Pre treatment wirh cirrhossis

[marco126]

My heptologist has said he will probly just start me on interfuron and ribavirin,to see if I respond to treatment after four weeks before he introduces ivechek,as I am cirrhotic does that sound like the best thing to do,just lessens my faith,but,It could all just be in my head.

[marco126]

Hey hectorSF man I paid $150.00 to have a special test done and he said I responded really well and I was a cc,and something about interlukinectect....do you know what this test was?

[BigDaddy_59]

I also did the 4 week lead-in because my last tx with consensus interferon (daily shot of nonpegylated) dropped my platelets to 6k and I (we) wanted to see how they responded before the PI as once you start them, if you have to stop them you can't start them again (at least for a long while).
My hepa was also concerned about me decompensating and made me get an angiogram to to make sure my heart would handle a  liver transplant.

[Dee1956]

Hi I think your doctor sounds very good; trying the peg and riba to see how you do on that alone, before adding the Incivek, sounds responsible

I was diagnosed with early transitioning to cirrhosis.  My doctor said that it was going to be hard on me and that he was only going to allow me to do 24 weeks.   As Hector above stated some people with compensated cirrhosis can be thrown into decompensated during tx.  My doctor said 24 weeks, it would either work or not.  He was not exposing my liver to an additional 24 weeks of tx.

I hope you do really well.  Please let us know how you are doing.

[marco126]

He has been open and said he want's to see how I respond to satndard treatment at four week.

[marco126]

I believe I will be getting the standard for my weight.

[can-do-man]

"It looks like Big Daddy started out at a whopping 1200 of Riba"

Thats for a person starting at weight 165 or more, for a man that would be pretty common.

[can-do-man]

Marco try not to be confused by all of this, those of us that had treated with Vic understand what and why your doctor is doing this... Hang in there.

[Idyllic]

Just to be clear are you starting out with a full (or weight-based) dose of Riba and the full dose of Peg (say 180-mcg, for example) or low doses that will be increased.  It looks like Big Daddy started out at a whopping 1200 of Riba.

Did your doctor by any chance mention how much of a drop in viral load he would consider 'responsive.'?

Perhaps maybe you could ask the doctor for details about what to expect the first four weeks. I mean it might help lessen your anxiety if you know the extent (if any) your response will determine the course of your treatment. :)

Best of luck
Keep us posted!

[can-do-man]

Not sure where the low dose is coming from as the lead-in is done for a reason with the new PI's....Just not so much with Incivek.


http://www.drugs.com/clinical_trials/new-data-analyses-victrelis-boceprevir-merck-s-investigational-medicine-examined-possible-11421.html

In the HCV SPRINT-2 treatment-naïve study, patients receiving VICTRELIS who had good response after the 4-week lead-in period, defined by a greater than or equal to 1.0-log10decline in HCV-RNA , achieved SVR rates of 81 percent (203/252) in the RGT arm and 79 percent (200/254) in the 48-week treatment arm compared to 51 percent (133/260) in the PR control arm. Patients with poor response after the 4-week lead-in, defined by a less than 1.0-log10 decline in HCV-RNA, achieved SVR rates of 28 percent (27/97) in the RGT arm and 38 percent (36/95) in the 48-week treatment arm compared to 4 percent (3/83) in the PR control arm

.........................................................

Bigdaddy here is also doing the 4 week lead-in with Incivek

http://www.medhelp.org/posts/Hepatitis-C/To-teplavir-or-bocrevir/show/1821060#post_8397347

2nd - the results from the C216 REALIZE trial (link below) showed an SVR rate for relapser cirrhotics as 82% without the lead-in and 86% with the lead-in. They said this was "not statistically significant" but I told my hepa that if I was in the extra 4% who SVR'd, that it would be pretty significant to me and she agreed! This study only had 145 prior relapser cirrhotics, but since I was going to do the tx anyway, I liked these numbers!

[HectorSF]

There is nothing harmful about this protocol. You will still need to do 12 weeks of triple therapy and an additional 36 weeks of Peg-IFN and RBV alone for a total treatment duration of 48 weeks

This protocol of treatment is similar to what has been done in pre-transplant patients at liver transplant centers for many years. Whether they will reduce your drug dosages of peg-IFN and RBV will depend on pre-treatment blood levels. This protocol been used to treat whose who are infected with HCV and may be have a moderate to high level of risk associated with doing treatment with a very damaged liver. It is used to determine if your liver can handle treatment, as sometimes treatment in cirrhotics can cause decompensation or total liver failure. This approach will more gently ease your liver into handling the treatment drugs.

This protocol is called LADR (Low-Accelerating Dose Regimen).

It will also determine if you respond to interferon. If you don't respond (by having a substantial viral load drop) then there is no point of doing treatment because most of the 48 weeks of treatment will be without Incivek and you will need the interferon and ribavirin to keep the HCV variants undetectable.
----------------------------------------------------------------------------------------------
Hepatitis C Therapy Before and After Liver Transplantation
Norah A. Terrault

http://onlinelibrary.wiley.com/doi/10.1002/lt.21624/full

"Pretransplant therapy, using a low-accelerating dose regimen (LADR), is an option for patients with mildly decompensated liver disease and low laboratory Model for End-Stage Liver Disease scores. Achievement
of an on-treatment virologic response is the goal of therapy.

LADR protocol with peginterferon and ribavirin is used; growth factor use is recommended to manage cytopenias. Select use only. Target patients with low MELD, treatment-naıve patients, or relapsers....the primary goal of pretransplant antiviral therapy is the attainment of an undetectable HCV RNA level prior to transplantation to eliminate or reduce the risk of recurrent infection. A secondary goal, which may be possible in a lesser proportion of patients, is a reversal of liver decompensation and avoidance of transplantation.

Pretransplant antiviral treatment is an option for selected patients awaiting transplantation, namely those with favorable virologic characteristics (a
non-1 genotype or low viral load) and mild to moderate decompensation. However, because complications can be serious, treatment of these patients should be confined to experienced centers. Better tolerated and more efficacious therapies are obviously needed."


Best of luck with your treatment!
Hector

[orphanedhawk]

I heard about one guy who had advanced cirrhosis. His doctor began him on smaller dosage of meds, and gradually increased them. Again, it it's standard but it worked for him and he did clear the virus.

[marco126]

Thanks can-do-man

[can-do-man]

While not standard treatment with Incivek some of the very top doctors think this is a very good ideal, especially when treating cirrhotic or hard to treat people The lead-in is used to gage the effect of interferon. With Victrelis if one does not have a very good response (at least a one log drop) in the 4 week period then its suggested treatment be halted as SVR rates was very low during trials..... Good luck