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Avatar universal

RVR and Shortened Treatment

I achieved RVR in three weeks, from start of treatment.  I've been reading serveral medical documents of studies that say, for G-2s and G-3s, 12 to 16 weeks may be long enough to achieve SVR.  I'm a G-3.  I'm curious what some of your opinions on this matter are.  It is not something I would do, I would not take that chance -- I'd be to paranoid.  Still there are studies that show that 12 -16 weeks come within a breath's difference of achieving the same response as 24 weeks in SVR.  I know in Europe, some countries have shorter treating times than the US.  Maybe the US is just more cautious and scrupulous.  

Just interested in any opinions.

Debbie
22 Responses
Avatar universal
it may be true - but its not treatment protocol here yet - rvr indicates that a full treatment course is almost guaranteed to work - congrats
96938 tn?1189799858
"i've been reading serveral medical documents of studies that say, for g-2s and g-3s, 12 to 16 weeks may be long enough to achieve svr."

two key words in that sentence "may be".

it sounds like you are tolerating treatment well.  why spit into the wind? you'll be done by the end of the year anyway.
179856 tn?1333547362
Agree but that's just me - why take the chance when things are going great, it's only 24 weeks right? That s  nothing!
Avatar universal
I'm not going to go and spit in the wind because it would probably fly back into my face.  I think the AMA, FDA and physicians in general in this country are probably far more cautious than other places around the globe.  That is good -- it is always better to be safe than sorry.  I do know that our FDA is one of the most stringent in the world, which can be frusterating for people needing a certain, promising drug that could help them.  Because of problems in the past with medications that seemed great in the beginning and later proved to be disappointing and even deadly, it is understandable that caution is warranted.  

Twenty-four weeks is nothing -- time goes by so fast -- now it is 18 weeks, hopefully.  

Thanks,
Debbie
87972 tn?1322661239
Hi Deb—

The 2009 AASLD Practice Guidelines discuss the clinical utility of RVR for genotype 2 and 3 patients in detail here:

http://www.hivandhepatitis.com/hep_c/images/hepatitisc.pdf

The section on RVR begins on page 1343; go to page 1344 for tables and discussion specific to GT-3.

By the way, this is the document that guides physicians and in fact the industry in HCV management; in fact, this defines our ‘Standard of Care’. Lots of valuable info here, and probably worth bookmarking for future reference.

--Bill
Avatar universal
Deb, stay the full course of 24 weeks.  Look at it this way, you don't have to do 48, or 72 weeks and i'd rather error on the side of doing a little more than less.  Maybe in the future the numbers will be more tested and accepted here.  Hopefully next year the PI's will make all of this a little shorter and much more successful.

Good luck, RVR is AWESOME.
Avatar universal
6 months is a long time to go through tx, but it's all relative especially if you have treated for 1-2 years. Do the time Deb, it'll be worth it.
Dave
648439 tn?1225058862
I was a Geno 1b and was RVR at 4 weeks and discontinued at 27 weeks on the advice of my team. I would not ahve even begun to make this decision for myself but had decided if my medical team thought it was Ok, I'd do it - instead of the normal 48 weeks for that Geno type.

There are a lot of variables to take into account rather than just the timing of RVR.

It worked for me - I am from New Zealand and they do shorten treatment here.
Avatar universal
this is from the hiv and hepatis link - they state the chance of relapse more than doubles - well 3% - 10% is more than triple in my mathbook - not good news - not accepted protocol - if your dr wants to shorten your treatment make sure hes aware of this - much more research needs to be done to change current protocol --------------

