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Biopsy
I am a G1 nonresponder from 1998. I elected to try and clear virus when results came in from 1st biopsy. No idea on when disease was contracted. I have had 2 biopsies. Last 5 years ago just showing inflammation. Had serum test done last month and it shows Stage 2 to Stage 4 fibrosis. Is there any reason to have another biopsy since I have to have treatment. Meeting nurse practitioner next week.
I actually went through treatment in 1999. Looked at past bills. The meds were interferon alpha 2b with ribavarin. Last biopsy September of 07. Both biopsies I went through were quite painful. Felt like I was kicked in the side by a mule. The serum test they did last month was for people who didn't want to go through a biopsy. Obviously it isn't accurate enough when there is a problem. The nurse said that in 04 I was a stage 0 and in 07 a stage 1 if I understood her correctly. They have never really went into detail on things with me and I guess I can blame myself for that. Thanks for all the info.
I am not sure which serum test you had but there is a significant difference between Stage 2 and Stage 4 fibrosis. In addition, if you had only inflammation 5 years ago (on biopsy) and are now showing Stage 2 to Stage 4 fibrosis on a serum test, I think it would be prudent to do a biopsy to determine exactly what stage you are at. Personally, I would want to know if I was at Stage 2 or at Stage 4.
Various factors, including cirrhosis, have a bearing on the length of treatment.
"Panel Recommendations
Response-guided therapy is recommended when using boceprevir-based triple therapy for noncirrhotic treatment-naive patients. After a 4-week lead-in with pegIFN/RBV alone, triple therapy should be prolonged for patients who have detectable HCV RNA at Week 8 (total treatment: 48 weeks) and shortened for patients who do not have detectable HCV RNA at Week 8 (total treatment: 28 weeks for treatment-naive or 36 weeks for treatment-experienced patients).
The FDA prescribing information suggests a response-guided approach for previous relapsers or partial responders treated with boceprevir-based triple therapy. After a 4-week lead-in with pegIFN/RBV alone, triple therapy should be prolonged for patients who have detectable HCV RNA at Week 8 (total treatment: 48 weeks) and shortened for patients who do not have detectable HCV RNA at Week 8 (total treatment: 28 for treatment-naive or 36 weeks for treatment-experienced patients). The EMA suggests a fixed duration of therapy comprising 4 weeks pegIFN/RBV lead-in followed by 32 weeks of boceprevir/pegIFN/RBV triple therapy then 12 weeks of
pegIFN/RBV in these patients, regardless of on-treatment response. Either approach is acceptable and can be used at the clinician’s discretion.
For previous null responders in whom a decision to treat with boceprevir is made, a fixed-duration 48-week course of therapy (4-week pegIFN/RBV lead-in followed by 44 weeks of triple therapy) is recommended.
For treatment-naive patients found to be poorly interferon responsive after the lead-in phase, consideration should be given to administering 44 weeks of boceprevir-based triple therapy after the initial lead-in phase, but the futility rules should be strictly applied.
It is recommended that cirrhotic patients treated with boceprevir receive a fixed-duration 48-week course of therapy (4-week pegIFN/RBV lead-in followed by 44 weeks of triple therapy) regardless of previous treatment experience.
Response-guided therapy is recommended when using telaprevir-based triple therapy for treatment-naive patients and previous relapsers. All patients should receive 12 weeks of triple therapy, followed by a period of pegIFN/RBV alone. The duration of pegIFN/RBV is based on achievement of undetectable HCV RNA at both Week 4 and Week 12. Patients who meet this criterion should receive a total of 24 weeks of therapy (12 weeks of triple therapy followed by 12 weeks of pegIFN/RBV alone), and patients who do not should receive a total of 48 weeks of therapy (12 weeks of triple therapy followed by 36 weeks of pegIFN/RBV alone).
All previous partial or null responders and cirrhotic patients treated with telaprevir should receive a fixed-duration 48-week course of therapy (12 weeks of triple therapy followed by 36 weeks of pegIFN/RBV alone). Tolerability should be followed closely in patients with cirrhosis.
The EMA stipulates that in situations where cirrhotic or prior null responder patients cannot tolerate boceprevir-based triple therapy, consideration could be given to continuing pegIFN/RBV for the remaining 12 weeks (total treatment duration, 48 weeks).
Some data suggest that patients with stage F3 fibrosis may also benefit from fixed-duration therapy for both boceprevir and telaprevir, and some clinicians may wish to follow the same guidelines used for cirrhotic patients in these individuals with advanced fibrosis."
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx
Various factors, including cirrhosis, have a bearing on the length of treatment.
"Panel Recommendations
Response-guided therapy is recommended when using boceprevir-based triple therapy for noncirrhotic treatment-naive patients. After a 4-week lead-in with pegIFN/RBV alone, triple therapy should be prolonged for patients who have detectable HCV RNA at Week 8 (total treatment: 48 weeks) and shortened for patients who do not have detectable HCV RNA at Week 8 (total treatment: 28 weeks for treatment-naive or 36 weeks for treatment-experienced patients).
