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223152 tn?1346981971

Pre-dosing Ribavirin

I wondered what the thoughts were on pre-dosing ribavirn in conjuntion with triple therapy.  I will be doing the 4-week lead in for Victreslis soon (I hope) and wonder about predoing with ribavirin before the 4-week lead in.  My doctor prescribes to the Victrelis labeling --- that is, 100 IU/mL at week 12 means end of treatment.  That scares me and I want to do whatever I can to make sure I am clear at 12. I figure this is a last chance now that I am stage 3-4.

Searching the archives I found this comment by HR

"The predosing of riba holds good theoretical merit, since the effective concentrations are not reached quickly with riba and also because "riba resistance" is not a likely quality that HCV could easily obtain"

Sounds like win win to me.

What do some of you thinK?
39 Responses
408795 tn?1324939275
I think I read about pre-dosing back in the day but I personally don't think it's necessary.  Especially not with triple therapy.  I seem to remember that most of the people who were pre-dosing were repeat SOC's.  Even tho you may be a retread I think you have an excellent chance with the Boce.  good luck!!
Avatar universal
Because of your response to tx the first time i really don't think you need to pre dose, the Victrelis will knock those hard to get little buggers out quick, your looking at 48 weeks so no need to add to the misery............ Remember kat this is  triple therapy, long after HR was here.

Now back to counting beans girl.....
Avatar universal

I imagine HR was  advising there on re-treating with SOC ,I wonder if he would think it was applicable now.
I guess it could be a bit of a double edged sword...on the one hand you load up on riba.. possibly to get a better result early on..however as you know Riba can start to tank HGB. at about 3 or 4 weeks..then you add VIC just about at that time(which as we know has HGB. issues in many)...and the kaka  hits the fan. You have HGB. issues that cause a  reduction .  which subverts the good early start.

If it was me I would just make sure for the 4 week lead in I was doing the absolute maximum amount of Riba I could stand and proly pass on the extra time

Just my thoughts tho..

Good luck
979080 tn?1323437239
there is no clinical data on it and I personally have never seen anybody do it. Could HgB become a problem ? of course but if it does it is likely to happen anyway  If I am informed correctly with direct antivirals
breakthrough can become a bigger issue than it is with SOC alone.
Would predosing Riba possibly help that nobody knows.
With INF the addition of Riba is what increased SVR and direct antivirals
so far still rely on those two.
On the other hand this PI is still so new that doing anything but trial
established protocol seems risky.

just my intial thoughts to the subject .......

223152 tn?1346981971
however as you know Riba can start to tank HGB

Yes, I have concerns about this but that is about the only reason I can think of not to do it.

Yes, I did have HGB issues first time around but I didn't start Procrit until week 17 when hgb got to the 10s for 2 weeks.  With procrit it never got any lower than 10.  It just takes so long for riba to get to the proper serum level, it just seemed to make sense to jump-start it.

can-do -- you are right that I did have a good response to INF but - and I think this is a bit but -- the response for stage 3-4 may be a lot worse than the response when I was 1-2, five years ago.  That's what the hepo says too.  ----- so I may predose those 6 days of five-year old riba anyway.

As it stands right now, I have been denied by BCBS of Texas for the PegIntron , if you can believe that.  They are okay with Pegasys, but the doctor wanted the PegIntron, and I did relapse using Pegasys so I am all for the PegIntron.  The appeal process may take up to 45 days and my doctor is now on vacation until Tuesday.  I thought I would be well on my way by now, but this is a slow process.  They haven't denied the Victrelis, but I don't think they will do anything until after thaey see the PCR from the 4-week lead in.

223152 tn?1346981971
good thing I am not a professional typist. --
victrelis not whateber
big but, not  bit but....
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