The one shortcoming
of this approach is that the relapse rate more than
doubles from 3% to 13% in those treated for 24 weeks, to
10% to 30% for those treated for 12 to 16 weeks. Importantly,
patients with HCV, genotypes 2 and 3 who relapse
after a short course of treatment almost always achieve an
SVR when re-treated with a standard 24-week course of
therapy. No predictors of an RVR were identified in multivariate
analysis in the single study that performed this
analysis.117 Predictors of an SVR among these studies
were HCV genotype 2 infection, a low baseline HCV
RNA level (800,000 IU/mL), and the absence of bridging
fibrosis or cirrhosis.118 Patients with genotype 2 and 3
infections who fail to achieve an RVR (mostly patients
with HCV genotype 3 infection with high viral loads and
bridging fibrosis or cirrhosis) have poor SVR rates with 24
weeks of therapy and may benefit from longer duration of
treatment, but this has not been prospectively evaluated.
Based on these results, it appears that patients with
HCV genotype 2 or 3 infections who achieve an RVR can
shorten their duration of therapy to 12 to 16 weeks. However,
a recent large multicenter, multinational trial that
included 1,469 patients with genotype 2 and 3 infection
has challenged this concept
548668 tn?1394187222
I remember pouring through those studies when I was about 10 weeks into a 24 week tx.  I think that's when I started counting the rest of my treatment in full moons instead of weeks - it seemed to sound less.   Hehe - I know you'll do the full course, but you have the very best best chances.    What kept me going was knowing that I could 'stop' at any time... which of course I didn't.  Best wishes for the rest of tx.
Avatar universal
I was RVR at 4 weeks (geno 1b) and some studies were indicating that 24 weeks might be good enough.  I soooo wanted to stop at 24 weeks but I truly couldn't let myself stop, knowing I would never forgive myself if I relapsed.  So, like Kristina538, I got through it "knowing I could stop at any time...which, of course, I didn't."  Keep it going and do the course and don't look back.  :)
Avatar universal
Ribavirin Dosage in Patients with HCV Genotypes 2 and 3 Who Completed Short Therapy with Peg-interferon α-2b and Ribavirin
Posted: 08/11/2010

".....In summary, the results of our study suggest that in patients with HCV genotypes 2 and 3 infection completing short therapy with Peg-IFN α-2b in combination with weight-based doses of ribavirin, a high starting dose of ribavirin appeared one of the factors influencing the rate of RVR. We would recommend administering ribavirin at a dose of ≥15 mg/kg when considering short treatment duration. Larger prospective studies would be required to confirm the role of higher ribavirin doses on SVR, as both the need of maintaining the full planned dose of ribavirin throughout treatment to achieve an optimal SVR rate and the improvement of SVR in patients still viremic at treatment week 4 after an intensified ribavirin dosing suggest that higher ribavirin dosage affects SVR. Finally, the evidence that genotype 3 may derive more benefit from high dosages of ribavirin warrants further confirmation of the present post hoc analysis."

Full article at: http://www.medscape.com/viewarticle/723032
Avatar universal
Hi there,

My partner is stage 3 early 4 and was undected at week 2 and genotype 3.  Here in canada they gave him the option to stop at 16 weeks but stated becasue he was stage 3 early 4 that he was best to go the 24.  Which he just finsihed
Avatar universal
I wish him good luck.
Mike
Avatar universal
in order for an existing protocol to be changed - the new must outperform the old - now svr rates for shortened are close - a case could be made if that were the only criteria - but rate of relapse must also also considered along with other performance data - i believe in the future this will be possible
Avatar universal
mikes post about early ribavirin dosing is interesting - ive heard this a few years ago - im not sure they are incorporating this knowledge in current trials - things that make ya go hmmmm - i know riba has its drawbacks - but so does hep c
96938 tn?1189799858
About the first thing you read about combo treatment is that riba does not work alone, without peg.  I was advised, as others were, that pre-dosing with riba (before first peg) was a good idea.  The theory is that it takes riba a while to get up to systemic concentration. So after a week or two the riba level is up, at which point the peg is introduced.  It made sense to me when discussed with the liverhead.  I'm not sure if it was responsible for my treatment outcome, but I think the concept at least helped in getting to undetected sooner.  And, fast response is important especially for us relapsers.
Avatar universal
yes -perhaps pre dosing would be better as high level pre dosing is what i was inquiring
Avatar universal
as the higher the level of riba in the blood corresponds to a higher rate of rvr and svr
96938 tn?1189799858
Oh yeah, and a grown-up dose of the riba too.  As indicated above, 15 mg/kg/day is a good neighborhood.  Fixed dose is for treatment lightweights, literally.
Avatar universal
yes - i did see that - however i didnt do the math - thanks
Avatar universal
i remember talking to someone whose dr put them on an unholy dose of riba - im not sure but i think it was 6 pills 3x/daily she did svr - but was complaining of everything from a-z
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