When do you retreat after relapse?

[pcds]

Wondering if there is a defined period.  Wondering why retreating would have a different effect or outcome then extended tx, which does not seem very hopeful in maintaining SVR.

[Cory255]

I'm not sure what you mean.  I've undergone treatment for hepatitis c once.  I only did 44 weeks.  I was UND at wk 12, stayed UND till EOT (44 weeks), did 44 wks, and then relapsed.  

Treatment is generally 48 wks for geno 1's.  Once month post TX, my PCR showed I had relapsed.

Yea, it's not gonna be easy, and you may want to stop, but I would wait for your wk 12 PCR, and since you've already started treatment at this point, I would wanna finish 100% of the treatment if UND at week 12.

[pcds]

re read your note.  You did complete 48 wks didn't you, then at 44 wks post EOT you relapsed.  Sometimes I think I should stop tx now and not complete 48 wks of hell.  This getting worse all the time.

[Cory255]

It is devastating to deal with failing treatment.  When it happens there is a tendency to want to rush into treatment after a relapse.  I don't think it's such a good idea to put yourself through treatment again so soon.  

I personally was UND at wk 12, stayed UND till EOT, did 44 wks, then relapsed.  I'm still young and haven't been infected with the virus for very long.

I need a good year or two to recover from treatment, and wait for stronger meds.  

[pcds]

Preparing for worst as the odds are against me, and hoping for the best.  Right now I have nothing but time to ponder the possibilities.
VL will be taken this Friday, results sometime the following week.  Psychologically I am prepared to stop if need be.  I have come up with positives for either result.  All the better to cope with whatever the results are.  I'm a bit fatigued by my obsession with HCV.  I can see a period of time between stopping tx after 12 weeks, having some normalcy, before plunging in again when new stuff is available.

[carol411]

Judy, Please tell us that this question does not mean that you have your twelve week results.  I understand planning for the worst, but I'm still counting on the very best news for you.

Carol

[WriteItDown]

There are indeed clinical trials for patients who have failed previous treatments. Not saying there are any ones good for you right now, but they definitely exist. However, if you can wait, Telaprevir is likely not too far off from being approved.

[banarep]

you just need to keep looking for trials.  i had been treated twice before and found a telaprevir trial.  they exist, check with local hospitals (teaching ones), etc.

I have a friend who started retreatemtn 2 weeks after he relapsed and he is now 2 years svr.  so who really knows.

[Bill1954]

Judy, clinical trials have strict ‘wash out’ periods between treatments (usually six months) to ensure an old substance is completely eliminated prior to introducing new product.

I’m unaware of any defined period of time required between non-trial Tx. From a personal experience, I was ready to retreat almost immediately after I relapsed the first time. It took 30 days to discover the relapse, then another four months to set up a referral to a new doctor, insurance approvals, etc. Five months after my last injection, I was starting over again.

As to your last question, I don’t have info; my last treatment was 96 weeks, so the point was moot in my situation--

Bill

[Trinity4]

Most doctors recommend retreating no sooner than six months after the first EOT.

After relapse, the patient and doctor should closely review all aspects of the initial treatment to see if a more aggressive approach can be taken.  There are many reasons why a person fails treatment but some of those factors can be eliminated such as insulin resistance, increasing riba or interferon dose, changing interferon, or avoiding dose reductions.

In my opinion, if relapsers or non-responders can wait for the PI's that would be the wisest thing to do.  I say this because having done 72 weeks of SOC myself and not achieving SVR, doing the same thing over again for 48 wks or even longer would most likely produce the same results.  Some of us for some reason have a more resistant virus and combine that with advanced liver disease you have a scenario that is not conducive or SVR so we need that PI to attack and kill the virus.

Trinity
  

[pcds]

When I have looked at clinical trails they require pt be tx naive, which I take to mean never been treated for HCV, so I think my window of opportunity for a clinical trail has closed, unfortunately my medical person at the time never even mentioned a trail, and there are open trails right here where I live.  

[WriteItDown]

I think for many people nowadays who relapse, they plan to re-treat with the new drugs which will give them a much better shot at SVR. So, instead of attempting a longer tx, or using infergen or something, they are waiting for Telaprevir or Boceprevir to be approved, or getting into clinical trials. That's your best bet these days if you can afford to wait.