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Avatar universal

Length of TX for 2s

Hi All,

I wanted to share something and get your opinions.  I am a 2 and have treated now for 20 weeks (clear at week 11).  My biopsy had showed minimal damage.  So I have 4 more shots to go . . . I had thought.

The doctors at Cedars want me to do longer on this treatment because I did not clear at week 4 (I had at least a 2 log drop) and I was only taking the middle dosage (135) of the pegasys because of the sx for the 2nd, 3rd and 4th shot.  I went back up to 180 with 1200 of riba on week 5 and cleared at week 11.

Standard therapy for a 2 is 24 weeks if you clear by week 12.  I did.  I consulted with other doctors at UCLA and they said that there is no reason for me to do longer than the 24 weeks.

I'm going to stop at week 24, very gratefully, as I know so many of you (my heros) have to do so much more.  But I'd like to know if anyone knows of some reason why if I fit all the criteria, I should go longer.  This is my first time doing the tx.  Is there some new criteria?

Thanks for your thoughts.

-cbee
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Avatar universal
gosh i definately agree with chevy (lin). in my opinion, i think your dr risked your treatment by lowering your dose. what the heck was he thinking? this is a reason in my eyes that i would continue if i was in your shoes...also the fact that you were not clear on 4 weeks for type 2....shame on him for lowering your dose unless it was a life or death issue. there are meds that can help with side effects to prevent lowering doses which have shown hurts people's chances of clearance. this is my opinion and i would go as long as reasonable to have the best chance of clearance. why would you want to start over again if you don't clear if you can just add some time on now instead?

we do care here, hope you go a bit longer than the minimum.

sandi



Helpful - 0
Avatar universal
cc2
I don't know your history but I can give a little of mine.  I would think about your decision before making a choice.  But here was my situation on the Peg Combo tx three years ago.
I was 2b with over 1 million viral load, between stage 2 and 3 on liver damage.  I started tx at the age of 50 and I am female and had Hep C for 30 years. I did only 3 weeks of full tx then did half tx for 11 weeks, 7 weeks at 3/4 tx, stop a week, did another 2 weeks at 1/2 tx and then had to stop complete.  (I was very ill on tx and very low blood counts and only did 23 weeks).  They did not even do a viral load till 15 weeks and I was not optimistic at that point.  However, I was non detectable, which gave me the incentive to keep going.  

You really need to think about this before you quit.  I was "VERY" fortunate and of course I give it all to my faith and the help from this forum and the wonderful people.
If you are not very ill and blood counts are stable then maybe go for another two - four weeks if you can.  Better safe then sorry and if I would of stablized I would of went longer.  

No matter what your choice is I wish you the best and that you stay non detectable.
Blessings
Helpful - 0
Avatar universal
I should have made myself more clear. I did only 3 shots at the medium dosage at the very beginning because of very serious sx, I went from 3 million to 69,000 at 4 weeks.  At 6 weeks I was at 74.  At 10 (not 11 as I originally stated) weeks I was undectable and less than 2 IU.  I know many doctors don't even do a PCR until 12 weeks.  So there are many 2s who wouldn't know if they cleared at 4 weeks.  My other doctors at UCLA (who have been the greatest supporters) agree that I need no more than the standard therapy. Standard therapy for 2s is if you clear at 12 weeks is 24 weeks.  I've e-mailed with Dr. Cecil a few times and according to him 6 months of therapy is correct from the details above.  I have a lot of respect for him.

I was just curious if there are any 2s who didn't clear at week 4 and then cleared before week 12 were told they should do longer treatment.  I'm just fine with the 24 weeks.  

