SVR rates confusion

[wyntre9]

Let me say up front I'm confused!

I thought I understood about SVR rates but after reading forum the past few days it occurs to me that I may be interpreting everything a** backwards.

Clarification, PLEEZE!

I'm 1A, not UND by week 12, Und around week 16, currently on 72 week TX.

I thought that 1A's who reached UND by week 12 had at least a 50% chance of SVR by doing 48 week SOC.

I also thought that slow responders (ie; those who reach UND between weeks 12 and 24) had an SVR rate of only 29%.

Therefore, my understanding was that slow responders who extend to 72 weeks TX increase their chances of SVR .....  but to WHAT?

I mean, do the studies say 1A's who extend to 72 weeks have a 50% SVR rate?  Is it 70%?  29%?

Does anyone know?

Wyntre

[wyntre9]

hope you know i was kidding

wyn

[jmjm530]

The only thing you can do is print out every study -- full text, not Liz's commentaries -- that is pertinent to your genotype and situation, or as close as possible, and then really study them in detail. I did that with what was available at the time I had to make my decisions, and even then the match-ups were very difficult. I caution people to make these types of decisions by reading snippets here from studies that may or may not match up to their situation. What we learn is is an exellent *starting* point, but certainly not an end point. All these studies (full text) can be ordered online with a credit card or fetched from a medical library. Next step after digesting is to test them against a good liver specialist to get the on-the-street take, so to speak. I know, for example, when I presented data to my doc why I should stop at 48 weeks (based on my RVR) he told me had been seeing lots of relapses lately in the older (that is me) population of those with more significant liver damage. Based on that I extended another six weeks although I must say two other liver specialists told me 48 weeks was enough. So in a sense you're correct -- study up all you can, and then come up with a position and then read backwards to support it because you won't get 100% coherency. The important thing though is to study up, or in lieu of that get in touch with some of the best clinicians out there  which generally means seeing someone at a major teaching center.

-- Jim

[wyntre9]

Jm,

I have always looooved, no, treasured your posts but could you Pleeeze make a minor concession to the dyslexic, ADD-afflicted on board and put some friggin PARAGRAPH BREAKS in there!!!!!

i mean, i KNOW it won't technically BE a P. break but it would make it soooo much easier for dolts like me to try and comprehend.

On the other hand, in my case that's obviously futile so why should you bother making that effort?

you're right . . .  

but if i understood your point, it's a good one...  i think. . .

Bill,

You taking classes or giving classes?

Glad you're feeling better, again.  Hope I can say the same sometime soon.

wyn

[Bill1954]

Thanks for clarifying, Jim;

I was aware of some discrepancies, and was trying to be careful (CMA) by allowing Liz Highleyman to provide the interpretation :o). Yeah, it’s difficult to get apples-to-apples with a lot of this data… it’s almost like ‘pick a position and then find a study to support that position’, huh?

Bill

[Bill1954]

Wyntre: too funy!

FL: I'm actually taking second semester Spanish in school; if I had to translate this directly from Madrid, though, I might be arriving with the same stats Wyntre is :-).

[jmjm530]

Part of the confusion is that some of the studies listed above used fixed-dose ribavirin (800 mg/day) instead of the weight-based dose many of us use. I haven't reviewed all of the studies lately but I haven't been aware that EVRs (detect at week 4, UND by week 12) who use weight-based ribavrin whould across-the-board extend to 72 weeks. Hey, I was detect at week 4 but UND at week 6 and two prominent liver specialists strongly recommended only 48 weeks. Plus there are other factors that should enter into the equation such as amount of liver damage and how well you're tolerating treatment. On the other side of the coin, if you really feel that the odds drop significantly if your're not UND by week 4, then I think it's just as reasonable to stop treating after 4 weeks as opposed to extrending to 72 weeks in the subset of folks with little or no liver damage. Treating 72 weeks is a long haul with interferon and you just don't know what kind of shape you're going to be left in.

-- Jim