Incivek or victrelis

[geebee270]

does anyone know why some people get incivek and some get victrelis?

[micheall]

I had to ask my dr if I could cut back on the fat intake.He said that because of my good results of my blood test,it wouldn't hurt to cut back some.I did 10 grams of fat.I love ice cream.All the weight I gained come off after stopping Incevic.But on the 11th week of Incevic complications set in and I had to stop tx.On my 3 week follow up I was UND.So talk to your dr.You need to eat the fat for the absorption on Incevic.

[nan535]

My husband, an African American,  had decompensated ESLD when his hepatologist decided to start him on the triple treatment with telapevir. The reason he decided that would be best was because he said that he had zero success with the old treatment with blacks. As there was a good possibility he would not be able to complete treatment because of his advanced liver disease he wanted him to have the benefit of the third drug from day 1.   (As I understand it, the Victrellis isn't introduced until week 4.)

In hindsight, the man was a genius!  My husband had to stop treatment at Week 5  on November 1st, 2011. He remains UND eight months later.
Had he used the other treatment he probably never would have been undetected at Week 5 after only 1 week of the third drug.

Nan

[srw920]

I primarily chose Victrellis because I have Ulcerative Colitis and I can't afford to gain anymore weight.  I couldn't risk adding more "plumbing" issues to my life and adding large amounts of fat, I refuse to purchase larger clothes.  I am sure you will make the right decision for you.  Sue

[geebee270]

Hi Micheall, I was reading over all my post and wanted to ask you what did you eat for your 20 grams of fat. I dont start for awhile and its for my lymphoma to not come back. I look at food labels to much. im 102 lb and want to gain but this fat thing worries me. peanut butter is all I can really afford. It seems easy. I know ice cream nuts cream cheese. what was easy for you? or is eating hard to do anyways? bye gb

[brianmo]

I did Victrelis because I did not want to eat 20 grms of fat with my meals. I went over all the pros and cons with doctor, she gave me weeks to think about it and I made the final decision. Glad I did. EOT was Arpril 4. I am back to normal. Its not an easy decision to make.

Mo

[micheall]

My dr put me on Incevic because of the time factor.I just got finishing 11 months of Peg/Bib and rested 6 months to start 3x tx. of Incevic.The 2nd week I joined this forum.I needed support which I did not have before.My dr said because of the good results of my low VL that I would be a good candidate for the new tx.A great chance of killing HCV.I should have joined a lot sooner to acquire the knowledge to talk over the new treatment.I didn't know what to ask the dr.I had a hard time swallowing the 20 grams of fat 30 minutes before Incevic.If I had more knowledge I would of had better questions for my dr for comparing Incevic to Victrelis.

[Dawn703]

Pooh covered things well. You also have to be your own advocate, so do some research. Personally I was like Jasmine, I did research on both PI's, and decided which I wanted to treat with and discussed this with my Dr. Again as Jasmine stated, there are other circumstances that Dr.'s take into consideration as well before deciding on the PI, so even though you may WANT to treat with a specific PI, it may not happen. You need to be educated on both drugs so that you can ask questions and be prepared for the side effects. As far as I know, there have been no side by side studies between the two PI's, so not sure you can make your decision on which is more effective based on the studys' final results. So I think you should not worry about success rates of each. I based my decision (Incivek) mainly on duration of treatment as well as duration I would have to take the PI.

[JasmineT]

Hi geebee, pooh covered things very well.  Here is a link to a presentation that shows some simplified comparison.  You will notice in some cases with incivek you only have to treat 24 vs 28 weeks.  In other cases with victrelis, you may only have to treat 36 vs 48 weeks.  On both there is a chance you may have to do the full 48.  It depends on your current stats.

http://www.natap.org/2011/PDF/NurseMary.pdf

I did a lot of googling on teleprevir (now called incivek) and boceprevir(now called victrelis) before I chose to treat.  I made my decision based on the odds for success and the shortest duration for interferon based on my specific liver and health state.  You will minimally need to know your genotype, viral load, and what stage your liver is in based on biopsy results.

Your hepatologist can make a recommendation but it's good to be aware of what you think you want and why so you can ask the right questions.  If you read carefully through the trial results that fit your situation you will find good hints on what might be best for you.  It would also be good to review the potential side effects and warnings for anything that may be more pertinent to you.

Hoping you make svr.  Odds are good.

[pooh55811]

I think a lot of it depends on which drug the doctor is most familiar with and also on the side effects. Sometimes the patients also have input into which drug they want to use.

With Inc., one is treating with Inc for only 12 weeks, and then just Interferon and Riba for the remaining 12 weeks. With Vic, people are on Interferon and Riba for 4 weeks and then all 3 drugs for the remaining 24 weeks.

The following guidelines are for Treatment Naive Patients and Relapsers. (Previous Partial Responders and Previous Null Responders receive 48 weeks of treatment.) (Cirrhotics also generally receive 48 weeks of treatment.)

