Aa
Interferon question, alpha 2A/2B
Does anyone know or can point me in the right direction as to what is the major difference between the two other than manufactures interferon’s and are there any major differences in the side effects of each.
Thanks
Jasper
Thanks
Jasper
I have found several abstracts pertaining to the three phases of the inf and riba interactions on the virus but did not have any studies for the riba effects which you have provided and is what I was looking for.
ifn appears to play the more critical role at the start of tx and rbv at the end.
ribavirin monotherapy exhibits a moderate mutagenic effect early during therapy that is not detectable in combination with pegylated interferon alfa.
Patients receiving ribavirin monotherapy showed higher overall mutational frequencies within NS3 and NS5B during therapy as compared with baseline.
You have been a great help as well as others in pointing me in the right directions to the information I needed in the quest for the data and to answers my many question as to satisfy my mind and to understand this virus. No I’m not really stressing over a possibility of relapse, but what may be done at this juncture to help ensure that I may achieve the elusive SVR.
The 18 day gap in the INF may work to my advantage here in the long run on many levels, if in fact this has occurred. As given to my stats from above and being a 1b I have responded rather well so far in combating the virus and holding it at bay and it may or may not be a waste of time going the extra mile into the end of treatment. What might have been created in the gap is that if any stronger or more resistant virions that may have escaped and which may be still lingering, will flourish in the absents of the induced INF and the lower production of the natural INF, thus the chemical signaling process had already started in the virus and virions in which the replication cycle may have already started which I am sure it has if there are any un-neutralized virions floating around. The continuation of the riba in the absents of the INF but may have continued to do its job in this part of the equation. It is my understanding that in the first initial phase is when most of the eradication of the virions are eliminated with in the liver so this is where I have started in a shorter duration of the INF cycle for the next three weeks.
I may have already past the window of opportunity to put the virus into check and as you say, I will know soon enough one way or another but I do not plan to tx again if all possible and will explain at a later time. I would like to make a correction on the lap’s days, in actuality it was 15 instead of 18 because the insurance cleared the cert with the help of a little harassment and have implemented my own eot war game. Yes, a little deep but I understand it, again, thanks for your help.
Jasper
ifn appears to play the more critical role at the start of tx and rbv at the end.
ribavirin monotherapy exhibits a moderate mutagenic effect early during therapy that is not detectable in combination with pegylated interferon alfa.
Patients receiving ribavirin monotherapy showed higher overall mutational frequencies within NS3 and NS5B during therapy as compared with baseline.
You have been a great help as well as others in pointing me in the right directions to the information I needed in the quest for the data and to answers my many question as to satisfy my mind and to understand this virus. No I’m not really stressing over a possibility of relapse, but what may be done at this juncture to help ensure that I may achieve the elusive SVR.
The 18 day gap in the INF may work to my advantage here in the long run on many levels, if in fact this has occurred. As given to my stats from above and being a 1b I have responded rather well so far in combating the virus and holding it at bay and it may or may not be a waste of time going the extra mile into the end of treatment. What might have been created in the gap is that if any stronger or more resistant virions that may have escaped and which may be still lingering, will flourish in the absents of the induced INF and the lower production of the natural INF, thus the chemical signaling process had already started in the virus and virions in which the replication cycle may have already started which I am sure it has if there are any un-neutralized virions floating around. The continuation of the riba in the absents of the INF but may have continued to do its job in this part of the equation. It is my understanding that in the first initial phase is when most of the eradication of the virions are eliminated with in the liver so this is where I have started in a shorter duration of the INF cycle for the next three weeks.
I may have already past the window of opportunity to put the virus into check and as you say, I will know soon enough one way or another but I do not plan to tx again if all possible and will explain at a later time. I would like to make a correction on the lap’s days, in actuality it was 15 instead of 18 because the insurance cleared the cert with the help of a little harassment and have implemented my own eot war game. Yes, a little deep but I understand it, again, thanks for your help.
