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Prednisone while on harvoni
I have mentioned before I am GT3 treating for 12 wks on harvoni with ribavirin. The choice to do this instead of the SOC 24 wks sovaldi riba was because I am already sick and fatigued with cryoglobulinemia (a vasculitis caused by hep c), and other autoimmune conditions, and would have preferred to wait for Daclatasvir or GS5816, but was under a lot of medical pressure to get those illnesses under control through hep c treatment, as we had exhausted all other options. My liver is not too bad at stage2 grade 1, the bloodtest showing no fibrosis, biopsy showing fatty liver, which my hepatologist disagrees and says is just inflammation given my labs are so good. My viral load however at starting 1 week ago was 60 million. I still haven't yet read a number that high in all the threads I have read over the years. I had been on (and still am on) prednisone since October 2014. I am down to 10 Mg's.
Does anyone know if being on prednisone will decrease my likelihood of clearing the virus? It is so imcredibly difficult if not impossible for me to get off it right now as my joints swell up and I am in severe pain all over from the cryoglobulinemia, I habe been trying to get below 7.5 without much luck, and my cryo doctor and myasthenia gravis doctor keep pushing me to up the dosage. Surely starting with such a high viral load won't be helpful either...
My two thoughts on the matter are that doing three months on the harvoni will give my body and liver a good break in the least until an easier ribavirin free treatment comes along if I am unable to clear, or, it I am not showing progress try to push for another 12 weeks. Unfortunately I started out with fairly low hemoglobin to begin, so I am unsure if I could manage six months on ribavirin, or manage all the side effects, especially knowing it is about to become obsolete for my genotype within a year or so. 12 weeks is doable for me in the condition I'm in, if I have a good chance of clearing. My gastro unfortunately doesn't seem to,have much of a clue, and seemed to go for this treatment for me sure he could get it because the insurance co would love how,cheap it was compared to SOC. No discussions of effectiveness etc, no discussions of present meds. I've barely seen the guy for 6 minutes in the two visits I've had with him.
Anyone heard of people treating while on lower dose prednisone? I have read the studies done of people treated with prednisone prior to treatment which wasn't great outcome wise.
Does anyone know if being on prednisone will decrease my likelihood of clearing the virus? It is so imcredibly difficult if not impossible for me to get off it right now as my joints swell up and I am in severe pain all over from the cryoglobulinemia, I habe been trying to get below 7.5 without much luck, and my cryo doctor and myasthenia gravis doctor keep pushing me to up the dosage. Surely starting with such a high viral load won't be helpful either...
My two thoughts on the matter are that doing three months on the harvoni will give my body and liver a good break in the least until an easier ribavirin free treatment comes along if I am unable to clear, or, it I am not showing progress try to push for another 12 weeks. Unfortunately I started out with fairly low hemoglobin to begin, so I am unsure if I could manage six months on ribavirin, or manage all the side effects, especially knowing it is about to become obsolete for my genotype within a year or so. 12 weeks is doable for me in the condition I'm in, if I have a good chance of clearing. My gastro unfortunately doesn't seem to,have much of a clue, and seemed to go for this treatment for me sure he could get it because the insurance co would love how,cheap it was compared to SOC. No discussions of effectiveness etc, no discussions of present meds. I've barely seen the guy for 6 minutes in the two visits I've had with him.
Anyone heard of people treating while on lower dose prednisone? I have read the studies done of people treated with prednisone prior to treatment which wasn't great outcome wise.
You're welcome Jules. Ah, I see. Porphyria. I hadn't heard the short. It's like me using cryo and people not getting it. 24wks on harvoni riba! That should be pretty effective, you'd think. What GT are you? All the very best to you in getting rid of the virus. For me and it sounds like you the immune conditions it has caused have been more of a problem than the HCV itself. I can't wait to be done with it.
Fantastic information Hector. I had read you writing this before and find it encouraging, although it makes you realize that you have no idea how to gauge how your treatment is going.
I wonder what you think of the very small trial done on GT3 with harvoni (ion 2 I believe). I am one of the few GT3's I have heard of treating with harvoni (actually only one other I read of, but assume there are more), no doubt due to the fact that such a small study size means that there are not enough stats to to make a recommendation for harvoni 12 wks plus riba vs sovaldi 24wks plus riba. I believe further study into harvoni for GT3 wasn't done not because the initial trial was not showing promise (as the results seemed great), but rather because they already had the pangenotypic GS5816 in the works, which they knew was going to be a huge success for all genotypes including gt3, and no riba required. I'm hopeful that my 12wks will be just as good results wise without exposing myself to as much ribavirin toxicity.
I'm interested to hear if you have any thoughts on this? I haven't had a meaningful discussion with anyone, including my gastro, who basically just did what I asked, and unfortunately I seemed to know more than he did, including about upcoming treatments - he claimed there were no treatments in the works for my genotype! I only ended up treating with him because I suddenly got approved for harvoni while I was waiting for an appointment with a good hepatologist. I am desperate for a good intelligent conversation!
