Why is Ribavirin prescribed with S+O?

[LurkAndLearn]

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.

[goater]

Hi Mark,

Excellent news on your post PCR, you've got to be excited!   If I'm not mistaken this first month is the most predictive for SVR.  It really is great to see these results from the current generation of treatment drugs.

I remember your post back when your bilirubin went to 6.3.  I had to look up GS but that would explain a lot of the elevated bili.  I believe you are also 1a right?  What stage is your liver?

I'm cirrhotic and over the past couple years, even during the latter days of  SOC+Vic in 2012, the bilirubin has been WNL.  Six months ago it bumped to 1.6 and baseline this time before starting S/O+R was 2.2.

The two week draw showed 3.9 which is little lower than the same time when treating with SOC back in 2006.  It may settle down in a bit.  

Best wishes on your SVR on 7/7.
Marty

[nan535]

     "I started all of this out in '96 with a hepatologist coming in to the exam room with tears streaming down his face to tell me I had the virus so severe and load count so high they approximated that I had 30 days left to get my affairs in order.  Then gave me a VCR tape about HCV....when I watched it all the people on it who had HCV died in their sleep.  Frightening tape,
     Mentally I was in shock with him crying and all but at the same time silently screaming ********. I quietly got up, handed him a tissue, and told him to get off his *** and find me a hepatologist who was proactive.  I had a lot of living to do."

I reposted your initial paragraphs because it is a powerful testimony on how no one should ever let anyone else (including doctors) take their hope away. Saying I am shocked at what this doctor did to you is a huge understatement.  Thank God that you had the strength, belief  and yes, hope that you would beat this thing and not let his own ineptitude make you believe that your life was over.  Here you are 17 years later still fighting the incredible fight.
I'd be curious if you ever let him know how wrong he was.  I hope he did not do that to anyone else who are not as strong as you are.  I believe my husband is alive today and also fighting the good fight because he too had the strength, belief and hope that he would beat this thing.  

Know that you will continue to be in my thoughts and prayers and that soon this will all be behind you.

Nan

[NYCMark]

Hi Marty,

I completed 12 weeks  of Sol/Oly (SIM/SOF) + ribavirin on April 7. I've been undetectable since week 4 of treatment, including a test at 4 weeks after treatment completion.
I did have some lab abnormalities during early treatment, including a rise in my bilirubin up to 6.3 (from 1.4), as well as an increase in my creatinine to 1.7 (from 1.2).  I did have to decrease the riba dose from 1000 daily to 600 daily because of increasing anemia.
The bilirubin remained somewhat elevated in the 3+ range throughout treatment, and has returned to normal now that I've completed.  Creatinine was treated with better hydration.
Bilirubin elevation is occasionally seen with Olysio, but elevation to 6-7 is unusual.  My doctor believes it is due to underlying defect in my liver's metabolism called Gilbert's syndrome, an otherwise asymptomatic problem.

My 12 week EOT blood test for SVR will be about July 7 - keeping my fingers crossed.

Mark

[goater]

Thanks for this very informative post.  Great news on your post 20 day undetected.  Will you test again before the post 12 week test?. I'm also a 1a cirrhotic

I'm on day 27 of Sol/Oly +Riba and was interested in seeing how Olysio spiked your Bili.  Mine was elevated (3.9) at my 2 week labs and I just blamed the Riba for RBC hemolysis and the liver converting that to bilirubin.  Looks like Oly may have a hand in it since you didn't take the Riba.  Has your Bili / enzyme's returned to pre-tx levels?

Did you notice any physical changes prior to your first UND that led you to believe you'd become UND?  For as long as I can remember I've had rather excessive oily scalp and skin.  During the last treatment with SOC+Vic my skin secretions changed and became what I'd consider normal.  This occurred several weeks before I'd gotten the first undetected PCR.  Skin remained normal throughout the remainder of tx and was UND at EOT.  However, several weeks before my relapse PCR my skin had become oily again and I'd just knew that I had relapsed.  

Scheduled for the 4 week lab/PCR in two days.  If this oily skin theorem is worth anything I noticed a change beginning on day 18.  

Encouraging information with Sol/Led + Riba for cirrhotic's in the Electron studies.  Hopefully, you and the rest of us here won't need to go that route.

Best wishes on your SVR,
Marty

[heart_in_the_keyes]

Interesting Hoping for Cure....are your platelets still in the 40's?  Mine went down to 9 but came back up to 10...hanging in there in the lower teens.  He was going to do sovaldi/Oyslio /riba but liver in too bad of shape.  So he removed the Oyslio.  I am genotype 1. He didn't do the Oyslio because I was Child Pugh cirrhosis. So your next to last paragraph probably fits me.

