Stopping Tx at 12 weeks Geno 2?

[Doofus_jones]

I'm wondering if anyone here has updated opinions on stopping peg and riba at 12 weeks (vs 24 weeks recommended)  if undetectable at 4 weeks and 12 weeks? Geno 2 only.

Pete

[can-do-man]

As the one study said age did not reduce the the relapse rate substantially for any of these groups.

Myself I think in your case I would really consider a shorter Tx. As was said by doctor Kwo..."Truncation of therapy to 12-16 weeks should be considered only in patients who achieve rapid virologic response but experience tolerability issues."

With a heart condition you fit that mold........... Best to you.

[R Glass]

I’m surprised that you are txing with a Heart Condition. I had to do a Stress Test and get approved by a Cardiologist before they would even start tx.

[Doofus_jones]

Can-do-man

Looks like age is against me.

Although I was undetectable at 4 weeks have had a tough time. Stents in heart at 4 weeks. Blood transfusion at 6 weeks. One week on Eprex.

Right now my blood work appears to be passable but I'm suffering symptoms of anemia. I'm concerned my heart is not going to take it.

I'm now on a laundry list of drugs:-

6 months for heart surgery:-

Pariet
Plavix
Lanoxin
Cartia

For HepC:-

Peginferferon
Ribavirin

For blood count:-

Eprex - inject Monday, Wed, Fri

For insomnia due to riba:-

Stilnox - half tab.

One wonders what this cocktail inside you all the time can be doing to other areas of your body.

Also taking B12 and now D2 1000

Still not through week 10. Cannot really work anymore or even walk very far.

best

Pete

[can-do-man]

In the pilot trial, all patients with RVR were treated for 14 weeks, while in the larger trial participants with RVR were randomized to receive therapy for either 14 or 24 weeks.

In an analysis of all RVR patients treated per protocol, 91% of those who received 14 weeks of therapy achieved SVR, compared with 95% of those treated for 24 weeks. The difference of 4% fell well within the pre-determined 10% margin needed to show inferiority, allowing the researchers to conclude that 14 week treatment was non-inferior to 24 weeks.
The relapse rate was highest among participants older than 40 years, those with genotype 3, and those with a high baseline viral load. However, prolonging treatment from 14 to 24 weeks did not reduce the relapse rate substantially for any of these groups.

http://www.hivandhepatitis.com/hep_c/news/2010/1026_2010_a.html

[can-do-man]

Things I would think about. Have you been doing weight base Riba? Your liver stage? Do you want to risk having to do 48 weeks if you do relapse? Being an RVR you have odds around 95% doing 24 weeks. Would I risk that? No way, all that said there is this below.

Patient Case: Treatment Duration in Genotype 2 Patient
The patient is a 61-year-old white female with genotype 2 HCV infection. She works on an assembly line. A liver biopsy in 2010 showed stage 2 fibrosis. The patient expresses interest in undergoing therapy for hepatitis C and wants to hear more about research she has read regarding the potential to truncate peginterferon/ribavirin therapy to as little as 12-16 weeks.
Would truncation of therapy be a potential option for this patient?
Analysis by Paul Y. Kwo, MD:
Truncation of therapy to 12-16 weeks should be considered only in patients who achieve rapid virologic response but experience tolerability issues. The AASLD guidelines note the standard of treatment for genotype 2 or 3 HCV infection is 24 weeks of peginterferon plus 800 mg/day of ribavirin.[19] Several studies have examined shortening of therapy in these patients. Most studies that have examined truncation of therapy to 12-16 weeks have used weight-based ribavirin ranging from 800-1200 mg, regardless of peginterferon choice. The largest randomized trial that compared 16 with 24 weeks of therapy used flat-dose ribavirin, and this study showed that 24 weeks was superior to 16 weeks.[19] Thus, the standard of care is 24 weeks of peginterferon with 800 mg/day of ribavirin. However, if the patient tolerates therapy poorly, therapy could be truncated at 12-16 weeks, provided the patient achieves a rapid virologic response at Week 4. Without a rapid virologic response, the patient should receive 24 weeks of therapy as there is a higher risk of relapse among those who truncate therapy, particularly among late responders