UND at week 28, finally!

[smaug48]

I just heard that my week 28 PCR was negative - YES!!!  What a relief.

I'd like to take this opportunity to thank everyone for being here - you guys are helping me keep my sanity while going through tx!

According to a new study posted by drofi (I'll call it the Arase study, the first author's name), these were the SVR %'s for super late virological responders, which was defined as achieving und between weeks 25-48.  The patients in the study were geno 1b.

Continuing tx for:
20-29 weeks after und - 18% (2 out of 11 people)
30-39 weeks after und - 20% (1/5)
40-49 weeks after und - 40% (4/10)
50-59 weeks after und - ND  (couldn't find in the study what this stands for)
>=60 weeks after und - 100% (2/2)

I wish people would stop saying that not getting to und by week 24 means a 2% chance of SVR!!!

Here is the link for the study
http://www.jstage.jst.go.jp/article/internalmedicine/47/14/1301/_pdf
or  http://tinyurl.com/5efhmy

I am geno 1a.  My understanding is that tx for g1a  and 1b is identical, so I can apply these results to my case.  Does anyone have a different opinion on that?

smaug

[jmjm530]

Please read "Smaug's" last post as well as some of the interim ones.  

He and I are in *agreement* on what Schiffman says. And no, I did not change my mind during the thread.

The fact that Smaug (or anyone) may not agree with Schiffman's conclusions is a different matter. I suggested a remedy in my last post, i.e. contact Shiffman.

You are also skipping over the advice that many here have been given -- NYGirl from Dr. J. as one example -- re stopping at week 24 if not UND.

Things change in the HCV research landscape and we can only report what we know at a given time, and perhaps this new study will offer some an alternative approach to consider -- but that doesn't mean we should just accept it at face value any more than we should reject it based on previous guidelines.

-- Jim

[zazza]

I so disagree with you on your interpretation of Schiffman's words. (At least your first interpretation, I am not sure if you changed your mind in your last post.) You are reading things into his statements which are not there. I totally agree with Comeagain's and Smaug's interpretation of the quote. People who never become UND during tx obviously can not SVR.

I think we should leave Schiffman's paper behind, and concentrate on studies that actually look at extended tx for super late responders. Just like Smaug I am unaware of any studies other than the Arase study which have actually looked at extended tx for super late responders. As long as noone can actually show us such a study, I think we should refrain from trying to find excerpts here and there that we interpret to prove our own point. Sorry Jim, if I seem harsh here.

I am kind of surprised though that super late responders means all who become UND between week 24 and 48. This is a very long time period, and usually tx has to be extended exponentially in relation to how long it took to become UND. Maybe one can contribute this to the research of extended tx for super late responders being so new.

I think the Arase study brings hope to people like Smaug who just barely missed UND at week 24 and have the motivation to continue treating right now. People who become UND later should be careful since the study sample is so small.

Also, I can not see how Smaug's borderline detectables can be discounted as false positives. They may be discounted because of being so close to UND, but not as false positives, since Smaug got 2 in a row with 2 weeks apart. I know on my borderline detectable test result it said "repeatable borderline value", so at least in Sweden they recheck these.

By the way, the link worked now when I typed it in manually. :)

[jmjm530]

Perhaps write/email Shiffman and ask what he's basing that statement on and maybe also refer to the newer study posted? That's what I'd do if in your situation. Also perhaps things have changed since he wrote that. The more info we collect the better.

[smaug48]

I agree that Shiffman is clearly saying that they won't SVR.  

But I am making a distinction between a person who reaches UND after week 24, and a person who never reaches UND after week 24.  In what you posted, it seems that we agree that Shiffman is saying that someone who has not reached UND by week 24 will NEVER reach UND and therefore cannot SVR.

I guess I'm saying I disagree with Shiffman's statement, because I'm talking about someone who actually reaches UND after week 24 (like myself).  I have not seen any research saying that people who became UND after week 24 and then treated 72 weeks had an extremely low chance of SVR.

smaug

[jmjm530]

I know that wasn't your inference, but I was getting frustrated not being able to find the wording I had read previously. As to the Shiffman article, I think if you re-read it carefully, you'll see he definitely is talking about SVR.

He says with parens mine:

Since these
patients (those still detectible at week 12) are not HCV RNA undetectable they cannot achieve a SVR..."  Then he goes on to say that these patients will not become undetectable WITH LONGER TREATMENT (caps mine).

So..l. if they can't become undectable with longer treatment, then it stands to reason they won't SVR

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Yes, be intereresting to see what Dieterich says, but like I mentioned earlier, I think he will discount your very borderline detectibles and assume you were UND by week 24. In other words my guess is he will tell you to extend treatment.

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[jmjm530]

The link works for me, maybe try again. If not, maybe "tinyurl's" aren't welcome in Sweden :) If that's the case, let me know and I'll get you the original link somewhere -- just don't want to screw up the formatting since that link is three lines long.

http://tinyurl.com/6j466y