Well boys & gals, had to stop my riba today.

[orleans]

How long will I maintain a useful amount of riba in my blood? I was 100% compliant until 1/30, that is 26 weeks. I suffer migraines and they have progressively become more numerous the last 3 months. I decided I was gonna make 24 wks no matter what. Was intending to do 36 weeks as a RVR. Starting last tues. EVERY time I took my Riba I got a headache. Imitrex is the only thing that works for me but you are not supposed to take more than 4 doses per month. My Neuro. says 8 doses a month are safe. 1 or 2 doses a day is NOT good. Gonna see if I can get in to see him but he can be tough to get to. Soooo, back to my ???. I know riba has a very long 1/2 life. Anyone know how long I can go without it before re-starting it would be a waste? jerry  

[CMcH]

Hopefully you will achieve SVR if you had a RVR and had a low starting VL. Not sure of the half life of Riba? I'm sure others do so I will bump you back up to the top.

[orleans]

283,000vl. Yes, my hope also. I plan on continuing the Peg/Alinia for the additional 12 weeks at least. jerry

[CockSparrow]

If you werent taking Alinia, you would be risking breakthru and/or Relapse.
So you would be better off dose reducing to 600 and see if that helps.
As you are taking Alinia who knows.
And as you well and truely RVRed then 24 weeks may well have been enough.
You are taking a risk, but in my opinion not a very big one.

The riba half life is 12 days.

CS

[orleans]

Yeah, I tried reducing, first to 1000mg, then 800, then 600, no luck. No riba yesterday but still picked up a headache last nite. The migraines were my main concern when deciding treatment. I feel fortunate to have made it as long as I did with out them becoming chronic. Any reason you can think of for me not not to continue on with the Peg/Alinia? (asuming the migraines back off) jerry

[sauteedliver]

I was able to achieve undetectable with a dose as low as 200 mg. of ribavirin + ifn. Riba caused severe gastrointestinal problems for me along with anemia. That was over the course of many years of treatments. Unfortunately I've always had rebound. Never got an SVR. I am amazed you made it this far with such a high dose. I don't recommend you go that low however.

[HCA]

Riba reduction in RVR patients post week 16 does not prejudice SVR.
There was a good study on this but I didn't bookmark it.(Don't bookmark anything now).
Role of riba critial in first 16 weeks to supress design of successful variant.
I would be surprised and disappointed if you don't clear.
The half life is not really an issue.

[orleans]

I too had read something along these lines and you have bought it back to my very weary mind. thanks for the good word, jerry

[jmjm530]

I'm not saying you're incorrect, but are you sure this study was for genotype ones and not genotype 2 and three? I say this because there was a recent study on those two genotypes regarding riba reduction. As to the specific question, regardless of long half-life your serum rebel levels will decrease probably after just a few days off of it. And the other thing you might ask yourself is if the headaches are related to the rebel her to the interferon? Sometimes hard to tell since we take them both at the same time.

[Myown]

Orleans,

Headaches can also be a sx of Alinia. Maybe you should consider dropping the Alinia and going back on the Riba??

http://www.drugs.com/sfx/alinia-side-effects.html

Alinia
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Alinia:

Diarrhea; headache; nausea; stomach pain.

Good Luck,
MO

Ps. I just stopped the Alinia the other day but still on SOC. I think I had enough Alinia. My stomach was bothering me.

[orleans]

The headaches have been getting more frequent over the past couple of months but "came on" just kinda whenever. For the first time, last tues. nite,  I took my riba and along with the "riba feeling" I get about 40 mins. after I take it (you know the sensation) I noticed the onset of a migraine. I mentioned it to my wife but figured it was a coincedence. Not so, EVERY time after that I got one. First I tried to break up the dose 200mg at a time, then the reductions. No luck. So Jim, what do you think about continuing the Peg/Alinia. I have not heard of anyone just droping the riba and staying on Peg alone. jerry

[jmjm530]

I would consider it my own just said in the post above. You could try dropping thealinia and keeping the ri BA and see how it goes . Hours your hemoglobin? Are you on Procrit?

[HCA]

Yes-geno 1.
All my reading and comments are geno 1 specific for obvious  reasons.

[orleans]

hgb is fine,12.5. I'm not so sure I'ld choose riba over Alinia at this point. Alinia has done quite well w/out riba. But that is really a different subject. I just got my Neuro. to see me on thurs. I have my doubts but if he can cook something up I'll try it. My real question is how long of a break, in days, can one have without screwing up the continous stream of riba in ones' blood?

[jmjm530]

again, I'm not disagreeing with you, but I think you would agree that Jerry would be best served if he tried to dig up the actual study, in full text version,  to go over with his medical team.