Jasper
dsrt: congratulations - all the more so for having the foresight to make the right call ! Unfortunately "expert opinion" seems to be given more weight than direct evidence most of the time...
get: you might also want to look at the following recent study on the effects of dose reduction:
http://www.ncbi.nlm.nih.gov/pubmed/17241864
Personally, I would try to not stress unduly. If your 18-day gap caused resurgence and breakthrough you'll know soon enough and it's not at all clear extending would help; you would probably be looking at full re-tx. Even missing three doses puts you at 94% compliance. Also, as noted in the above and in recent quantification of of rbv's mutagenic effect:
http://www.ncbi.nlm.nih.gov/pubmed/17484896
ifn appears to play the more critical role at the start of tx and rbv at the end.
get: you might also want to look at the following recent study on the effects of dose reduction:
http://www.ncbi.nlm.nih.gov/pubmed/17241864
Personally, I would try to not stress unduly. If your 18-day gap caused resurgence and breakthrough you'll know soon enough and it's not at all clear extending would help; you would probably be looking at full re-tx. Even missing three doses puts you at 94% compliance. Also, as noted in the above and in recent quantification of of rbv's mutagenic effect:
http://www.ncbi.nlm.nih.gov/pubmed/17484896
ifn appears to play the more critical role at the start of tx and rbv at the end.
Actually, I dose reduced to 800 at week 19, quit after my 23rd shot, and have been undetected 5 years now. Got a big black mark as a non-compliant patient with my gastro and, I assume, my insurance, but hey, I can live with that.
So, from what I gather, and from information provided here and gazing through the pubmed abstracts there are “NO” studies or research pertaining to the soc treatments in a start/stop study towards the end of treatment in the geno 1a/1b groups even given the 80/80 rule and using the pcr <10 / <2 test available today and all the in tailed aspects of each test as to ascertain the true viability of SVR at the end of treatment, so it is a cr*p shoot for most who are treating with soc? Cruelworld had the right idea in a prior thread in which I agree with what he had said pertaining to 2/10 viral test towards the end of treatment.
Bottom line is that there are “NO” studies other than to 80/80 rule and if this is the case there is a HUGH gaping hole in the way treatment is handled.
jasper
Bottom line is that there are “NO” studies other than to 80/80 rule and if this is the case there is a HUGH gaping hole in the way treatment is handled.
jasper
a copy of those recommendations is here:
http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm
it's all a bit dated, but the list of participants/endorsements at the bottom indicates broad-based consensus.
Their conclusions about dose/duration for g2/g3s were still a bit tentative:
"Thus, 24 weeks of treatment and an 800 mg dose of ribavirin appears to be sufficient for persons with genotypes 2 and 3, while patients with genotype 1 need 48 weeks of treatment and standard doses of ribavirin."
The huge Hadziyannis et'al study was still unpublished data at the time and in fact didn't get published until '04.
http://www.ncbi.nlm.nih.gov/pubmed/14996676
I can understand your Dr. being cautious in '03, but disregarding the NIH endorsement does seem unusual. Anyway, I hope the extra time and rbv did no harm and got you to svr.
http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm
it's all a bit dated, but the list of participants/endorsements at the bottom indicates broad-based consensus.
Their conclusions about dose/duration for g2/g3s were still a bit tentative:
"Thus, 24 weeks of treatment and an 800 mg dose of ribavirin appears to be sufficient for persons with genotypes 2 and 3, while patients with genotype 1 need 48 weeks of treatment and standard doses of ribavirin."
The huge Hadziyannis et'al study was still unpublished data at the time and in fact didn't get published until '04.
http://www.ncbi.nlm.nih.gov/pubmed/14996676
I can understand your Dr. being cautious in '03, but disregarding the NIH endorsement does seem unusual. Anyway, I hope the extra time and rbv did no harm and got you to svr.
In re the 2002 NIH Consensus Report:
Five years ago I walked into my gastro's office with a copy of that report in my hand to ask my doc why I, as a geno 3, was treating for 48 wks with 1200 riba when the report said 24 wks with 800 riba worked just as well. He pointed out that that 'consensus' was based primarily on a single European study. He said once he saw those results duplicated, maybe, in a couple years he'd consider changing his protocols.