I wonder what you think of the very small trial done on GT3 with harvoni (ion 2 I believe). I am one of the few GT3's I have heard of treating with harvoni (actually only one other I read of, but assume there are more), no doubt due to the fact that such a small study size means that there are not enough stats to to make a recommendation for harvoni 12 wks plus riba vs sovaldi 24wks plus riba. I believe further study into harvoni for GT3 wasn't done not because the initial trial was not showing promise (as the results seemed great), but rather because they already had the pangenotypic GS5816 in the works, which they knew was going to be a huge success for all genotypes including gt3, and no riba required. I'm hopeful that my 12wks will be just as good results wise without exposing myself to as much ribavirin toxicity.
I'm interested to hear if you have any thoughts on this? I haven't had a meaningful discussion with anyone, including my gastro, who basically just did what I asked, and unfortunately I seemed to know more than he did, including about upcoming treatments - he claimed there were no treatments in the works for my genotype! I only ended up treating with him because I suddenly got approved for harvoni while I was waiting for an appointment with a good hepatologist. I am desperate for a good intelligent conversation!
Thanks for the info T! PCT is porphyria cutanea tarda.
Hopefully Harvoni & Riba for 24 weeks will do the trick this time!
Jules
Hopefully Harvoni & Riba for 24 weeks will do the trick this time!
Jules
There is no need to worry about your viral load being relatively high. It may take a whole for you to become undetectable (the added Ribavirin will help to reduce it more quickly). With all the new DAA treatment regimes EVERYONE becomes undetectable on treatment. The other important thing to know is ..unlike older interferon based treatments with the new DAAs therapies, when a person becomes undetectable has no impact on SVR rates. Studies have been done, and we have seen it at our clinic as well, whether a person is undetectable at week 1 or week 8 makes no difference in the final outcome. SVR rates are the same.
By the way, a few post liver transplant folks sadly get a very aggressive form of recurrent hep C. It develops within only a few months post-transplant with viral load levels in the 10s of millions to sometimes hundreds of millions. Even in these people, it has been shown that current DAA treatments can make them undetectable and even cure some of them. Previous to current treatments, this recurrent aggressive form of hep C caused cirrhosis in the new liver and liver failure typically within months. Happily with our new DAA treatment regimes these folks have hope that they never had before.
Even though this form of aggressive hep C is a rare post transplant occurrence, it is one of many reasons that it is prefered to treat a person BEFORE transplantation so there is no recurrence of the virus and the possibility of this very horrible consequence of the virus.
Be well.
Hector
By the way, a few post liver transplant folks sadly get a very aggressive form of recurrent hep C. It develops within only a few months post-transplant with viral load levels in the 10s of millions to sometimes hundreds of millions. Even in these people, it has been shown that current DAA treatments can make them undetectable and even cure some of them. Previous to current treatments, this recurrent aggressive form of hep C caused cirrhosis in the new liver and liver failure typically within months. Happily with our new DAA treatment regimes these folks have hope that they never had before.
Even though this form of aggressive hep C is a rare post transplant occurrence, it is one of many reasons that it is prefered to treat a person BEFORE transplantation so there is no recurrence of the virus and the possibility of this very horrible consequence of the virus.
Be well.
Hector
Thank you very much Hector. This is exactly what I was looking for! It doesn't seem likely I will get much lower than 7.5 Mg's while on treatment, so I am glad to hear it won't be a cause of treatment failure. I hope my high viral load comes down in the shorter treatment time I am on.
Congratulations on your new liver, and completing treatment with sovaldi and olysio! Great timing for you, and also for me for and many many others, for these new drugs.
Congratulations on your new liver, and completing treatment with sovaldi and olysio! Great timing for you, and also for me for and many many others, for these new drugs.
" will (prednisone) decrease my likelihood of clearing the virus?"
No.
Prednisone has been proven in studies to have no impact on treatment or treatment outcome when used while treating hep C.
Many of us liver transplant patients have treated or are treating our hep C while taking prednisone. There is issues with drug-to drug interactions or any impact on SVR rates.
Prednisone is a corticosteroid used to treat certain inflammatory diseases and is particularly effective as an immunosuppressant drug.
It is used in all liver transplant patients after their transplants for both of its properties, anti-inflammatory and immunosuppression to prevent the rejection of our new liver.
Initially we take 1000 mg + daily right after the surgery, while we are in ICU and the first days after surgery, and then the dosage is tapered down over time to 5 mg per day, our daily maintenance dose for a period of months. Of course the timing of when this happens is different for each patient and is their recovery process. We take prednisone along with our other immunosuppressant drugs for many months and than taper the prednisone and other post transplant drugs until we are taking only our immunosuppressants and maybe a few drugs or vitamins which we take for the rest of our lives.