Treatment with Incivek involves 12 weeks Incivek, Interferon, and Riba, and then 12 more weeks of Interferon and Riba. This is for people who are Und at end of weeks 4 and 12. Anyone not Und at week 4 does total 48 weeks.
"The prescribing information for telaprevir in treatment-naive patients recommends that all patients begin with a 12-week period of triple therapy with telaprevir 750 mg 3 times daily (every 7-9 hours) plus pegIFN/RBV.[53] Telaprevir should be administered with food, specified as standard or high fat (standard-fat meal would be 21 g, such as 2 ounces of cheese or a half cup of nuts). After 12 weeks, telaprevir should be discontinued and pegIFN/RBV continued; for individuals with an eRVR (undetectable HCV RNA at Weeks 4 and 12), pegIFN/RBV should be continued to treatment Week 24. Conversely, for individuals without an eRVR, pegIFN/RBV should be continued through treatment Week 48 "

Treatment with Victrelis has a lead in phase of 4 weeks Interferon and Riba. "For early responders (HCV RNA undetectable at Week 8) who maintain undetectable HCV RNA at Week 24, triple therapy can be discontinued at treatment Week 28. For late responders (HCV RNA detectable at Week 8 but undetectable at Week 24), treatment with pegIFN/RBV and boceprevir should be continued through Week 36, then followed with an additional 12 weeks of pegIFN/RBV through treatment Week 48."

Victrelis:

"In clinical trials, the most notable adverse events with boceprevir, when compared with pegIFN/RBV, included anemia, neutropenia, and dysgeusia. Among 1225 treatment-naive individuals treated with boceprevir in clinical trials, 50% developed anemia (hemoglobin < 10 g/dL), 25% had neutropenia, and 35% had dysgeusia compared with 30%, 19%, and 16%, respectively, in those treated with pegIFN/RBV (n = 467).[51] Rates of anemia were 45% with boceprevir (n = 323) vs 20% with pegIFN/RBV (n = 80) in the RESPOND-2 trial of treatment-experienced patients. In total, 10% of individuals in the treatment-experienced study and 6% of individuals in the treatment-naive study reported hemoglobin levels < 8.5 g/dL vs 1% and 3%, respectively, of those receiving pegIFN/RBV. Rates of dysgeusia in this trial were 44% with boceprevir vs 11% with pegIFN/RBV. Dysgeusia was not a major dose-limiting adverse effect.

In the SPRINT-1, SPRINT-2, and RESPOND-2 trials, a total of 13% of patients treated with boceprevir-based therapy discontinued treatment because of adverse events, a similar proportion to that observed among patients treated with pegIFN/RBV.[51] In total, 39% of patients treated with boceprevir-based therapy required RBV or pegIFN dose adjustments vs 24% of those treated with pegIFN/RBV, with anemia being the most common reason for dose modification.

In boceprevir clinical trials, anemia was managed with RBV dose reduction and/or erythropoietin. Forty-three percent of boceprevir-treated patients received erythropoietin to manage anemia. Approximately 3% of patients required blood transfusion.

In the SPRINT-2 trial, the SVR rate in boceprevir-treated patients who did not become anemic was 58%.[58] For patients who became anemic with boceprevir treatment, the SVR rates were in the 70% range. Rates of SVR were 74%, 78%, and 71% for patients who used erythropoietin, reduced RBV, or required both to manage anemia (Figure 13). A similar pattern was seen in the RESPOND-2 trial. Thus, RBV dose reduction did not impair the likelihood of success with boceprevir treatment. It appears that anemia may be a marker of exposure to the PI and RBV.[59] "


Incivek:

"The most notable adverse events with telaprevir in clinical trials included rash, anemia, pruritus, and anorectal symptoms. Reported rates for telaprevir triple therapy (n = 1797) vs pegIFN/RBV control (n = 493) were 56% vs 34% for rash, 36% vs 17% for anemia, 47% vs 28% for pruritus, and 29% vs 7% for anorectal symptoms, respectively.[53]

In total, 10% of patients receiving T12PR48 in ADVANCE and 15% of those receiving T12PR48 in REALIZE discontinued all therapy owing to adverse events; the respective rates with pegIFN/RBV were 7% and 3%.[24,29] Among patients in the T12PR48 arm of the treatment-naive phase III trial,[29] 7% discontinued telaprevir owing to rash and 4% owing to anemia. In the treatment-experienced trial, 5% in the T12PR48 arm discontinued owing to rash and 2% owing to anemia.[24] Among patients treated with telaprevir, 32% required a RBV dose modification for anemia vs 12% for those treated with pegIFN/RBV.

In telaprevir clinical trials, erythropoietin use was prohibited and anemia was managed through RBV dose reductions. In a pooled analysis of patients from the ADVANCE and ILLUMINATE trials, 12% of patients (44 of 361) who had hemoglobin reductions to < 10 g/dL required blood transfusion vs 5% of those from the control arms (5 of 92).[60]

In the same pooled analysis of treatment-naive patients in ADVANCE and ILLUMINATE, RBV dose modifications (reductions or interruptions) were not associated with lower rates of SVR in patients who were treated with a telaprevir-based regimen.[60] Anemia appeared to have no association with SVR rates. "


http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%206.aspx