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Avatar universal

Need some advice

I am going to discuss my bx with my Gastro-enterolgist(?)in a couple of days. I have genotype 1b and my vl is 2.4mil. After raeding many posts here and much research on the internet the chances for SVR for HCV genotype 1 are 50-50 or less. This does not seem good. Since this may be the case, would it be a good idea for me to pursue a group test where the shelf life is much longer than the pegalated interferone of today. I would only need to take a shot every 2-4 weeks, because this brand of interferone stays bilogically longer in the system. I understand people are given this  new tx when they don't clear after 48-72 weeks with pegalated interferone/ribi. I know there may be some risks invovled, but I would be willing to take a chance. The SVR rate is higher with this new tx for genotype 1's. Please let me know if this is worth discussing with my Dr.
Thanks all.
CIGASO.
35 Responses
Avatar universal
Everything is relative. When I first tx'ed back in 1992, the SVR rate was 10% or less for geno 1's. So the 50% figure of today is a HUGE step up and forward. Also, as you pass certain milestones during tx (eg - being clear at week #12), those odds continue upward.

As far as going into an Albuferon trial (which I assume is the type interferon you are referring to), the first thing to look at regarding existing test results is the number of patients used in the trial(s) that these increased SVR results are based upon. And what were their negative predictors going in (viral load, age, genotype, extent of liver damage, etc)? What SVR rates did each sub-group end up with? And what was their length of treatment? If they have results only based upon a small sample population or narrow sub-groups, the SVR data may be unreliable. I can pay to dig into the numbers and the data.

As far as the trial you might be interested in, some questions to ask are: what are the restrictions? Would you be guarenteed to receive Albuferon? At full dose? Would you get the proper weight-based dosage of riba? Would they go the extra mile to keep you at full dosage (i.e. - via Neupogen and Procrit, if need be)? Would they extend your tx if you don't meet certain milestones (clear at week #12, etc) or is it 48 weeks and out?

I wouldn't be too overly sold on an interferon based solely upon it staying in your system longer. The current peg versions stay in your system longer than the original mono interferon. Yet the trade-off for the pegs in gaining longer half-life was a decrease in overall potency.

Is it worth discusiing with your doctor? Sure is. Never hurts to learn more and get a professional's opinion. You can also ask him about any trials that involve adding Zadaxin to the existing peg/riba mix, though there are some mixed results so far as to it's effectiveness.


TnHepGuy
Avatar universal
I was a 1B and finished 48 wks of tx mid-September this past year.  Still clear as far as I know......will have my 6-mo PCR in mid-March.

My doc explained that we start with a 50% chance.  If we have a 2-log drop or more at 12 wks, our chances are increased to 60%; then 70% at 24 wks if we are undetectable at that time.  If still clear at 48 wks, our chances increase to 80%.  And if still clear at 6-month post-tx, we are 90+% of staying clear.
Hope that helps.

Good luck to you.
Avatar universal
The chronology that Lynn 5477 presented above -- does anyone have this info for geno 2b's?  I've gotten a bit lost in the discussions about when the pcr's are to be done, how often is best to have them and what they're supposed to tell you.  Lynn's chronology was great--just wonder what it is for my genotype.

Also--I received my first biopsy results over the phone, I was told stage 2 grade 2, described as "moderate".  He says he is fine with me putting off treatment for awhile if need be, and I'm considering waiting until after my busy season (Aug. 1).  I was going to ask him for pegasys rather than the pegintron, because my impression is that the sides aren't as bad ?...but that there may be a trade off with potency ?(or maybe not?)--that there isn't really a clear choice between the 2 types?.  Can someone verify or clarify these impressions?  I am a 57 yr old female diagnosed 2000, geno 2b, VL (11/9/04) 1,440,000 ALT 259 AST 199.

Thanks to all of you for being there.
Avatar universal
Ten, yes you are correct. It is Albuferon. Good advice. I will check and see if the data was from a limited sub-group. And the shelf life info you gave is very important. If I recall correctly, the study stated that there was a greater reduction in AST, ALT and vl from Albuferon. I'm going to do more research. Ten, you sound like you have had a tough time. I hope things get better. Thanks.

Lynne, I am glad to hear you are one of the 50% who cleared. It sounds encouraging. Thanks.
Avatar universal
SVR odds for geno 2's are 90%+. Truly wonderful odds. And the tx regime is half the length of time of geno 1's (24 vs. 48 weeks).

Working in your favor is the fact you are female, have a low viral load and (believe it or not) have a relatively high ALT quotient (which is defined as your actual beginning ALT divided by normal-high, usually given as 52. So in your case your ALT quotient would be: 259/52 = 4.98). One negative factor is your age. As far as your bx goes it would probably be considered a wash to slightly negative, since you are at mid-level in terms of liver damage.

As far as when to have PCR's done. If I were a geno 2 I would want to be tested no later than week #4. And would look to be clear at that point in time, too. If I wasn't, I would consider extending beyond 24 weeks since the majority of 2's show serum clearance by then.

The jury is still out (and may be for a long, long time) on actual SVR differences between Pegasys and Peg-Intron, since no head-to-head studies have been done. The pharmaceutical companies are reluctant to do so since the 'loser' would end up dropping market share.

So, to sum up: as a geno 2 you have great odds of acheiving SVR. Try and not get too caught up in the details and the minutiae (like I tend to .. ahahahha). Keep your focus on the big picture, which is to do what needs to be done to achieve the goal of SVR. And to that end, when you do go to treat, make sure your doc is behind you 100% and you are both on the same page. That he/she will rx you Procrit and Neupogen to keep you at full dosage rather than cutting it. That he/she will extend your tx if the circumstances call for it, etc. Call your pharmacy to be sure that they will both carry and timely get to you all of the drugs you might need (including the Neupogen and Procrit). Call your insurance company to verify they will cover these medications. As much of this type of thing you can take care of ahead of time, ensures that no last minute crises crop up which might end up hurting your SVR odds via a dose reduction.


Best to you.

TnHepGuy
Avatar universal
Your post to laika was excellent. I think you should hang a shingle. Mike
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