and cut your losses. And again, if you RVR, then 72 weeks might not be even necessary.
Another key ingredient in all this would be a liver specialist on board who is willing to work with you on your plan and provide support, helper drugs, etc, if and when necessary.
BTW since you got close to 2000 mg/day of ribavirin last time treating, you should know that a recent study by Lindahl shows that riba is saturable. That means that only so much can be absorbed at any one time. For that reason, if you end up getting over 2000 mg/day,. you probably want to break up the doses and therefore dose three times a day, as opposed to the usual two doses.
-- Jim
How about an approach of pre-dosing the Alinia (say, in the 2-4 week range/per the Egyptian study) and then adding the riba one to two weeks prior to the final addition of the Infergen?
Also, as has been suggested, have you considered having a riba-saturation test done early on in tx to see where things stand? If you're results were only relatively low, for example, you could try and boost the riba a bit to reach an acceptable level.
As you already know, you're out in uncharted turf when doing this. You don't know what has been causing the tx failures (inf-resistance, low riba absorption, etc.) but in each re-tx you try, your remaining pharmaceutical options diminish - along with the odds of SVR. So, you need to be "creative" with the remaining arsenal - and pre-dosing sounds like a relatively safe bet/attempt.
TnHepGuy
Also, as has been suggested, have you considered having a riba-saturation test done early on in tx to see where things stand? If you're results were only relatively low, for example, you could try and boost the riba a bit to reach an acceptable level.
As you already know, you're out in uncharted turf when doing this. You don't know what has been causing the tx failures (inf-resistance, low riba absorption, etc.) but in each re-tx you try, your remaining pharmaceutical options diminish - along with the odds of SVR. So, you need to be "creative" with the remaining arsenal - and pre-dosing sounds like a relatively safe bet/attempt.
TnHepGuy
Wow, Our stats are identical except I was overweight on tx and failed the second round. Even VL is a match! Praying for a Christmas SVR for you.
Geno 3 relapser. Ist tx was Pegintron and 800 (not weight based) riba for 24 weeks. Got to und before 12 weeks, relpased post tx. 2nd tx was 1200 Riba (weight based) and Pegasys, with the pre-dosed riba and the double peg and total of 46 weeks. Start of tx 2 v.l. was 4 million. Early cirrhosis, not overweight, 56 y/o. The early und was primary goal. The liverhead said 'und by week 4 go 48, if not und by 4 go 72'. So, I was driven to the need for a very early response. 3 month pcr results expected tomorrow so not sure how the cake baked in this recipe turned out yet. But, was und at 3 weeks post tx.
willing - The riba serum concentrations may not be the only thing that needs time to come up to speed. HR has spoken many times on a possible, or even likely, effect of riba in that it provokes some type of immune response in the patient that works concomitantly with the direct and referred effects of IFN. I don't recall exactly offhand how that response was characterized by him, but I believe it had something to do with making it more difficult for the virus to hide from the T cells. It effectively spray painted them fluorescent orange so they could be seen and zapped, instead of sneaking around in their lipid over coats. Anyway, I suspect it takes the body time to immunologically react to the effects of ribavirin (similar to IFN), if in fact this theoretical mode of efficacy is correct.
George you DO know that the riba has to be ingested with fat right? There's a huge difference in riba absorption depending on whether or not the riba is digested in the presence of fat. If that 1600mg/day you were taking was ingested without a good amount of fat each and every time, pharmacologically it was only the equivalent of taking roughly half that amount!
FLguy you were the one I was trying to think of, going UND in 2 weeks on SOC. If you were geno 1 and didn't start out with a very low VL, that is amazing (and rare too). That's VX950-like is what it is. What were your stats again?
George you DO know that the riba has to be ingested with fat right? There's a huge difference in riba absorption depending on whether or not the riba is digested in the presence of fat. If that 1600mg/day you were taking was ingested without a good amount of fat each and every time, pharmacologically it was only the equivalent of taking roughly half that amount!
FLguy you were the one I was trying to think of, going UND in 2 weeks on SOC. If you were geno 1 and didn't start out with a very low VL, that is amazing (and rare too). That's VX950-like is what it is. What were your stats again?
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