The sovaldi not causing any bad effects...but the riba....it lowers your platelets....has increased my fatigue....haven't noticed any sun problems...did with interferon though....took years to get over it...my skin would sunburn even though fully covered up.  Until we lowered the riba I was having tightness of chest, along with the dizziness.  

You are so correct. Exercise is good....if you aren't dizzy...too much sleeping slows down your blood flow which a bad liver has to work overtime to move to your other organs...so  it is best to eat right, exercise, drink plenty of water and get plenty of rest while on any of these treatments

Hope you are doing okay.  

[hoping4cure]

I finished the SOV/OLY12 week treatment back in mid May. I am a 1a with cirrhosis, my platelets have remained constant at 45. I was treated with the triple therapy which included Incivek back in 2011 and made it 6 months until I couldn't take it anymore. Relapsed after two months. I was a little reluctant to try another protease inhibitor because of the problems associated with the first generation, being hospitalized from the drug and the doctors not knowing what to do if the rash had kept advancing. Oyslio is so much safer plus a low dose, one pill a day as apposed to being saturated with nine pills a day, three every eight hours. Regarding the Sovaldi/Oyslio treatment, I was so sure the virus had returned after completing the 12 week treatment that I went ahead and had myself tested at day 20 EOT. I just wanted to get the bad news over with and not wait another 10 days plus 4 to get the results back. I got the results back yesterday and to my surprise, I am still undetected. From what I’ve read online most that do relapse are within the first 30 days with these new meds. Someone posted online that after 30 days the chance of relapse is only 2% which I hope turns out to true. If treated previously with a protease inhibitor there might be some resistance to Oyslio. The Sovaldi/Ledipasvir Electron group's cure rate was 100% for people that were prior null responders with Sovaldi and ribivarin. Those 100% numbers included those treated with compensated and decompensated cirrhosis as long as ribivarin is added to the mix. So retreating with Sovaldi doesn’t seem to be an issue as it would be with Oyslio. Those with cirrhosis actually only had a 65% cure with the Sovaldi/Ledipasivir treatment without ribivrin in the Electron group. I asked my doctor to add the ribivarin to my treatment and even extend it out beyond the 12 weeks but he declined to do so. I was approved for 24 weeks if needed. It seems like a lot of doctors are adding even low doses of ribivarin to the Sovaldi/Oyslio treatment as an insurance policy when treating those with advanced liver disease. I read online that one doc was even only adding 300mg a day. When Sovaldi was first tested as a mono treatment 100% of people on the trial cleared the virus. When the treatment was stopped 100% relapsed. When ribivarin was added later in the following trial the cured number of people went through the roof. So it makes perfect sense that ribivarin would be added to help boost the immune system especially for those that are older, been treated before and are advanced. I felt during treatment that the Oyslio did stress the liver somewhat because bilirubin and ALP numbers went up along with some weight gain around my stomach. After 48 hours of stopping the treatment I developed pretty bad muscle and joint pain which comes in waves even weeks after treatment. What helps most is hitting the gym and staying totally away from anything that is inflammatory such as sugar, caffeine, dairy products etc. something that people with liver damage should be doing anyway. My doc might have only wanted me to do the 12 weeks because not many have been treated with this combo and if it failed to just have me retreated in October with the Sov/Led ribivarin treatment even if I can only tolerate the ribivarin for part of the treatment. There were many more people treated and much more hard data available from trials conducted using that combo. Best to eat right, exercise, drink plenty of water and get plenty of rest while on any of these treatments. I got a bad sunburn in 15 minutes when I was out in direct sunlight. Watch out for weight gain around your mid section which is what happened in my case and if you do make sure you let your doc know about it. Definitely felt a little bloated during the second and third months. The specialist up at Duke said he wanted me to get real skinny, no fat around the mid section so I'm now trying to get that to be a reality. I hope this helps someone, not many posts from people that have completed the treatment so far.

“Perfect Results for Sovaldi/Ledipasvir, But Only With Ribavirin”

“Among genotype 1-infected patients who had failed prior treatment with SOF plus RBV, 100 percent (19/19) achieved SVR12 following 12 weeks of LDV/SOF plus RBV. Additionally, 65 percent (n=13/20) of genotype 1-infected patients with decompensated or Child-Turcotte-Pugh Class B cirrhosis receiving 12 weeks of LDV/SOF without RBV achieved SVR12. LDV/SOF with and without RBV was well-tolerated, including among patients with more advanced liver disease.”

http://www.hepmag.com/articles/ELECTRON2_SOF_2501_25458.shtml
- See more at: http://www.lifebeyondhepatitisc.com/2014/04/hep-c-treatment-combo-sovaldi-olysio-hep-c-patient-tammy-part-1/#sthash.KANUlsMV.dpuf