Five years ago I walked into my gastro's office with a copy of that report in my hand to ask my doc why I, as a geno 3, was treating for 48 wks with 1200 riba when the report said 24 wks with 800 riba worked just as well. He pointed out that that 'consensus' was based primarily on a single European study. He said once he saw those results duplicated, maybe, in a couple years he'd consider changing his protocols.
uh.. yes, there *was* some doubt about optimal tx length for naive g2/g3s but this has been settled for at least 6 years now:
From that recent JAMA soc review (http://jama.ama-assn.org/cgi/content/full/297/7/724)
"Expert guidelines recommend 48 weeks of peginterferon plus 1000 to 1200 mg of ribavirin (combination therapy) for patients with genotype 1 infection and 24 weeks of peginterferon plus 800 mg of ribavirin for genotypes 2 or 3 infection.[8-9]"
refs 8 and 9 are the 2002 nih consensus conference and a 2004 tx review. Recent controversy has been about about when that 24 can be safely reduced.
The link above references PMID 16527652
http://www.ncbi.nlm.nih.gov/pubmed/16527652
which is the most recent '06 installment of Shiffman's near-annual survey of re-tx strategies. Unfortunately I don't have access to full-text, but from reading earlier versions, it's safe to assume the review only summarizes existing work and does not present new data. Thus if there is data out there showing a beneficial effect for 48-week or longer re-tx for g2/g3s that's not it (though it may cite it..).
From that recent JAMA soc review (http://jama.ama-assn.org/cgi/content/full/297/7/724)
"Expert guidelines recommend 48 weeks of peginterferon plus 1000 to 1200 mg of ribavirin (combination therapy) for patients with genotype 1 infection and 24 weeks of peginterferon plus 800 mg of ribavirin for genotypes 2 or 3 infection.[8-9]"
refs 8 and 9 are the 2002 nih consensus conference and a 2004 tx review. Recent controversy has been about about when that 24 can be safely reduced.
The link above references PMID 16527652
http://www.ncbi.nlm.nih.gov/pubmed/16527652
which is the most recent '06 installment of Shiffman's near-annual survey of re-tx strategies. Unfortunately I don't have access to full-text, but from reading earlier versions, it's safe to assume the review only summarizes existing work and does not present new data. Thus if there is data out there showing a beneficial effect for 48-week or longer re-tx for g2/g3s that's not it (though it may cite it..).
Try this: http://linkinghub.elsevier.com/retrieve/pii/S0891552006000031
No, I believe the older protocol for geno 2's was 48 weeks and then changed to 24. Don't have time to look for those studies now. And I do think there may be something different about the subset we're talking about in terms of MO -- RVRs who relapse -- and that's really what we're talking about here. As far as slower responders are concerned, then the re-treat strategy would have more emphasis on viral response -- i.e. change of meds -- then length. See if you can pull up that article cause it may prove me wrong :)
-- Jim
No, I believe the older protocol for geno 2's was 48 weeks and then changed to 24. Don't have time to look for those studies now. And I do think there may be something different about the subset we're talking about in terms of MO -- RVRs who relapse -- and that's really what we're talking about here. As far as slower responders are concerned, then the re-treat strategy would have more emphasis on viral response -- i.e. change of meds -- then length. See if you can pull up that article cause it may prove me wrong :)
-- Jim
there's nothing new about 24 weeks for g2/g3 (see for example the 2002 NIH consensus treatment recommendations). The recent Jacobson study simply confirms the findings of earlier work. One would certainly like to have data on relapser outcome, but in its absence you've got to make do with what's available.
In making guesses, following "an accepted re-treatment protocol by leading liver specialists" carries little weight in the absence of supporting data. IMHO, a hallmark of HCV therapy is Drs making guesses on their patients' behalf and not acknowledging them as guesses. Though many patients seem happy to go along with this, and assume their Dr knows something they don't, asking for evidence is not a bad strategy.
As noted above, in the Jacobson data the relapse rate should have been lower for 48s if the extra time made a difference. Quite possibly the extra time only benefits a subset too small to affect the overall average, as was the case with 48 vs 72 for g1 slow-responders. . And more data should make this clear, etc. etc.
However, both MO and Skip were RVRs, thus far from slow-responders. Given that you've got to guess with what's out there *now*, I'd guess Jacobson suggests barking up another tree...
jim: sorry - couldn't figure out which article you were referring to. The pubmed id is a good way of explicitly identifying pubs, do you have the pmid for it?
