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IL28B & Hepascore & new PI Questions

I tried SOC tx in the past --  at 12 weeks was still detectable and discontinued tx --  I decided to wait for new meds instead of extending tx to 72 weeks.
I had my last biopsy in Feb 2007 which was Grade 2  Stage 2.  Previous biopsy was done in 2002 and was Grade 2  Stage 0.  (Looks like my stage went up significantly in 5 years.)
I have a prescription for IL-28 B and Hepascore.  The IL-28B  test will identify a gene to tell how whether I am more likely to respond to the medication.  Instead of doing another liver biopsy, the Hepascore test apparently will give an idea of liver damage.
Questions:
Because I was still detectable at 12 weeks with previous treatment,  is it likely that my gene will not be the responsive type?
Does anyone think that there is any value in getting another liver biopsy?  And how accurate is this Hepascore test?
Does anyone know if the insurance companies (my insurance is Empire Blue Cross Blue Shield) will pay for these two blood tests?
Any ideas on whether PI Teleprevir or Boceprevir is more effective?
Appreciate your comments and thoughts.
Thanks.
gingerpal

6 Responses
446474 tn?1446351282
Question 1.
What was your viral load response? Did you drop more or less then 2 logs?
Null response: Failure to reduce HCV RNA by at least 2 logs10 (100 times) after 12
weeks of prior treatment.
Partial response: At least a 2-log10 (100-times) drop in HCV RNA.

Question 2.
Assuming compliance with meds, answer depends of viral response as in answer 1.
Probably not C/C as would have been RVR.

Question 3. You are going to treat? If so there is no need of biopsy. Hepascore test is about 88% + accurate for degrees of fibrosis F2 and greater.

Question 4. Blue Cross of California covers the test. Call your insurance company an ask if they cover IL28B. You may need CPT  code numbers from your doctor or on script.

Question 5. Telaprevir and Boceprevir are similar in their effectiveness. You may want to choose based on possible 24 weeks of Telaprevir treatment vs 48 weeks

Hectorsf.
Avatar universal
One of the Vertex presentations (if memory serves) is how the genetic marker tests relate to triple therapy. We may see some data at EASL.

willy
Avatar universal
Thanks so much for your responses.

In regards to the potential ILB28 gene test results compared to my viral load during treatment :
Below are my viral loads while treating with ribavirin and interferon  (I think I did the log-math correctly).
VL tests was performed by LabCorp Quantasure Plus:
Pre tx VL =    2.8 million IU  =   6.453 log
2 wk post tx VL =  136,000 IU = 5.134 log
4 wk post tx VL =    10,900 IU = 4.037 log
8 wk post tx VL =        270 IU  = 2.43 log
12 wk post tx VL =        20 IU  = 1.30 log

Does this give an indication of my ILB28 gene, and my expected respsonse rate with the new triple therapy?

24 weeks of tx would sure sounds nice…but my doctor said that the tx will be 48 weeks regardless of how soon my viral load would disappear (even if RVR he said it’s still 48 wks of tx).

Avatar universal
From your log drops you had a very good response to treatment, sense you really do need to treat again why worry about ILB28 test. Sounds like with your response you have a great chance with one of the new PI's..........Best of luck to you.

cando
179856 tn?1333550962
It seems to me that you had a good response to the meds too perhaps just adding one more riba a day or switching up interferons could have gotten you to UND at 12. Get the test then get ready for the new meds to come out. I would definitely biopsy though - it does seem you really did have quite some jump from 0  to 2 and I believe you need the most accurate info you can get.

IF the new drugs dont come out at least you will know if adding the riba, switching the interferon etc is a viable option for you if you dont have time to wait.
Avatar universal
Thanks all for your responses.  I am going to Quest Lab this morning to get the IL28B and Hepascore blood tests.  Quest had turned me away previously because they did not know how to do these tests, but now they think they can do them.  So hopefully soon, I will get the results and will post the info.
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