The FDA prescribing information suggests a response-guided approach for previous relapsers or partial responders treated with boceprevir-based triple therapy. After a 4-week lead-in with pegIFN/RBV alone, triple therapy should be prolonged for patients who have detectable HCV RNA at Week 8 (total treatment: 48 weeks) and shortened for patients who do not have detectable HCV RNA at Week 8 (total treatment: 28 for treatment-naive or 36 weeks for treatment-experienced patients). The EMA suggests a fixed duration of therapy comprising 4 weeks pegIFN/RBV lead-in followed by 32 weeks of boceprevir/pegIFN/RBV triple therapy then 12 weeks of
pegIFN/RBV in these patients, regardless of on-treatment response. Either approach is acceptable and can be used at the clinician’s discretion.
For previous null responders in whom a decision to treat with boceprevir is made, a fixed-duration 48-week course of therapy (4-week pegIFN/RBV lead-in followed by 44 weeks of triple therapy) is recommended.
For treatment-naive patients found to be poorly interferon responsive after the lead-in phase, consideration should be given to administering 44 weeks of boceprevir-based triple therapy after the initial lead-in phase, but the futility rules should be strictly applied.
It is recommended that cirrhotic patients treated with boceprevir receive a fixed-duration 48-week course of therapy (4-week pegIFN/RBV lead-in followed by 44 weeks of triple therapy) regardless of previous treatment experience.
Response-guided therapy is recommended when using telaprevir-based triple therapy for treatment-naive patients and previous relapsers. All patients should receive 12 weeks of triple therapy, followed by a period of pegIFN/RBV alone. The duration of pegIFN/RBV is based on achievement of undetectable HCV RNA at both Week 4 and Week 12. Patients who meet this criterion should receive a total of 24 weeks of therapy (12 weeks of triple therapy followed by 12 weeks of pegIFN/RBV alone), and patients who do not should receive a total of 48 weeks of therapy (12 weeks of triple therapy followed by 36 weeks of pegIFN/RBV alone).
All previous partial or null responders and cirrhotic patients treated with telaprevir should receive a fixed-duration 48-week course of therapy (12 weeks of triple therapy followed by 36 weeks of pegIFN/RBV alone). Tolerability should be followed closely in patients with cirrhosis.
The EMA stipulates that in situations where cirrhotic or prior null responder patients cannot tolerate boceprevir-based triple therapy, consideration could be given to continuing pegIFN/RBV for the remaining 12 weeks (total treatment duration, 48 weeks).
Some data suggest that patients with stage F3 fibrosis may also benefit from fixed-duration therapy for both boceprevir and telaprevir, and some clinicians may wish to follow the same guidelines used for cirrhotic patients in these individuals with advanced fibrosis."
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx
"Last 5 years ago just showing inflammation." Do you mean you don't know what stage it was 5 years ago? Why not get a copy of the report from the doctor who ordered the biopsy? It may be helpful but then again you should have a biopsy about every 5 years or so anyway.
"Had serum test done last month and it shows Stage 2 to Stage 4 fibrosis." This is obviously pointless "information" as there is a huge difference between a patient with stage 2 liver disease and stage 4. At stage 2 the odds of SVR are not affected by your liver disease. At stage 4 the odds of SVR are reduced by more than half and in a previous non-responder this could be a major game changer as for are prognosis is concerned.
You are in your 50s which is when liver disease progresses more rapidly than before age 50. It would be very wise of you to get a current update on the status of your hepatitis C and liver disease. You don't want to miss a window of opportunity based of guessing.
Before 1998 the only treatment was interferon. The odds of beating hepatitis C was very low for all patients. Did you treat with both interferon alfa-2b and ribavirin or just interferon? Either way if I were you I would seriously think about treating the virus with one of the new treatments that are now available for genotype 1 patients. It is a totally new world compared to when you were treating in 1998.
Please demand a biopsy when you see the NP. This is vital to your future outcome. Don't miss this opportunity before your options for getting rid of your virus become less palatable. I.E. cirrhosis and all of its affects on your life.
Good luck to you.
Hector
"Had serum test done last month and it shows Stage 2 to Stage 4 fibrosis." This is obviously pointless "information" as there is a huge difference between a patient with stage 2 liver disease and stage 4. At stage 2 the odds of SVR are not affected by your liver disease. At stage 4 the odds of SVR are reduced by more than half and in a previous non-responder this could be a major game changer as for are prognosis is concerned.
You are in your 50s which is when liver disease progresses more rapidly than before age 50. It would be very wise of you to get a current update on the status of your hepatitis C and liver disease. You don't want to miss a window of opportunity based of guessing.
Before 1998 the only treatment was interferon. The odds of beating hepatitis C was very low for all patients. Did you treat with both interferon alfa-2b and ribavirin or just interferon? Either way if I were you I would seriously think about treating the virus with one of the new treatments that are now available for genotype 1 patients. It is a totally new world compared to when you were treating in 1998.
Please demand a biopsy when you see the NP. This is vital to your future outcome. Don't miss this opportunity before your options for getting rid of your virus become less palatable. I.E. cirrhosis and all of its affects on your life.
Good luck to you.
Hector
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