Riba dose reduction ok in some cases...

[mremeet]

Not sure if this has already been discussed, but here's an interesting study finding that "minor" cumulative dose reductions up to 60% do not adversely affect SVR rates. Those who clear in 4 weeks or less can get by with even less. Nice to know for those who are having real problems with riba sides. Here's the link and text:

http://www.hivandhepatitis.com/hep_c/news/2007/012607_a.html

Ribavirin Dose Reductions Due to Adverse Events Do Not Compromise Sustained Response in Some Patients

Research has shown that adequate doses of ribavirin play an important role in reducing the risk of relapse in hepatitis C patients treated with interferon-based therapy, especially those with genotype 1.

The current standard of care for chronic hepatitis C is pegylated interferon plus ribavirin, given for 24 week to patients with HCV genotypes 2 or 3 and for 48 weeks to those with hard-to-treat genotypes 1 or 4.

In the present study, reported in the January 2007 issue of Clinical Gastroenterology & Hepatology, University of Pennsylvania researchers evaluated the effect of ribavirin and pegylated interferon alfa-2a (Pegasys) dose reductions on sustained virological response (SVR) in patients with genotype 1 HCV.

Data were pooled from 569 participants enrolled in 2 Phase III trials of 48 weeks of treatment with Pegasys plus ribavirin. All patients were evaluated for the effect of cumulative drug exposure on 4- and 12-week responses. The 427 patients who completed treatment were evaluated for effect of drug exposure on SVR. (cont...)

[jmjm530]

And I thought I had it bad with my moth problem on treatment. Get thee to a hotel and let hubby do the best he can. Your health and sanity is the most important thing right now.

Be well,

-- Jim

[sfbaygirl]

Those special fire zone cleaner guys were there today, as well as the electricians. They put bandaids on the problems for the moment. Next week they will be back with the crews to clean the clothes and rugs and walls and furniture. This is what I'm talkin' about! I can't handle those 30 people in my house with me stressing at each move. You are both correct, I don't need to be in prision for whacking some construction guy with a chain saw. I need to stay away. The twinkie defense worked, not sure the Riba one would. Think I'll stay away! Problem is John, while very smart, doesn't multitask or handle things like this easily. Drives me nutz....so I will literally have to stay away in order to save my marriage, the poor construction guys and my sanity. Thanks for the thoughts! Can I call either of you for bail if I need to?

[ladybug52]

Yeah I'd hate for you to set the precedent for temporary insanity secondary to riba-rage! Back away from the 2x4's!
really, you do need to stay out of the fire zone till they get it cleaned up. It will probably set off migraines and lung problems to boot. I cough up much more **** since starting tx, I know it's a side. I think.

[Skepsis]

seems contradictory me too. Following table is representative (perhaps somewhat pessimistic)for the distribution of RVR EVR  and SVR during treatment:

               RVR   EVR   Week 24    SVR

All patients   52%   71%    75%       40%  
Genotype 1     40%   63%    68%       29%

(<a href="http://www.clinicaloptions.com/HIV/Conference%20Coverage/Washington%20DC%202004/Capsules/1751.aspx">RVR EVR [Week24 response] and SVR</a>).

If overall SVR reduction is not significantly different then regarding the 60% non-RVR GT1 population the 40% RVR should have shown a "response boost" by riba dose reduction.

This statement is obviously a mistake, the remaining conclusion is however: a dose reduction with riba to 60% should be a mandatory option for RVR patients to investigate, along with shortening treatment time to 24 weeks - an already recommended change for treatment protocol.

Skepsis

[jmjm530]

Ribavirin aside, why is it necessary to full-dose the Peg after non-detectible, especially in the case of RVRs? You would think that someone should have done a study on this ? Why not trial a mainteance dose of Peg at that point? All we have are retrospective studies that suggest missing a couple of shots hurts SVR but I would imagine this to be far different from titering down the Peg after RVR when I imagine the immune system doesn't quite need the same boost it did when there was more virus. I know some may disagree, but while ribavirin may be more of a short term problem, it's the Peg I see as what can potentially really screw us up post treatment.

-- Jim

[jmjm530]

It just seems that the more you get into this that about half of us are probably taking twice the amount of medication we need to kill the virus and the other half probably aren't taking half enough. If they could come up with better ways to test/monitor our progress in terms of viral eradication, maybe some of us won't have to use a sludgehammer when a hammer would do and vice versa. My guess is there's a lot more money to be made in developing new drugs than in developing tests to see how well the drugs are really doing. End of rant and off to the gym.

-- Jim

[jmjm530]

My understanding is that a little bit of "chit chat" is OK as long as the chit chat flows from the main chat as opposed to standalone chit chat which belongs in the other chat if I'm making any sense with this chatter.

