Adherence to HCV Therapy Helps Boost Response
NEW YORK (Reuters Health) Jan 30 - High adherence to hepatitis C virus (HCV) therapy prompts significantly better response than does suboptimal drug exposure, Philadelphia-based researchers report in the January 15th issue of Clinical Infectious Diseases.
As lead investigator Dr. Vincent Lo Re III told Reuters Health, "we found that adherence of 85% or more to the hepatitis C treatment regimen of PEG-interferon and ribavirin, as measured by pharmacy refill data, was associated with increased hepatitis C viral suppression and early virologic response to treatment."
Dr. Lo Re of University of Pennsylvania School of Medicine in Philadelphia and colleagues studied 188 patients and compared the relationship between drug refills and HCV suppression.
At 12 weeks, patients with 85% or greater adherence showed a mean decrease in HCV load that was 0.66 log IU/mL greater than was the case in those with lower adherence. In those with high adherence, the mean decrease amounted to 1.0 log IU/mL.
Early response was also more common in the higher than the lower adherence group. For pegylated interferon, the proportion was 73% versus 29%. For ribavirin, the corresponding values were 73% and 55%. The researchers note that "adherence level to one medication corresponded in most cases to a similar level of adherence to the other medication."
Dr. Lo Re concluded that "identifying suboptimal...adherence to PEG-interferon and/or ribavirin using pharmacy refill data could allow hepatitis C providers to help patients to improve their adherence during treatment, which could help improve response rates."
Clin Infect Dis 2009;48:186-193.
Yup, I agree, why chance it -- but this certainly can calm a lot of fears for people who truly accidentally miss a dose of pills...because we know it happens to many of us when we least expect it.
Although I believe, in general, that the people at Penn are pretty smart people determining adherence based on prescription refills seems like a roundabout way to gauge adherence to a med schedule. Following their logic a person would have the best chance of SVR if they refilled on time even if they used their riba to control a moth population in their attics.
Also on the campus of the University of Pennsylvania is the Wharton Business school, arguably one of the best. Using the Med School's logic the business brainiacs at Wharton might say that the best way to insure solvency is to make frequent withdrawls from your banking account.
On second thought, these guy might be on to something. Hate to cut this short but I need to get to the bank.
As usual you make some valid & funny points but I have to disagree and I think monitoring prescription refill is a great way to see dose adherence. Way better then to take the word of a brian fogged person on these TX drugs :-) Just my opinion
I think instead of saying 80/80/80 is OK they are saying take your meds on time cause under that is NOT OK.
If you start telling people it's OK if they screw up once in a while they lose their urgency to keep the strict strict "I cannot miss a dose" scheduling and then could easily fall into the 70/70/70 area.
I don't know if you can really gauge if someone is taking thier meds by refills but I guess it is indeed better than just asking.
One of these days they'll come up with a 'riba pump'. Just fill the resevoir and the riba is dosed so the brain fogged person doesn't have to think about it. I think I read somewhere (for real) that the same concept for Interferon is somewhere in development.
I must admit tho it i a full time job taking the pills doing triple therpy ...you have to stay very focused
I think I'm fairly disciplined, but now that my thinking processes are in question, if it weren't for the little pill boxes, I'd be totally lost........
So the battle is down to knowing what day it is. Sometimes that's a stretch.
When I go in for my study visits, the study team dumps out my Riba bottle and counts the tabs, now that's a good way to know about compliance! Unless, of course, I'm dumping them down the drain...: )
They also count my Peg and when I was on the trial drug they counted that too. I wonder if they also do that in the Bocep trial?
I have all the pills pre-counted for the nurse when i go in for my visits....shes say she wished everyone was like me...im the only one who does it...its no big deal to me...actually it helps me keep track...and im in and out in a flash with my meds fast...
i even trim the empty boxes so there are no jagged edges..im also a neat freak
i just jot down the remaining pills on the top of the bottle and she just adds to it waht i need for the next weeks....since im getting thousdands of dollars worth of drugs for free...i may as well help the over worked nurse
counting pills?? what the hell? my office doesn't give a rats a$$. The doctor's assistant gave me 3 bottles of 300 count 200mg pills no questions asked, simply because I didn't agree with the Dr prescribing me 800mg.
Im in a trial and they account for every pill...so i just help her out...
You need to do some math. Is your situation that you are eating 800 mg but believe that you should be taking more? And, that the doc does not agree with more than 800 mg? I guess that I don't recall your situation.
You wrote that you have 3 bottles of 300 for total of 900. If you take 800 mg (4) per day (7) for 24 weeks you will have consumed 672 riba. You seem to have 900. You have enough for 1000 mg per day and 1200 for 8 weeks of the 24 weeks.
the vertex study nurse also counts my pills. I would never think of doing their job for them! Vertex is set to make Billions on me being a lab rat! and the study center is paid BIG BUCKS by Vertex, so let them do their own pill counting ! Actually even if I told them my pill count they still have to count them according to Vertex protocol. So I would think that by a nurse not counting the pills could lose their job.
That is really funny rock that you are obsessive the way you are with cutting boxes, counting pills, etc. But if i was to expect that from someone it would be you!
Think about it you may end up getting your nurse fired if the Bocep people find out she is not doing her job by counting those pills :-)
"i just jot down the remaining pills on the top of the bottle and she just adds to it waht i need for the next weeks...."
She's supposed to count them anyway.
i just make sure all is correct...