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.

[zazza]

fibrosis progression that is.

[zazza]

Well, Jim, in Sweden we have a proverb that goes:

Better one bird in your hand than ten birds in the forest.

Meaning here that I'd rather treat now than wait for a tx that I do not know when it is coming and what it really means to me in terms of SVR and liver progression.

[bandman54]

I have a nurse friend that works with hep patiens and tx, ...
she says that she rarely sees rapid progression from 1 to 3.

It can happen, but it usually takes awhile.

Another thing to consider, and it may have already been mentioned, is..
tx can make the virus more difficult to get rid of the 2nd time around...

No one told me that.
Wish I had waited.

Now I am waiting on the polymerase inhibitors.

bandman

[jmjm530]

Thanks for posting, a few thoughts.

First, what a shame that prior non-responders or relapsers were subjected to a study that only treated them for 48 weeks, regardless of viral response. The 22% overall SVR rate is not surprising but one might argue irresponsible on the part of the study engineers.

Moving beyond that, this study as stated is for prior non-responders and relapsers and not for treatment naive's which I believe were what the much larger WIN-R study was comprised of. So again, we have apples to donuts and a much smaller sample size here.

But let's assume for agument's sake that the figures are correct. A seven point differential between let's day F2 and F3. Does this still make the argument that treating NOW is better than to Watch and Wait if you were say an F2? (And let's face it, that's what this is all about, it always is here :) )  Yes, seven points is significant IF one were to treat with the same drugs. But if in fact ones strategy was to wait and treat with better drugs (such as the PIs in trial) then that seven points should be wiped right out with HALF the exposure to interferon, given the promising PI trial results. So, as I see it, the case for selective Watch n' Wait is still quite intact even assuming this study is valid which the much larger WIN-R study suggests it might not be.

But again -- and a bit off track -- I have to wonder what these trial doctors disclosed to these poor patients to get them into this trial. Something wrong here, don't you think?

-- Jim

[zazza]

Take a look at this study. I just found it. It looks interesting.

"Platelet Count (and fibrosis stage) Predicts Sustained Viral Response (SVR) in the Re-Treatment of Previous Interferon/Ribavirin (I/R) Non-Responders (NR): Results from the EPIC3 Program"

http://www.natap.org/2008/EASL/EASL_61.htm

[jmjm530]

Thanks for the study, but only 188 patients were evaluated compared to with the WIN-R study, where 4913 patients were evaluated. It's also unclear from your study if they independently examined SVR at stage 4 (like with WIN-R) or if the more advanced stages were more or less lumped together as per earlier studies. It's unfortunate that the smaller study does not reference the opposing WIN-R results, as is often the case when a study seems to contradict a previous one, but it doesn't so one can only speculate on the "why's" but the two things I mentioned above -- sample size and fibrosis breakdown -- are what come to mind.

-- Jim