The studies have showed results for 16 weeks in lieu of the 24 weeks for your genotype. Providing EVR by week 4, the SVR rates showed really no difference in the studies as well with the 16 weeks. I would take into consideration the degree of liver damage also. Stage 3 or 4 damage might want to go the full 24 weeks. Fatty liver amount should be taken into account as well.
I do not believe that this has caught on here in the States much unless the patients have done their homework and works with their doc to treat in this specific approach. Otherwise the patient just follows what the doctor tells them and I believe this plays a part for geno's 2 treating for 24 full months. I believe in individualized approach for treatment anyway.
If you're taking Pegasys and are UND at week 4, 16 weeks seem to be acceptable. If Peg-Intron, 12 weeks might be okay. But to play it safe, go the whole 24. The odds are slightly better with the full duration of treatment. OTOH, if your sides are unbearable, shortened tx is definitely an option. My doctor pulled me off Peg-Intron after only 13 weeks. I was UND 4 weeks after quitting, and next week will get the results of a 4 month post PCR. Just got some of the other numbers from that blood test yesterday, and my ALT remains normal, which is an excellent sign. I'm praying. But if I could have, I wouuld have completed the 24 week course.
There have been several studies for geno 2 and 3 on treatment duration where some of of these studies lean towards stopping early if you are UND at wek 4 while the other studies recommend going the distance OF 24 Weeks
I am geno 10a=3 and I am on week 20/24.. I was UND at week 4 and could have had the option to stop earlier,but as my sides have been managable I have decided to go the distance
Having said that....even if my sides were less managable than they are now....I would have tried to finish 24 weeks by Gods grace rather than face a higher possibility of a relapse...this is my personal opinion
But I guess it all comes down to how bad your sides are affecting you
Please find a link below advocates that longer treatment is better for hep C
Longer Hepatitis C Treatment Best?
Cure Rates Are Higher With Longer Treatment Of 6 Months, Research Suggests
(WebMD) Shortening treatment to less than six months does not appear to be a good strategy for patients with the most curable types of hepatitis C virus infection, new research suggests.
Patients with hepatitis C genotypes 2 and 3 who were treated for four months had lower cure rates and higher relapse rates than those treated for six months.
The study, which appears in Thursday's New England Journal of Medicine, shows that longer treatment benefits even those with highly treatable hepatitis C, researcher Mitchell L. Shiffman, MD, tells WebMD.
"I tell patients if they can tolerate treatment and can stay on it for 24 weeks, they have a better chance of achieving the best possible outcome, which is a cure," he says.
Hepatitis C Treatment Strategies
Long-term infection with hepatitis C virus (HCV) is a leading cause of cirrhosis, liver cancer, and liver transplants in the United States. As many as 4 million Americans are infected, but most don't know it, experts say.
About 70 percent of infected Americans carry the genotype 1 form of hepatitis C, which tends to be less responsive to treatment than genotypes 2 and 3.
With aggressive treatment, nearly 80 percent of people with genotypes 2 or 3 achieve complete and sustained viral eradication, or cures, compared with about 40 percent to 45 percent of people carrying genotype 1 virus.
These days, most patients are treated with a long-acting version of the injected drug interferon along with the antiviral drug ribavirin.
The standard course of treatment for patients with the more treatable types of hepatitis C infection is half that of patients with genotype 1 hepatitis C — 24 weeks compared with 48 weeks.
In several recent studies, it was reported that shortening treatment to four months and even three months had no impact on cure rates in hepatitis C genotype 2 or 3 patients.
In an effort to test these findings, Shiffman and colleagues from Virginia Commonwealth University compared outcomes among genotype 2 or 3 patients treated for four months and six months.
They report that 31 percent of patients treated with the shorter course of therapy eventually relapsed, compared with 18% of patients who got the full six months of treatment. Relapse was defined as having detectable levels of virus in the blood at follow-up despite complete viral eradication at the end of treatment.
Overall, 62 percent of patients treated for four months achieved sustained viral responses, compared with 70 percent of patients treated for six months.
Among patients who achieved complete viral responses within a month of starting treatment, 79 percent of those treated for four months achieved complete, sustained responses, compared to 85 percent of the patients treated for six months.
Individualized Hepatitis C Treatment
Shiffman understands the desire of patients and doctors to shorten treatment. The drugs used to treat hepatitis C are very expensive and they can cause severe fatigue, fever, depression, and other hard-to-tolerate side effects.
