Stage 1 to stage 3

[wantalivlong]

What is the shortest amount of time you've heard of someone going from stage 1 to stage 3 or 4?

Trying to guess how one is to know how long they should wait to treat OR if one should wait at all.

[Trinity4]

Pearlman asked me if I would be willing to have another one at EOT.  Compiling research I guess.  I may just to that.  I certainly would have concrete evidence, one way or the other.

Trin

[nygirl7]

Good luck, that should work and then the fibrosis should reverse some too

Hopefully, treating 72 weeks will give the liver plenty of time to have the fibrosis reverse.  I wish I had gotten a biopsy as soon as treatment was over so I could have seen for certain what the situation was. I always intended to but........

[jmjm530]

Better one bird in your hand than ten birds in the forest.
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There's another proverb that says a bird in your hand can sometimes lay an egg.

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Apache,

Did they lump advanced 3's and 4's together. It looks like that at first glance. If so, then the two studies may be consistent because WIN-R does suggest that stage 4's have a tougher time with SVR.

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Bandman,

Did you mean "grade 4" or stage 4? I don't think treatiment decisions revolve around grade. I had grade 4 around five years ago and grade 1 or 2 just before I treated. So it appears that grade can fluctuate a lot while stage tends to keep getting worse.

[bandman54]

I think it is worth trying the new treatments... if they would ever come out...

I do think a grade four should treat now.

I am a grade 1, stage 1 , so I am going to chill and hope they come out with the new meds soon.

bandman

[apache1]

This was from the AASLD 2008 Annual Meeting. This study shows a diffident difference in the time it takes for advanced fibrosis g2 and g3 to get a SVR

With advanced fibrosis the odds go down for g3 g2 in the below study, with shorter tx times, and SOC tx

Not sure if you could translate this to geno 1.
Just another study that shows something different than the other studies. Just something to think about.
This study spells out what they consider advanced fibrosis, Bridging fibrosis/cirrhosis was defined as metavir 3+4, Knodell 3+4, Ishak 4+5+6 on the pre-treatment liver biopsy.

http://publish.aasld.org/Pages/Default.aspx
AASLD 2008 Annual Meeting
#1239
Nov 03 8:00 AM - 5:30 PM
Q07. HCV: Treatment


Are there differences in treatment outcomes between HCV genotype 2 and 3 patients with advanced fibrosis treated with peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®)?
S. Bruno1; S. J. Hadziyannis2; M. L. Shiffman3; D. Messinger4; P. Marcellin5
1. AO Fatebenefratelli e Oftalmico, Milano, Italy.
2. Department of Medicine and Hepatology, Henry Dunant Hospital, Athens, Greece.
3. Virginia Commonwealth University Medical Center, Richmond, VA, USA.
4. Biometrics, IST GmbH, Mannheim, Germany.
5. Hôpital Beaujon, Clichy, France.


Background: It has been previously shown that among patients infected with genotype 2 or 3 HCV treated with pegIFN alfa-2a 180µg/wk plus ribavirin (RBV) 800mg/day, rates of sustained virological response (SVR) are generally higher for G2 and overall 24wks of therapy is better than 16wks. The objective of this retrospective analysis of data from two large international phase III studies, is to extend these analyses to patients with advanced hepatic fibrosis infected with G2/3 treated with pegIFN alfa-2a plus RBV for 16 or 24wks.

Methods: G2/3 patients with advanced fibrosis/cirrhosis included in this analysis were those assigned to 16 or 24wks of treatment with pegIFN alfa-2a 180μg/wk plus RBV 800mg/day. Bridging fibrosis/cirrhosis was defined as metavir 3+4, Knodell 3+4, Ishak 4+5+6 on the pre-treatment liver biopsy. Responses were defined as rapid virological response (RVR;HCV RNA <50IU/mL at wk4), complete early virological response (EVR) (non-RVR but HCV RNA<50IU/mL at wk12), partial EVR (non-RVR with a detectable but ≥2 log drop in HCV RNA at wk12) and non-EVR (<2log drop at wk12). SVR was defined as HCV RNA <50IU/mL after 24wks of untreated follow-up.

Results: Data were available for 380 patients with advanced fibrosis/cirrhosis (G2 16wks=107; G2 24wks=99; G3 16wks=84; G3 24wks=90). Among patients treated for 16wks of therapy, SVR rates were 51% and 44% for G2 and G3 respectively and for 24wks of therapy SVR rates were 66% and 53% respectively. By MLR independent baseline factors predictive of SVR included lower body weight, higher alanine aminotransferase quotient, higher serum albumin level, higher platelet count, lower viral load, G2 infection and assignment to longer treatment duration. Among patients treated for 24wks, rates of RVR were substantially higher among G2 patients (Table). Rates of SVR among patients achieving an RVR and assigned to 24wks of treatment were 77% and 90% for G2 and G3 respectively and rates of SVR among patients achieving a complete EVR were 44% and 34% for G2 and G3 respectively. No patient with slower responses achieved an SVR.

Conclusions: Among patients with advanced fibrosis/cirrhosis treated with pegIFN alfa-2a plus ribavirin, those infected with G2 HCV had higher rates of RVR and SVR compared to patients infected with G3 HCV. For patients achieving an RVR and treated for 24wks, rates of SVR were high for both G2 and G3 (77–90%). For both G2 and G3 patients with advanced fibrosis/cirrhosis abbreviated 16-wk therapy was less effective and should be strongly discouraged in this patient population.

Response at wk 4/12                                  
                                           n=206 G3            n=174 G3

RVR, n(%)                                                      
                                           88 (50.6)             132  (64.1)

cEVR n(%)                           60 (34.5)                66 (32.0)    
            
pEVR, n(%)                          3 (1.5)                 9 (5.2)    

Non-RVR/EVR, n/N (%)        5 (2.4)                17 (9.8)
                  
            Abstract Central® (patent pending). © ScholarOne, Inc., 2008. All Rights Reserved.
Abstract Central and ScholarOne are registered trademarks of ScholarOne, Inc.

apache

[Megan5515]

So is it even worth it to try some of these new treatments?  I have stage 4 now.  When I found out I was already stage 2 and within a few years I was stage 3.  I have tried treatment 3 times with no success.  I was planning on discussing new treatments with my doctor in december.  I'm not sure if the side effects are worth it.