[jmjm530]

Yes, all the numbers and different takes by hepatologists are confusing. And while earlier testing is helpful like you say, I was talking about putting more money into developing newer testing technologies that would flag early when someone's immune response was such that treatment was no longer needed. One hepatologist told me that such a test was already available in theory and what it did was differentiate between a real and interferon-induced T-cell response or something like that. Just think, if we had a test that could conclusively tell us when the meds have finished their job-- then everyone could be tested weekly and not spend one week more (r less) on tx than necesssary. I do disagree with you however on the low odds thing with treatment. If for example, someone is still detetible at week 12 or 24, I think it's important that they understand what the odds are of clearing the virus with SOC and/or extended treatment. If the odds are really bad and they have little or no liver damage, knowing the odds gives them a reasonable choice to stop and wait. On the other hand, if they have a lot of liver damage, knowing the odds might give them the impetus to increase their meds or treatment length. Unfortunatly, sometimes the repetition of these statistics can come off as depressing or as you say "take the fight" away but really don't have an answer to that one.

Be well,

-- Jim

[sfbaygirl]

I totally agree!

[jmjm530]

Don't they have special companies that come in and handle smoke damage, including taking care of the odors? I believe they use ozone generators, special fans/filters or something like that. Probably covered by your homeowner's insurance and some should have a 24/7 emergency number. I'd get hubby on the phone with one of those companies and your insurance company pronto. Don't want you posting from jail although the riba defense probably has not been used.

-- Jim

[jmjm530]

I agree that SVR becomes secondary to halting serious liver damage especially in those near the danger zone, however one defines that. No easy answers and yet many doctors seem to treat the whole process like an assembly line operation. Very frustrating.

As to the chit-chat, I agree that the line becomes blurry between the two forums -- but having said that, each forum seems to have taken on its own personality and I think that's a good thing. Sometimes you're in the mood for chocolate and sometimes vanilla.
SF, for example, just posted over there that she had a fire in her house last night. Can you believe that on top of treatment! Fortunately, no one was hurt and not too much damage. Sorry about that SF.

-- Jim

[sfbaygirl]

Yup, what a nightmare! I just got back from the house and I can't believe all the 2x8's that were burned right through to the roof and floors. The walls are gone. We are lucky to be alive! The Restoration people are there and electricians since the wires were all burnt. They are going to spray something to make it smell better, but being there smelling it makes me woozy. They tell me I am going to have to deal with the horrible smoke cleanup.(they will do it, but guess who supervises)...carpets, upholstry, expensive paintings and oriental rugs. I just don't know how I can do it!! I think I may live in the hotel and let them all do their own thing, otherwise I may grab one of those 2x8's and knock someone out for making too much noise. What a nightmare! I know this belongs on the otherside, but lots of people dont' go to both places, but I was good and didn't post it here until you did, so you are the bad boy! LOL Thanks for the kind words!

[jmjm530]

Never had to deal with fire/smoke damage, but from experience with past restorations and construction, either totally separate yourself from the construction zone via temporary sheet rocked walls (not hanging plastic, etc) or like you suggest, move out until all is clear. I think this would be especially important (mandatory hcv related advice coming) for anyone on treatment given potential skin and respiratory issues, not to mention the fact that eventually the riba might drive you to pick up that 2X8 and start swinging !

All the best,

--Jim

[sfbaygirl]

Great advise, I think I will take it! :) My eyes are burning and I get wobbly just being there in that smoke. It doesn't look bad, thank goodness, but I think you are right about the smoke not doing tx any good, especially trying to do it from a prison cell after whacking someone!

You are on fire!

[Imagine]

Wow, I'm marking this day on my calendar! Someone TOTALLY agrees with you Scott! :) :)

Hope you both enjoy your day.

[jmjm530]

First sentence should have read:

I'm a bit confused by the seeming discrepancy between "C" below and both "A" and the conclusion "D".

[jmjm530]

I'm a bit confused by the seeming discrepancy between "C" below and both "B" and the conclusion "D". "C" states "SVR was markedly reduced in patients who had ribavrin dose reductions and did not achieve rapid virological response". What the study does not address is how an increase in riba later in treatment might affect SVR although conventional wisdom suggests it won't, yet I know of at least one riba researcher who thinks it might. I also agree with Rev's comments, especially if one has significant liver damage. I was told to drop my riba late in treatment but didn't.

-- Jim

(A)Neither early virological response nor SVR were adversely affected by ribavirin reduction as long as the cumulative exposure was greater than 60%.

(B)However, the SVR rate was significantly reduced in patients with less than 60% of the intended cumulative ribavirin dose (P = 0.0006).


(C) In contrast, SVR was reduced markedly in patients who had ribavirin dose reductions and did not achieve rapid virological response.

(D)Conclusion

These findings led the study authors to conclude,

[mremeet]

(cont...) Results

Among patients who completed therapy, more had reductions (</= 97% of  the originally prescribed cumulative dose) of ribavirin than Pegasys (43% vs 27%).

Neither early virological response nor SVR were adversely affected by ribavirin reduction as long as the cumulative exposure was greater than 60%.

However, the SVR rate was significantly reduced in patients with less than 60% of the intended cumulative ribavirin dose (P = 0.0006).

Reduced SVR was associated with prolonged periods of dose reduction, temporary interruptions, or premature cessation of ribavirin.

Ribavirin dose reduction had a minimal impact on SVR in patients who achieved rapid virological response, defined as undetectable HCV RNA after 4 weeks, even when they received less than a 60% cumulative ribavirin dose.

In contrast, SVR was reduced markedly in patients who had ribavirin dose reductions and did not achieve rapid virological response.

Conclusion

These findings led the study authors to conclude,