Jerry, as mentioned earlier, your rebel levels will decline probably within days. How much of an effect this will have at your treatment juncture, with alinina , I really have no idea

[HCA]

Quote for you;
'The volume of distribution of ribavirin is large (2000 L/kg) and the length of time the drug is trapped varies greatly from tissue to tissue. The mean half-life for multiple doses in the body is about 12 days, but very long-term kinetics are dominated by the kinetics of RBCs (half-life 40 days). RBCs store ribavirin for the lifetime of the cells, releasing it into the body's systems when old cells are degraded in the spleen.'
I'll try and find the study.

[HCA]

Found another version of the same thing.
http://www.hcvadvocate.org/news/newsRev/2007/HJR-4.3.html#1

[jmjm530]

this study really has to be gone over with a fine tooth comb and also compared to other studies with the 80/80/80 rule. Also, unclear if the 60% is broken down into those who stopped riba completely or just some sort of average.

From the same study mentioned:

"To address the issue of the impact of dose reductions after week 12, we evaluated patients who had greater than 97% ribavirin exposure up to week 12 and then a reduced dose during weeks 13-48. Table 4 shows that ribavirin dose reductions after week 12 for patients with earlier optimal exposure had a negative impact on SVR when the cumulative exposure during weeks 13-48 was 80% or less (P = .0372; odds ratio, 0.79)."
http://www.natap.org/2007/HCV/012607_02.htm

[HCA]

This qoute is fairly unequivical tho'
'Ribavirin dose reduction had a minimal impact on SVR in the subset of patients who achieved rapid virological response (RVR) by four weeks, even if they received less than 60% of the intended cumulative dose'

[jmjm530]

yes, both quotes seem on "unequivocal" and therefore this study and others like it really have to be carefully combo over in full text before basing any kind of treatment decision on it.

[CockSparrow]

According to Shiffman, it is almost impossible to get Riba dosing below the 80 80 80 Rule unless you stop taking Riba. When this happens breakthrough and relapse rates are significantly high.
Except for one little subgroup, RVRs.

CS


Optimizing the Current Therapy for Chronic Hepatitis C Virus: Peginterferon and Ribavirin Dosing and the Utility of Growth Factors. Clin Liver Dis 12 (2008) 487–505
Mitchell L. Shiffman, MD

Prematurely discontinuing ribavirin leads to breakthrough and a higher relapse rate, even if the peginterferon dose remains unaltered. In a recent study, patients who were HCV RNA undetectable at treatment week 24 were randomly assigned to stop ribavirin and continue peginterferon alone or to remain on both drugs [8]. Within 6 weeks of stopping ribavirin, breakthrough began to occur and this increased stepwise over time. At treatment week 48, 24 weeks after stopping ribavirin, breakthrough had developed in 12% of patients. In contrast, breakthrough occurred in only 3% of patients randomized to continue peginterferon and ribavirin, and each of these patients prematurely discontinued ribavirin or both drugs in response to adverse events.

The only subgroup of patients who did not develop breakthrough or have an increased relapse rate after prematurely stopping ribavirin were those with an RVR.

As opposed to interrupting or prematurely stopping ribavirin, which enhances breakthrough and relapse, recent data suggest that merely reducing the dose of ribavirin in response to adverse events does not significantly affect these milestones, and therefore has little impact on the SVR.

It is therefore apparent that patients could not have received less than 80% of their ribavirin dose in this study through dose reduction alone. The only way this could have happened was for patients to have missed doses.

Missing just 3 days of ribavirin reduced cumulative ribavirin exposure at week 12 to 81%, and missing 7 and 14 days reduced this to only 77% and 71%, respectively. A more recent analysis has evaluated the impact of stepwise ribavirin dosing, from greater than 97% to less than 60% of the total expected cumulative dose, on virologic response and SVR [9]. It is important to note that this study included only those patients who remained on full-dose peginterferon for 48 weeks, and therefore evaluated the impact of reducing only the ribavirin dose. No significant impact of ribavirin dose on virologic response was observed. A significant decline in SVR (from 57% to 67% to only 34%) did occur but only when the total cumulative ribavirin dose declined to less than 60%. As illustrated in Fig. 5, this can only occur by interrupting or prematurely discontinuing ribavirin dosing.

[jmjm530]

I mean, RVRs may indeed be a unique subset. But still unclear how this would affect someone who stopped riba completely as opposed to dose reduced and therefore still kept some serum rebel levels.

[HCA]

Sure-you get conflicting studies as well.
Just trying to provide some scientifically based comfort in the face of a treatment decision which is a fait accomplit in any event.
We can always settle it with a snowball fight!

[jmjm530]

our posts crossed, but shiffman makes my argument a lot better :)

[jmjm530]

afraid you'll win the snowball fight, given my tendinitis :) I wasn't aware this was a "fait accomplit" .and i do appreciate your studies and input. Just playing devil's advocate because does not appear to be black-and-white issue and hopefully anyone considering dose reduction will grab as many of these fulltext studies as possible, pour over them, then bring them to their doctor.