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8683847 tn?1410760916

Why is Ribavirin prescribed with S+O?

I am Genotype 1a, no cirrhosis and was prescribed Sovaldi, Olysio and Ribavirin.  Curious what the Ribavirin addresses since I see some folks only have to take the Sovaldi and Olysio.
26 Responses
Avatar universal
That's a question I have wondered about myself. I am sure there are different opinions and I don't know if any are in stone. I was waiting to see if anyone else expressed an opinion before I replied but figured I would go ahead. I am Genotype 1a. no cirrhosis like you and was prescribed Sovaldi and Olysio only for 12 weeks. I told my doctor I did not want to take Ribavirin or anything else with these two others. He said okay but didn't think I would be approved. Surprising to the doctor and myself I was approved. The doctor said the main treatment drug is Sovaldi and the Olysio is prescribed with it due to the drug maker not wanting Sovaldi to ever be prescribed alone. I think it is possible that with all three the possibility of SVR is more likely, not sure. I hope someone else has an idea here.
683231 tn?1467326617
My thought is because that is what the American Association for the Study of Liver Disease Recommendations for Testing, Managing,
and Treating Hepatitis C recommends for the treatment of Genotype 1 treatment naive non-cirrotics who are eligible for interferon.

http://www.hcvguidelines.org/sites/default/files/full_report.pdf

based on the NEUTRINO clinical trial results

Also that is per the prescribing information on label usage on the Sovaldi prescribing insert the little paper that shouild accompany the prescription.


http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/sovaldi/sovaldi_pi.pdf

again this is based on the NEUTRINO clinical trial results as well.

The Sovaldi Olysio with or without Ribavirin is the recommended treatment for interferon ineligible patients like for example me because I have cirrhosis and also have failed interferon based treatment 3 times as a null responder. Of course the Solvaldi Olysio is off label as they are not intended to be used together but the COSMOS trial showed good efficacy for these types of patients. Of course being off label can make it more challenging to get this prescribed although many here have been successful getting this combination as we have seen.

So that's my 2 cents

Lynn
Avatar universal
When I talked one on one with the sovaldi rep she said a simple explanation is:

HCV blood cells are in a strand....kind of like a strand of twisted pearls.
They are connected.  The sovaldi comes in and "snips" the connection.

This makes the HCV cells start to separate from the cell strand.  Now think of the Riba as fighter pilots.  They come in...target the HCV cell...and destroy it.  

In the process they can also destroy good blood cells because they really can't differ between good and bad.  That is why you have to get weekly blood tests to check your blood platelets.

You will go UND (undetectable) during treatment hopefully leading to a status of SVR.  

So I vision the sovaldi and O as the seperator and the riba as the destroyer.
Have to separate the HCV cells to make them vulnerable.  
Avatar universal
Have you treated before?  If treatment naïve be thankful you're not taking interferon.   I'm also GT1a and on Sovaldi / Olysio + Riba.  This is day 25 and approved for 24 weeks.  However, I'm cirrhotic and treated twice before.  Was a null responder with 48 weeks of SOC and relapsed two months post 48 weeks of SOC+Victrelis.

Did you test for Q80K?  We didn't test as some of the later studies indicated that polymorphism associated with 1a's, if present, should not preclude the prescribing of Olysio.  Not knowing if I had Polymorphism is the main reason for adding Ribavirin.  My GI doc felt I'd remain healthy enough to wait for sol/led next year and was not as excited as I was to begin this course.  I thought that with a 9 year history of cirrhosis, why wait.

The three drugs all interrupt the ability of the virus to replicate itself but in distinct ways.  Sovaldi is a polymerase inhibitor, Olysio a protease inhibitor (somewhat similar to the last class of PI's) and Riba is thought to deplete nucleotides thus blocking replication and maturation of viral cells.

If you've never taken Ribavirin before keep an eye on your Hemoglobin (hgb) as hemolytic anemia is a common side effect.  So far at 25 days my hgb has fallen off rather slowly and a little higher than at the same point of previous attempts.  Expecting it to stabilize  in the 11's which is doable.

Been watching your awesome progress Lynn as we have similar stats.

Best wishes LandL,
Marty

Avatar universal
I am 3 weeks in with Sov/Olysio, 1a with cirrhosis, tx naive. I was not prescribed Rib as I already have low WBC, RBC, and platelets.  My hepatologist wanted to reduce risk for me. This is a legitimate case I have learned that has been accepted by a number of insurers in approving the off-label combination that excludes Rib.
683231 tn?1467326617
Hi Marty

I am now wondering why you and I are doing different treatments I am only taking Sovaldi and Olysio no riba and only 12 weeks. Although I am happy about the non riba and 12 weeks now I am worried about the possibility of relapse post treatment.

Ok read a little further I see you did Victrelis I never did that one because I already had cirrhosis by then that is my guess why the 24 weeks for you vs 12 weeks for me.

I have known I have hep c since 1990 and been a 3 time null responder. I also slowly progressed over the years and was diagnosed with cirrhosis in 2008. I did not have the Q80K check. I am holding I have treated enough I guess I will know in 12 weeks

Lynn
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