In making guesses, following "an accepted re-treatment protocol by leading liver specialists" carries little weight in the absence of supporting data. IMHO, a hallmark of HCV therapy is Drs making guesses on their patients' behalf and not acknowledging them as guesses. Though many patients seem happy to go along with this, and assume their Dr knows something they don't, asking for evidence is not a bad strategy.
As noted above, in the Jacobson data the relapse rate should have been lower for 48s if the extra time made a difference. Quite possibly the extra time only benefits a subset too small to affect the overall average, as was the case with 48 vs 72 for g1 slow-responders. . And more data should make this clear, etc. etc.
However, both MO and Skip were RVRs, thus far from slow-responders. Given that you've got to guess with what's out there *now*, I'd guess Jacobson suggests barking up another tree...
jim: sorry - couldn't figure out which article you were referring to. The pubmed id is a good way of explicitly identifying pubs, do you have the pmid for it?
http://tinyurl.com/yqtk7w
Not sure how or why, but the first hit (above link) may support your position, although I've been burned many times with "google" previews so you reall have to check out the actual article. Willing, you may have free access through academia, etc, If not, sounds like it might be worth the dime for MO to check out. Lordy, I spent quite a bi on full-text articles when my own tx was concerned.
-- Jim
Not sure how or why, but the first hit (above link) may support your position, although I've been burned many times with "google" previews so you reall have to check out the actual article. Willing, you may have free access through academia, etc, If not, sounds like it might be worth the dime for MO to check out. Lordy, I spent quite a bi on full-text articles when my own tx was concerned.
-- Jim
Willing: I know it's conventional to try 48 after failing on 24, and that study was not targeted on relapsers,
------------------
I really see this as key. All the study posted shows me is that 24 weeks is the new standard for treatment naive genotype 2's, as opposed to the older 48 week protocol.
In addition to what seems to be an accepted re-treatment protocol by leading liver specialists, II would think there would be studies on geno 2 relapsers who treated for 24 vs 48 weeks, but if not, then a good parallel might be the geno 1 studies which do seem to suggest that extending treatment on re-treatment has better results.
-- Jim
------------------
I really see this as key. All the study posted shows me is that 24 weeks is the new standard for treatment naive genotype 2's, as opposed to the older 48 week protocol.
In addition to what seems to be an accepted re-treatment protocol by leading liver specialists, II would think there would be studies on geno 2 relapsers who treated for 24 vs 48 weeks, but if not, then a good parallel might be the geno 1 studies which do seem to suggest that extending treatment on re-treatment has better results.
-- Jim
I guess we should give the ladies here their due with this "replicant". Great flick!
http://tinyurl.com/2oqftj
http://tinyurl.com/2oqftj
Jasper : sorry, not sure I understood your question If you're asking what to do about an 18 day gap in your ifn dosing, the answer is probably not to worry. Obviously staying on dose is preferable, but the standard cutoff at which the impact of not skipping meds has been quantified is 80%. The origin of the 80/80 rule is McHutchison'00 (PMID: 12360468 ). By following that you can find more recent refs, but as far as I know there's no data on the effect of compliance between 80 and 100. As to whether you can remedy the gap by extending, I believe your guess is as good as anyone's - including Dr S's... Also, neither ifn nor riba target any specific part of the viral genome. While vx950 blocks ns3 and r1626 blocks ns5b the soc drugs rely on our immune response rather than any direct effect.
mo : I'm not doing well with my typing today; that should have been abstract 1310 above, not 310. Sounds like you've got a good plan, though you may want to make sure your Dr. has read through the Jacobson/win-r study (PMID: 17894303 ). They were following a *large* patient group and were quite clear they observed no difference in 24 vs 48 for g2/g3s. I know it's conventional to try 48 after failing on 24, and that study was not targeted on relapsers, but if the extra time had any value for g2/g3s one would expect to see its effects in a study that large (there would have been more relapsers in the 24 arm). Varying dosages/switching ifns may be a better betting strategy...
mo : I'm not doing well with my typing today; that should have been abstract 1310 above, not 310. Sounds like you've got a good plan, though you may want to make sure your Dr. has read through the Jacobson/win-r study (PMID: 17894303 ). They were following a *large* patient group and were quite clear they observed no difference in 24 vs 48 for g2/g3s. I know it's conventional to try 48 after failing on 24, and that study was not targeted on relapsers, but if the extra time had any value for g2/g3s one would expect to see its effects in a study that large (there would have been more relapsers in the 24 arm). Varying dosages/switching ifns may be a better betting strategy...
