TX for 48 wks or 72 wks ?

[GingerB]

I am starting tx soon.  My doctor mentioned a 48 wk tx plan, and then mentioned 72 wks.  My genotype is 1 and my viral load is considered high.  This is my first time treating and may be my only time as  I am at an age where I do not know if I will be able to deal with tx another time.  Does anyone know how much better your chances are of clearing the virus with a 72 week tx plan as opposed to 48 wks?  And  would your 4 wk, 8 wk, 12 wk and/or  24 wk viral load reductions play a role in whether to extend the tx to 72 wks.  Or  would it be best to go for 72 wks regardless  if I am able to?   Do you know if the insurance companies typically pay for the extra 24 wks of medication?  I appreciate any information you can offer.  I am just trying to plan ahead - there is so much to think about.  Thank you.  Ginger B.

[mremeet]

Re-reading what both ginger and you said above, I agree what you said was technically not wrong or misleading. Sorry about jumping on you, it was just my first read of what you said appeared to be an almost airtight statement against 72 weeks of tx. You didn't "quote" ginger above (as I would have) when you said "regardless", and the way you worded it led me to mistakenly think that was your wording. I suspect nygirl (and perhaps others) read it the same way. Plus knowing how you feel about existing treatment and extended treatment, I was self-prejudiced into thinking you were going down that familiar road again. But I was mistaken and I apologize about that. I agree that she should not treat "regardless", come hell or high water no matter what happens for 72 weeks. Obviously there's more to it than that, and you're correct for pointing that out.

As Roseanna Roseanna Danna used to say: Never mind!!

[nygirl7]

The end.

[jmjm530]

Just to summarize, and then I'm done here -- because as you've stated this has been thrashed over between us in the past -- the question "Ginger" asked was:

"Or  would it be best to go for 72 wks regardless  if I am able to?"

It was quite clear -- at least to me -- that she was asking if she should do 72 weeks *regardless* of any other factors such as viral response. The correct answer as I saw it then (and now) is "no", she shouldn't do the 72 weeks regardless. It depends on other factors which I touched upon best as  I could. If you have "other factors" to add, that's fine.

Please have the last word.

-- Jim

  

[jmjm530]

Forgot to add that "age" was not mentioned as a factor by any of the doctors except my treatment doctor. When I did bring the subject up to one specialist, he said that my RVR trumped my age. Since then I have seen studies that support this, as well as studies that suggest that the level of fibrosis also isn't an important predictor of SVR unless it's stage 4.

[jmjm530]

Mre: . And again the part about nearly all circumstances up to an and even including cirrhosis is totally over the top, and we've certainly been down this road before. You should explain to ginger your own age, fibrosis level, extended tx with uber dosed riba regimen jim and how it worked out for you before blanketedly telling others to not do something similar to get their own SVR.
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I've discussed this before, but once again...

I treated at age 58 and at the time I started treating I was told I was between stage 3 and 4. I believe the original plan (with doctor 1) was to treat 48 weeks unless I was a slow responder, and then to treat 72 weeks.

At week 2, I switched doctors because I wanted to take a more agressive approach given my projected odds (before I had a vl test) of around 40% based on my age, and level of Fibrosis.

The "Uber" dose of ribavirin was my idea, and as I have stated in the past, I probably didn't need it because my week 1 vl was almost a two-log drop, and that was the week I was on a single dose of Peg and regular dose of ribavirin. Of course, I didn't get the vl test results back for a couple of weeks, so did not have that info in hand when I stepped up the meds.

I became UND at week 6 via sensitive TMA and remained UND via sensitive TMA througout treatment.

Near the EOT I consulted with perhaps 5-6 hepatologists (three I personally saw) regarding how long I should treat. All except my treatment doctor felt 48 weeks was the right number based on my RVR and the fact that I did not have cirrhosis. (It was determined mid treatment after my slides were re-read, that I was not between stage 3 and 4, but in reality probably closer to stage 2-3). I ended up compromising and treating 54 weeks, but looking back, especially with some of the more recent RVR studies -- not to mention 5 out of 6 hepatologists suggesting 48 weeks -- so looking back, I think 48 weeks was the correct number.

I don't think any of the above is inconsistent with my answer to Ginger.

-- Jim

[jmjm530]

Briefly, when I used the word "regardless" it was in the context of the way Ginger used the word "regardless" in her original post. Her doctor mentioned two options to her -- 48 weeks and 72 weeks, and yes, I assumed he mentioned those options because viral response was not known at that point. Something (viral response) Ginger mentioned later on. All I was saying is that you don't treat 72-weeks, "regardless", meaning sometimes you do -- I covered that as best I could -- and sometimes you don't.

As "HR" has said in the past, it's impossible to cover all bases/all scenarios in anwering a particular question, and the best you can do is try and deal with the core issue as you see it.

No problem if you want to expand, qualify or disagree with my answer. My quip with NYGirl was that she was not paraphrasing me accurately when she suggested that I was against 72 weeks of treatment , which I actually did touch upon in my last sentence.

-- Jim