Telaprevir, Boceprevir ... Should I TX?

[GreatBird]

Hi All,

It's been an eon since I asked a question here (at least a year--or maybe several), but this is how it stands. I just got the results back from the biopsy I had done last week. It shows absolutely no change (grade and stage wise) since the last biopsy I had in 2002, almost exactly six years ago. (I am a grade 1, stage 2). I have geno 1b. Usually a low-ish VL (under 1mil) and no symptoms (every time I think it's the hep it turns out to be something like menopause or Vit D deficiency or the like). I think I've been infected for almost 50 years (since I was six or seven).

As a TX naive patient, I have been asked to participate in the Boceprevir study. I am very interested in doing this because I have the time with relatively few commitments and the chances of clearance are finally good enough that it's very tempting. I'm also not getting any younger, and am currently insured (even though I got laid off from a job in July). (Not that I need insurance for the study, but it makes me feel more secure about the whole thing.)

So, one of my questions is: is there any advantage of Telaprevir over Boceprevir?

From the little information I've found, it sounds like Boceprevir has fewer sides and they both seem to be enough of a "magic pill" to make the SOC actually work (at least more of the time). My understanding of the Boceprevir trial is that of the three arms, if I end up on the non-PI arm and officially don't clear, at that point they would give me the PI.

I'm looking to the wise and knowledgeable folk on this board to let me know what they think. Should I? Shouldn't I? Is there an advantage to waiting any longer? I've always been adamant about waiting (a looong time ago I got into some rather rough words with folks on this board because my stance was so unpopular), and felt a definite advantage at not messing with my strain of HCV and immune system. So now it's somewhat weird to be standing at the starting line, and I'm a bit uncertain. Your thoughts and opinions, please.

[jmjm530]

Will: To delay tx without good cause, after say 50 or so, seems unwise.
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We are much in  general agreement -- although "age 50" could be debated. The disagreement is what is "good cause". Which leads to the reverse your statement which is equally true --  "To treat without good cause, after say --- or so, seems unwise".

We are in a unique point in time where " new drugs should be out in a couple of years" is no longer wishful thinking but the most probably outcome of trials and the subsequent FDA approval process. Waiting a year or so, as not to age ten --  with often the accompanying "outing" of latent autoimmune conditions --  is certainly something for anyone in the treatment decision making process to think about.

[willing]

yeah - I still have scars from the holes (and a lot of blood-stained t-shirts). The whole exercise made me deeply suspicious of the accuracy of staging. The surgeon got plenty of tissue, separate cores from each lobe, and some nice glossy pictures.

Then the pathology reports... I got 3 readings one from a world-class hepatologist, the other from transplant centers at Stanford and Pittsburgh (wanted to make sure). Two of the three agreed with each other and with the previous, standard percutaneous bx (some areas 1 some 2). The third, on the same slides, saw evidence of much more advanced progression with bridging - which would be much more consistent with the fibroscan results.

So go figure... at this point I've run out of experts; and am not really inclined to keep taking out more chunks just to see what stage I'm at (reminds me of that cartoon where Donald Duck destroys the house while chasing a mosquito). The experience has made me more philosophical about what it means to know something..

So when do those 12w test results come in ?

[Bill1954]

Sorry to interrupt this joint dissertation in philosophy, but I was wondering how the laparoscopic Bx results turned out; last we talked, you were still shaking the anesthetic out of your noggin.  And other than that—how are you?

Bill

[willing]

>my life and health (outside my liver) is not better since treatment

from the perspective of one still dealing with hcv infection that parenthesized qualification is an important one. H**, we're all dying, and can fully expect each day to get progressively worse - but there's no sense rushing things. To delay tx without good cause, after say 50 or so, seems unwise. The prevailing view of fibrosis progression, as I understand it, is not linear. Past a certain point it picks up sharply  with age and fibrosis level eg
http://www.ncbi.nlm.nih.gov/pubmed/14960533



The tx-related 10X aging is also something I experienced, and am not looking forward to, but the alternative looks worse.

stay well.

[jmjm530]

"a year or so" may be as long as three years for the drugs to come to market (not currently following the scheduling)  but the point is the same and we will certainly know more in a year than we do now.

[jmjm530]

Willing: Willing: However with respect to waiting, you really have to ask yourself what you're waiting for
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One last point. If one does make a decision as stage 2 to treat in the near future, then one reason to wait at least for a year or so is to wait for current trial data to mature and for the drugs to come to market. At that point one can not only make a more informed decision about which PI mix to jump into but also partake in individualized treatment including helper drugs, more frequent viral load testing as well as addittives such as Alinia, Statins, and whatever else looks promising at the time.