You know I'm just havin' some fun at your expense. Actually, the mixed interferon idea isn't new -- but a better strategy might be in double-dosing where you start inject each Peg on a different day of the week to take advantage of their different viral load "kill" curves. But in your case, you didn't have a problem killing the virus, just keeping them down -- so extended tx seems the reasonable course if you don't want to wait unitl end of year data on the European geno 2 Telaprevir trials are in. Yeah, I forgot to put "distinguised" in quote marks the first time. Not too many of those from what I read here. LOL.
-- Jim
-- Jim
Because we don't do flaky treatments in this distinguished facility
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hardy har har. Its not flakieeeeeeee. I'll book mark this page so I can ~remind~ you that I had the idea first and didn't need to see a study to prove it was a good idea Jimmmmie.
That "distinguished facitilty" ain't all that:)
----------------------------------------------------------------------------------
hardy har har. Its not flakieeeeeeee. I'll book mark this page so I can ~remind~ you that I had the idea first and didn't need to see a study to prove it was a good idea Jimmmmie.
That "distinguished facitilty" ain't all that:)
Get: hat does INF-peg go after in the replicon chain
------------------------------------------------------------------
Personally, I think this is the most noteworthy replicant in the entire Ridley chain:
:http://tinyurl.com/yryd72 although this one should also not be forgotten:
http://tinyurl.com/yrbt87
------------------------------------------------------------------
Personally, I think this is the most noteworthy replicant in the entire Ridley chain:
:http://tinyurl.com/yryd72 although this one should also not be forgotten:
http://tinyurl.com/yrbt87
Thank you all for the feed back on the difference between the two INF’s and may explain some internal things back early on in treatment. Thanks!
But I have one last question, and should know but am blank at the moment, what does INF-peg go after in the replicon chain and what does the Riba do and/or follow up on?
NSB5B - INF?
NS3 - Riba?
Or is it reverse?
jasper
But I have one last question, and should know but am blank at the moment, what does INF-peg go after in the replicon chain and what does the Riba do and/or follow up on?
NSB5B - INF?
NS3 - Riba?
Or is it reverse?
jasper
MO: I'll ask why not and I'll need to hear a good reason..
---------------
"Because we don't do flaky treatments in this distinguished facility " :)
---------------
"Because we don't do flaky treatments in this distinguished facility " :)
Daily injections? No thankyah. My doctors - the one I treated with last year thinks just extending will do the trick with the same peg - Pegasys.(geno 2b)
The new doc that I consulted with said Pegintron, but I was concerned about sx and he said okay to Pegasys, but now I'll talk to him and ask if I start with Pegintron will he switch me to Pegasys if I get sick- if I can't have a "planned split in tx." My point is that I would like the small molecule of Pegintron at least for a while, but I certainly wouldn't want to go on that Peg IF it was going to be a hard ride without knowing I could switch.
Willing, I'll wind up giving you a headache, if I haven't already. Run away from me while you still have the strength. Jim and mike may have already messaged you with those instructions. lol
Take care.
The new doc that I consulted with said Pegintron, but I was concerned about sx and he said okay to Pegasys, but now I'll talk to him and ask if I start with Pegintron will he switch me to Pegasys if I get sick- if I can't have a "planned split in tx." My point is that I would like the small molecule of Pegintron at least for a while, but I certainly wouldn't want to go on that Peg IF it was going to be a hard ride without knowing I could switch.
