Ending Interferon on same day as Riba - make sense?

[booocooo]

Hi All,

I spoke with my nurse Friday and I am scheduled to take my last shot on Thursday, Sept. 25.  I asked her how much longer will I continue the Riba and she said I won't, I will finish my pills that day too.  I see many people posting that they are doing five more or seven more days of Ribavirin after their last shot, why?

I'm geno 3a, was RVR at week 4.  Like I've shared before, I'm down to 104 pounds, on weekly Procrit, so this medicine has really kicked my butt.  Is she just trying to end my Tx sooner, or do other people stop Tx (shot and pills) all on the same day?  Thanks!

[nygirl7]

I would listen to Trish above - all the tests and studies that have been done to come to the 50% number for a geno one have to do with taking the meds for the specific period of time and not less.  Unless it was a life or death matter you don't have much to lose and you do have everything to gain. It's not a chance worth taking if you ask me.

[Trish77]

Well, since interferon has a life of about seven days in the body, it would seem to me that the ribavirin for the next seven days has interferon to interact with.  Otherwise, we'd have to take interferon every day for the ribavirin to do it's thing and we don't, we inject once a week and take the ribavirin daily.

I'd keep taking the ribavirin if I had a choice.  It seems a little like wasting the maximum effectiveness of that last injection to not take the ribavirin with it for the days following.  

If you have a choice, I would take it.

Congrats on your RVR and at approaching the finish line!  Hang in there!

Trish

[DB 0]

Stopped both on same day.

[R Glass]

I was also told to stop Riba the same day I did my last shot.
If I remember correctly, she said the Half Life of Riba last longer than the Half Life of Interferon.
Since Riba. is useless in fighting HCV without Interferon there is no need to continue taking it.
I hope I quoted correctly. R. Glass.

[indyjo]

Nurse said take for 7 days after last shot.

[mremeet]

I would keep taking the riba for 5-7 days after your last shot. Odds are it won't make any difference compared to stopping at the same time as your last IFN shot. But the fact of the matter is:

1. Pegylated interferon continues to effectively work within your system for about a week after your shot (that's why you take shots weekly).

2. Interferon's effectiveness is greatly enhanced by the addition of ribavirin when dosed at optimal levels.

3. It is true that ribavirin has long half life and if you did stop taking it the same day of your last shot, a significant amount of it would remain in your system for a week (and beyond). *But*, ribavirin blood serum levels would start to drop as soon as you stopped taking it. Certainly before the week is up (i.e. the window of efficacy for the last IFN shot), ribavirin blood serum levels would have dropped below the optimum levels associated with the best IFN/riba conjoined antiviral efficacy. So you'd be voluntarily giving up just a little bit of the fight right at the end of your treatment.

4. There are many relapsers (people who fail treatment) in all genotype groups (especially with geno 1). Of those relapsers there is an unknown percentage amongst them that were on the very verge of achieving SVR at the very end of their treatment. There is also an unknown percentage SVR's that had *just barely* crossed the threshold from relapse into SVR right at the very end of their treatment, even up to after their very last shot. There are people amongst these groups that if they had only extended their treatment by one more week, or pehaps even by just taking a few days more ribavirin on their last week - they would have been cured instead of relapsing. And conversely there are some who if they had curtailed their tx by only one week or even had stopped taking their ribavirin on the same day of their last shot (instead of continuing on for another week with it), they would have relapsed instead of SVR-ing. We don't know who those people are or how many of them exist amongst relapsers and SVR's. But rest assured they do exist and just because we can't pin down the exact percentages associated with these borderline relapsers/SVR's, that doesn't mean we should not think in these terms when we ourselves are at that critical juncture in treatment.

For my final week of treatment, these thoughts convinced (scared) me into going ahead and suffering through another week of ribavirin after my last shot. I ended up SVR-ing afterwards. It probably did not make a difference, but it is a possibility for the reasons specified above - so you never know!  Good luck...

[jmjm530]

Probably should add that I was doing 54 weeks of tx, had lost mucho weight on treatment, and was on Procrit (epo). How much this factored into what my doc told me, I really don't know. Personally, I doubt if it would make any difference but to do it again I'd probably do the same :)

[jmjm530]

I've heard it both ways here, based on members reporting their doctor's instructions. My hepatologist told me I could stop the riba the same day as the Peg, however he had no problem if I took the riba for another week. I took the xtra week of riba. Whatever you do, keep in mind that you still will have riba in your system for some time after your last injection. Riba has a long half life.

[Bill1954]

Aw, Booocooo;

Both times I treated the instructions from my doctor were to complete my last ribavirin seven days after the final IFN injection. Because we start Tx with an interferon injection followed be a week of ribavirin, it’s necessary to close treatment this was to receive (in your case) a full 24 weeks of riba as well.

As enigma mentioned, your team might have determined that for whatever reason it’s not in you best interest to do the final week; I’d suggest you confirm this with your doctor to rule out any miscommunication involved.

All my best—

Bill

[Xenigma]

ahhh...No it doesn't make sense unless your nurse-where's your Doc? has a reason for it like your blood counts (Anemia/hgb)  You should have one week of Riba left after your last shot as we start the Riba the morning of our 1st shot (unless we pre-dosed beforehand)
I'm sure others will explain in more detail but that's SOC from what I understand, it's not something we want to take for another week believe me.
Good luck!...
enigma