But he says a better strategy than shortening treatment is lowering drug dosage in patients who have trouble tolerating hepatitis C treatments.
He adds that rapid response to treatment has become as important as viral genotype for predicting response to treatment.
Patients who show no signs of hepatitis C infection within a month of beginning treatment have a 90 percent cure rate, regardless of genotype, he says.
"We are learning that the optimal way to treat hepatitis C is to monitor the virus during treatment, no matter what the genotype, and adjust treatment duration based on response."
T. Jake Liang, MD, of the National Institutes of Health, says this individualized approach to hepatitis C treatment will become more common as more is learned about the virus.
Liang is chief of the liver disease branch of the National Institute of Diabetes and Digestive and idney Diseases.
"As our technology improves we will be more able to identify patients who will benefit from a shorter course of treatment," he tells WebMD. "For now,
though, genotype 2 and 3 patients who can tolerate the treatment should remain on it for a full six months."
Heres the link below
http://www.cbsnews. com/stories/ 2007/07/11/ health/webmd/ main3047056. shtml
Wishin you the best in whatever you decide
Following is the actual clinical review of Schering's application for PEG-Intron to The Center of Biologics Evaluation and Research (CBER), the division of the FDA that regulates these types of drugs. In other words, it is the highest authority's (CBER) review of PEG-Intron, as studied by the very people who most wanted it to be approved (Schering). It reads like an admission, an admission that the drug is neither safe nor effective, but "hey, it's all we've got". It may shock you. It may only confirm what you already know.
§ PEG-Intron is the Same Drug as Interferon Only Worse
§ PEG-Intron is NOT Safe
§ PEG-Intron is NOT Effective
You need only read one paragraph into the study to learn that PEG-Intron is the same drug as Interferon, only modified to stay in your system longer (Thereby killing you more consistently) ."PEG-lntronTM, peg-interferon alfa-2b, is a covalent conjugate of recombinant interferon alfa-2b with monomethoxy polyethylene glycol product. The biological activity of peg-interferon alfa-2b is derived from its interferon alfa-2b moiety."
compared to interferon alfa-2b treatment.Time to response to treatment and time to relapse were not superior with peg-interferon alfa-2b treatment compared to interferon alfa-2b treatment. Health-Related Quality of Life Scores were not improved in any of the interferon treatment groups either during or after treatment."
After reading 43 pages of evidence, in Schering's own words, that PEG-Intron is not effective and not safe.
Dr. Russell Blaylock, a board-certified neurosurgeon and author of the books Health and Nutrition Secrets That Can Save your Life and Natural Strategies for Cancer Patients, contributed this outstanding article about interferons, which are used widely for the treatment of multiple sclerosis (MS), hepatitis, cancer and more. If you, or someone you know, are taking these drugs, this article will help you decide if the benefits outweigh the many risks.
By Russell L. Blaylock, M.D.
How Interferon Ruins Your Brain:
The mechanism of this injury to the brain appears to involve the brain's special immune cell called the microglia. Normally, these cells remain dormant in the brain. That is, they are sleeping. Microglia cells can be activated by numerous factors, including mercury, aluminum, iron, overvaccination, and brain trauma, strokes, infections (viruses, bacteria, rickettsia) and cytokines such as interferons.
Once activated, microglia can move about the brain secreting very toxic compounds, which include two excitotoxins (glutamate and quinolinic acid). These excitotoxins dramatically increase free radical generation in the brain as well as oxidation of lipids (called lipid peroxidation). These radicals damage synaptic connections, interfere with neurotransmitters and can even kill neurons. In addition, these activated microglia generate other toxic compounds such as prostaglandins (PGE2), which increase brain inflammation.
If the microglia activation is short lived, the damage to the brain is minimal and recovery takes place. Yet, should the activation continue, which would occur with high-dose and long-term use of interferons, the damage could be substantial and irreversible.
Being a G2 RVR doing the short course will give you an excellent chance of SVR. However doing 24 weeks gives you a slightly higher chance of SVR. If you were LVL the short course is worth considering, otherwise do the full 24 weeks. Relapse sux.
Me I’d do 24 weeks just to make sure you kill the all little buggers.
G2s and G3s should not be lumped together. G2s have a higher SVR rates than G3s. G3s also have higher relapse rates, even though they have similar RVR rates.
The Studies don’t break things down enough.
G2 LVL RVRs have over 90% SVR in both the short course and the Full course.