-cbee
Helpful - 0
Avatar universal
I doubt you'll find any data that supports the recommendation of your Cedar Drs. As a two there's no demonstrated benefit to doing more than 24 weeks and, since you were undetectable by 12, you can look forward to a >80% shot at SVR. The impact of reduced compliance is hard to assess, though it's been shown to be measurable when compliance falls below 80% of the drugs for 80% of the time ( a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12360468&query_hl=11">McHutchinson et al 2002</a>), which it didn't in your case (assuming you were taking your 800 riba throughout). The main reason to continue is probably psychological insurance: in the unlikely event you do relapse, you'll know you did everything your Drs recommended.
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Avatar universal
here's that link again <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12360468&query_hl=11">McHutchinson, et al 2002</a>
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Avatar universal
My NP mentioned that they are seeing a lot of relapses at the North Shore LIJ hospital, when I asked if it was g1s she said even twos seemed to be ralapsing more, even those that did 24 and 48 wks. She said she is keeping a log for her own use, with their stats.  When not a lot of data is available, gut feeling will have to do.
Helpful - 0
Avatar universal
In this study - <a href="http://www.hivandhepatitis.com/hep_c/news/2004/112904_a.html">Treatment for 14 Weeks with Pegylated Interferon Alfa-2b (Peg-Intron) and Ribavirin in HCV Infection with Genotype 2 or 3</a> - EVR for geno 2's and 3' is defined as "<i>undetectable HCV RNA at weeks 4 and 8</i>". Patients who obtained EVR (which was 78% of this group) were then assigned a tx time-frame of 14 weeks. The remaining non-EVR group was given the standard 24 week tx and went on to an SVR rate of only 56%.

Here is a study - <a href="http://www.hivandhepatitis.com/2004icr/39easl/documents/0419/041904_hcv_c.html">Peginterferon Alfa-2b (PEG-Intron) Plus Ribavirin Can Cure HCV Genotypes 2 and 3 - that suggests that geno 2 patients who are non-EVR by week #4 have a 81% SVR rate.


I'm sorry I don't have more information to offer you (maybe a geno 2 here might have some saved to offer up?), but from what I remember reading the best SVR rates in geno 2's are those that show clear by week #4. Applying the longer EVR time span of 12 weeks to geno 2's (which really is more applicable and useful with geno 1's) seems to be a great disservice, at best, by any doctor. In your case you missed the week #4 mark and obtained clear somewhere between weeks #6 and #10. Another negative factor in your case is your dosage lowering. I don't think it would be unreasonable to add 4-6 weeks more of full dose tx to finish out your regime and give you the best single shot at waving goodbye to the virus once-and-for-all.


TnHepGuy
Helpful - 0
Avatar universal
Please forgive my lack of HTML skills. Hopefully, this version of the above post is easier to read:


In this study - <a href="http://www.hivandhepatitis.com/hep_c/news/2004/112904_a.html">Treatment for 14 Weeks with Pegylated Interferon Alfa-2b (Peg-Intron) and Ribavirin in HCV Infection with Genotype 2 or 3</a> - EVR for geno 2's and 3' is defined as "<i>undetectable HCV RNA at weeks 4 and 8</i>". Patients who obtained EVR (which was 78% of this group) were then assigned a tx time-frame of 14 weeks. The remaining non-EVR group was given the standard 24 week tx and went on to an SVR rate of only 56%.

Here is a study - <a href="http://www.hivandhepatitis.com/2004icr/39easl/documents/0419/041904_hcv_c.html">Peginterferon Alfa-2b (PEG-Intron) Plus Ribavirin Can Cure HCV Genotypes 2 and 3</a> - that suggests that geno 2 patients who are non-EVR by week #4 have a 81% SVR rate.


I'm sorry I don't have more information to offer you (maybe a geno 2 here might have some saved to offer up?), but from what I remember reading the best SVR rates in geno 2's are those that show clear by week #4. Applying the longer EVR time span of 12 weeks to geno 2's (which really is more applicable and useful with geno 1's) seems to be a great disservice, at best, by any doctor. In your case you missed the week #4 mark and obtained clear somewhere between weeks #6 and #10. Another negative factor in your case is your dosage lowering. I don't think it would be unreasonable to add 4-6 weeks more of full dose tx to finish out your regime and give you the best single shot at waving goodbye to the virus once-and-for-all.


TnHepGuy
Helpful - 0
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