Willing, I'll wind up giving you a headache, if I haven't already. Run away from me while you still have the strength. Jim and mike may have already messaged you with those instructions. lol
Take care.
mike : thanks for the correction, actually I do remember your posting that before and mistyped 2a and 2b... Last time someone ran a 2a vs 2b sides comparison post 2a seemed to do better but as I recall there were also some 2b fans.
mo : if you're looking at anti-viral effect, consensus ifn would probably be a better choice to investigate than 2a vs 2b. Re-tx with cifn has gotten some good results, see for example that aasld abstract 310 in the 72-week thread. On the other hand, in you're interested in comparing side effects, that seems like an excellent plan!
mo : if you're looking at anti-viral effect, consensus ifn would probably be a better choice to investigate than 2a vs 2b. Re-tx with cifn has gotten some good results, see for example that aasld abstract 310 in the 72-week thread. On the other hand, in you're interested in comparing side effects, that seems like an excellent plan!
Let me ask all something, are there any studies and/or research data available to date that may apply to a reversal of SOC close to the end of treatment. Let’s say, if one follows SOC, 180-peg INF, 1200mg riba for 22 weeks and then reduces riba to 1000mg from there to 44 weeks. All the sudden, stops INF but continues with the riba dosage until INF is obtained. The span between last injections until new injection is approx 18 days in which the elevated INF levels cascade downward to, and beyond the natural INF threshold accentually stopping all production of INF and because of this an imbalance and system shock has created an opportunity for existing or undetectable virions to restart the replication process again. Now, if in this time frame of INF imbalance which has caused chaos across all systems associated with fighting the virus, in which it may have actually started, what would be the best course of action at this point going forward?
I have been asking a lot of specific questions here as of late on a wide array of areas associated with the virus in the preparation of a what if, and have a fail safe plan in which to fall back on given the probability of an unfavorable out come of the INF time laps.
Are there any Studies and/or Research Data available given this scenario?
UND since week 8
180-pegINF x44 weeks
1200mg Riba x22 weeks
1000mg Riba x22 weeks
Abrupt stoppage INF week 44
Continuation Riba 2xan/3xpm
INF time laps 18 days
Extension time?
Thanks!
Jasper
I have been asking a lot of specific questions here as of late on a wide array of areas associated with the virus in the preparation of a what if, and have a fail safe plan in which to fall back on given the probability of an unfavorable out come of the INF time laps.
Are there any Studies and/or Research Data available given this scenario?
UND since week 8
180-pegINF x44 weeks
1200mg Riba x22 weeks
1000mg Riba x22 weeks
Abrupt stoppage INF week 44
Continuation Riba 2xan/3xpm
INF time laps 18 days
Extension time?
Thanks!
Jasper
Yeah,I'm going 48 weeks this round. Ya know what? I am a control freak in a way - probably a big way and thats no good. Probably have a bad case of OCD - although I always thought it was a "made up disease," and haven't been dx, but then again I haven't asked any of my doctors for their opinion. lol So anyhow, I look at everything and then change my mine 200 times and then I finally say "okay, I did what I could possibly do and can't do no more." But it takes me a long time to get to the place where I think I "did all I could do." So in short - I'm nuts, but my football lovin' husband loves me though..
Yes,it was hard to relapse after being RVR, but I had to stop complaining about that cause there are lots of other things that could be worse. Alot of members here have been thru and some still going thru alot worse, so I look at their testimonies and strength to help encourage myself along the way.
I wish you the very best and I so hope to hear that you are SVR.
Good luck moa, nice talking to you.
Yes,it was hard to relapse after being RVR, but I had to stop complaining about that cause there are lots of other things that could be worse. Alot of members here have been thru and some still going thru alot worse, so I look at their testimonies and strength to help encourage myself along the way.
I wish you the very best and I so hope to hear that you are SVR.
Good luck moa, nice talking to you.
I don't know Myown, whether one Peg has a higher relapse rate than the other. It must be tough to have been RVR, then to relapse. I am hoping it will not happen to me over the next few weeks (although I won't know one way or the other for 6 months, as PCR's are not readily available in Canada).
You may want to try some of the alternatives that others have done (longer treatment, using just the other peg, etc.) before speculating on mixing pegs. I guess medicine is as much an art as a science though, and as I am neither a doctor, scientist or artist, who am I to say? Good luck.
You may want to try some of the alternatives that others have done (longer treatment, using just the other peg, etc.) before speculating on mixing pegs. I guess medicine is as much an art as a science though, and as I am neither a doctor, scientist or artist, who am I to say? Good luck.
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