Now that I have finished my hep C treatment I will start to taper it off 1 mg at a time. I recently finished treating with Sovaldi, Olysio + Ribavirin while taking 5 mg of prednisone daily.
Good luck with your treatment!
Hector
No.
Prednisone has been proven in studies to have no impact on treatment or treatment outcome when used while treating hep C.
Many of us liver transplant patients have treated or are treating our hep C while taking prednisone. There is issues with drug-to drug interactions or any impact on SVR rates.
Prednisone is a corticosteroid used to treat certain inflammatory diseases and is particularly effective as an immunosuppressant drug.
It is used in all liver transplant patients after their transplants for both of its properties, anti-inflammatory and immunosuppression to prevent the rejection of our new liver.
Initially we take 1000 mg + daily right after the surgery, while we are in ICU and the first days after surgery, and then the dosage is tapered down over time to 5 mg per day, our daily maintenance dose for a period of months. Of course the timing of when this happens is different for each patient and is their recovery process. We take prednisone along with our other immunosuppressant drugs for many months and than taper the prednisone and other post transplant drugs until we are taking only our immunosuppressants and maybe a few drugs or vitamins which we take for the rest of our lives.
Now that I have finished my hep C treatment I will start to taper it off 1 mg at a time. I recently finished treating with Sovaldi, Olysio + Ribavirin while taking 5 mg of prednisone daily.
Good luck with your treatment!
Hector
http://www.ncbi.nlm.nih.gov/pubmed/8778197
http://www.medscape.com/viewarticle/413634
Hi Jules, sorry to hear you are having other issues too, but congratulations for getting Harvoni. I'm sorry, I haven't heard of PCT so dont know about that. I don't know for sure if the prednisone will cause relapse, all prior studies have been on interferon riba, but there were quite a few small studies that seemed to show a higher relapse rate, possibly due to higher viremia caused by prednisone and as far as I can tell from my reading high ALT's resulting in greater morbidity (although in combination with the existing illness).
My concerns were more about high viremia (which I certainly have), and prednisone suppressed immune system making it difficult to kill all HCV virus. Really I was hoping someone knew more than me. Unfortunately so far on this forum I have not had any questions answered, just more asked of me, which was not what I was hoping for as I knew there was some experienced members here. Perhaps those members just aren't seeing my posts!
The studies above are just two I picked out. I couldn't find the one I found last night that was a little more specific on a quick search, but if you use the obvious tags, you will find plenty to read through.
http://www.medscape.com/viewarticle/413634
Hi Jules, sorry to hear you are having other issues too, but congratulations for getting Harvoni. I'm sorry, I haven't heard of PCT so dont know about that. I don't know for sure if the prednisone will cause relapse, all prior studies have been on interferon riba, but there were quite a few small studies that seemed to show a higher relapse rate, possibly due to higher viremia caused by prednisone and as far as I can tell from my reading high ALT's resulting in greater morbidity (although in combination with the existing illness).
My concerns were more about high viremia (which I certainly have), and prednisone suppressed immune system making it difficult to kill all HCV virus. Really I was hoping someone knew more than me. Unfortunately so far on this forum I have not had any questions answered, just more asked of me, which was not what I was hoping for as I knew there was some experienced members here. Perhaps those members just aren't seeing my posts!
The studies above are just two I picked out. I couldn't find the one I found last night that was a little more specific on a quick search, but if you use the obvious tags, you will find plenty to read through.
According to www.drugs.com there are no drug interactions between Harvoni and prednisone.
I took prednisone during triple therapy, with Victrellis, because I was in a PCT breakout and my ALT/AST were rising rapidly. (Not a good sign). So instead of completing 48 weeks my Dr stopped me at 36 weeks. I was UND since week 8 but on my 6 mo post EOT I had relapsed.
But I don't think it was due to the prednisone. I think it was because of my high iron levels and PCT. My Hepa told me it was going to be difficult for me to SVR.
"Anyone heard of people treating while on lower dose prednisone? I have read the studies done of people treated with prednisone prior to treatment which wasn't great outcome wise."
Where did you read these studies? I just finished prednisone and am getting ready to start Harvoni.
jules
I took prednisone during triple therapy, with Victrellis, because I was in a PCT breakout and my ALT/AST were rising rapidly. (Not a good sign). So instead of completing 48 weeks my Dr stopped me at 36 weeks. I was UND since week 8 but on my 6 mo post EOT I had relapsed.
But I don't think it was due to the prednisone. I think it was because of my high iron levels and PCT. My Hepa told me it was going to be difficult for me to SVR.
"Anyone heard of people treating while on lower dose prednisone? I have read the studies done of people treated with prednisone prior to treatment which wasn't great outcome wise."
Where did you read these studies? I just finished prednisone and am getting ready to start Harvoni.
jules
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