Aa
cautiously optimistic with Alinia
I just received my recent bloodwork, and it seems that the Alinia approach is doing something. My PCR results are:
pre tx: 2,300,000
2 weeks alinia 1,800,000
5 wks alinia and 1 1/2 wks riba: 400,000
I continued the riba for a total of 3 weeks and just took my first pegasys shot tonight. This is the lowest that my VL has been since my previous tx, so I'm taking it as a good sign and keeping my fingers crossed for an RVR, no dose reduction, and ultimately SVR. Thank you all for your help and support (especially Willing who posted the studies that convinced me to get off the bench and into the batter's box).
pre tx: 2,300,000
2 weeks alinia 1,800,000
5 wks alinia and 1 1/2 wks riba: 400,000
I continued the riba for a total of 3 weeks and just took my first pegasys shot tonight. This is the lowest that my VL has been since my previous tx, so I'm taking it as a good sign and keeping my fingers crossed for an RVR, no dose reduction, and ultimately SVR. Thank you all for your help and support (especially Willing who posted the studies that convinced me to get off the bench and into the batter's box).
alinia monotherapy is absolutely useless for hcv especially if you re not geno4, you can only improve SOC SVR by alinia nothing else
I took Alinia for 1 month as a monotherapy and liver enzymes went down 50%, but my VL shut up from 4,000,000 to 17,000,000 so I stoped...my doctor said, that she will droped me, if I continue use Alinia...does anybody knows a good liver dr, round Naples, Florida....Thank you Bill
I have Hepetatis C for the past 20+ years...got it during blood transfussion overseas....I took the Rib and Inter treatment, but being Gen type 1 I was only partial responder....my virus runs from 4 mill to 15 mill, also my liver enzymes are high.....my ultrasound showed my liver to be clean, no fatty deposit...OK
Despite my very agressive Hepetatis C, I have lots of energy, if I could, I would play tennis whole day...
Last month I have decided to try Alinia 2x500mg/day....alone..monotherapy.....next week I am going for blood test so will see....I must say, that taking the Alinia, my endurance level is up....well, will see...
I am buying the Alinia on Line from oversea for $ 57 + 18 postage (1 month supply)..no PR required...
.
Despite my very agressive Hepetatis C, I have lots of energy, if I could, I would play tennis whole day...
Last month I have decided to try Alinia 2x500mg/day....alone..monotherapy.....next week I am going for blood test so will see....I must say, that taking the Alinia, my endurance level is up....well, will see...
I am buying the Alinia on Line from oversea for $ 57 + 18 postage (1 month supply)..no PR required...
.
i weigh between 72-74 kg.
The 21mg/kg is cumulative average adding up all the daily Riba doses divided
by number of days and than divided by bodyweight.
currently around 19mg/kg with 1400
The 21mg/kg is cumulative average adding up all the daily Riba doses divided
by number of days and than divided by bodyweight.
currently around 19mg/kg with 1400
halftime *is* very good - like the winter solstice. But I'm now thoroughly confused. How much do you weigh? How can 1400 correspond to 21mg/Kg and 1200 to SOC dosing (~14mg/Kg) . I weigh 82Kg was prescribed 1200, am planning on 1400 and will increase to 1600 if Hgb doesn't drop enough (but not otherwise).
just rechecked my HgB , 10.5 @wk21 with 1400mg exactly where I want it to be.
Looking forward to my halftime wk24 meeting with my Hep.
All bloods are stable , wk20 NGI QuantaSure result still pending.
If you would see all my HgBs and correlating Riba dosages you would clearly
see that my SOC dose of 1200 and without predosing (i did 5 weeks !!)
would have never brought on anemia.
Looking forward to my halftime wk24 meeting with my Hep.
All bloods are stable , wk20 NGI QuantaSure result still pending.
If you would see all my HgBs and correlating Riba dosages you would clearly
see that my SOC dose of 1200 and without predosing (i did 5 weeks !!)
would have never brought on anemia.
bali - thanks. Good point about the HgB drop lag, had not thought about that. Two weeks seems ample for rbv steady state but maybe not for the HgB to stabilize. Still, it's not likely that the HgB drop of itself is doing anything helpful. You're braver than I am about the 21mg/Kg. What s bothers me about the safety claims is that they are invariably preceded by "appears" and though Drs invariably err on the underdosing side they likely have their suspicions. For quite a while I bothered by carcinogenic potential - can a substance that is a known teratogen and believed to induce a higher mutation rate in the virus not have some of the same effect on our own dna? However, there's been a *lot* of rbv down the hatch by now and I have never seen a single report linking it to increased cancer risk, so that's looking more like paranoia on my part. Not doing an il28b as there are zero ifn-less choices on my horizon. However, will attempt to track 1st and 2nd phase slopes which amounts to the same information. The 1st phase slope, ie drop 48h after 1st shot, is typically used to measure the epsilon parameter (ifn effectiveness) in vl models.
it has been my personal experience and other tx`ers personal experience that
it takes about 2 weeks for your HgB to react to a dose increase.
you need to figure that into your planning if you want a >3g drop early on.
predosing also really helps here because you are able to get a "feel"
before you start INF.
it takes about 2 weeks for your HgB to react to a dose increase.
you need to figure that into your planning if you want a >3g drop early on.
predosing also really helps here because you are able to get a "feel"
before you start INF.
personal judgement , based on digesting all aspects and information
available to me
- historically we know that Riba was what increased SVR rates
before Riba SVR rates were a lot poorer
- we have data that showed Riba at higher doses even as IV
is "safe" other than the usual toxicity , principally anemia ect..
- we have some data that shows better SVR with higher Riba
- I find many tx`ers who have been around the block who believe
they did not SVR the first time because they were underdosed
- we have evidence that weight based Riba dosing brings higher
SVR than flat dosing because heavier people get underdosed
with flat dosing
Doing Riba dosing based on HgB requires good monitoring.
I started out weekly CBC , than bi monthly ,than monthly
It is a lot of work and definately requires personal engagement.
Not everybody`s cup of tea
Here are some more studies a friend had posted:
Use of Epoetin (EPO) to Manage Anemia in Chronic Hepatitis C Patients Treated with Pegylated Interferon plus Ribavirin
Successful treatment of chronic hepatitis C with pegylated interferon plus ribavirin is often limited by anemia. An adequate amount of ribavirin reduces the risk of post-treatment HCV relapse, but the incidence of anemia rises with higher ribavirin doses.
As reported in the August 2007 issue of Hepatology, researchers conducted a study to determine whether using erythropoietin, or epoetin alpha (EPO), with or without a higher dose of ribavirin, could enhance sustained virological response (SVR) rates.
They randomized 150 treatment-naive patients (36% African-American) with chronic genotype 1 hepatitis C into 3 treatment groups:
• Group 1: pegylated interferon alpha-2b (PegIntron) 1.5 mcg/kg/week + weight-based ribavirin 13.3 mg/kg/day (800-1400 mg/day);
• Group 2: pegylated interferon + weight-based ribavirin + EPO (40,000 U/week);
• Group 3: pegylated interferon + high-dose weight-based ribavirin (15.2 mg/kg/day; 1000-1600 mg/day) + EPO (40,000 U/week).
In groups 2 and 3, EPO was started at the onset of therapy in order to maintain hemoglobin levels between 12 and 15 g/dL. When required, the ribavirin dose was reduced by 200-mg steps.
Results
• A significantly smaller percentage of patients in Group 2 compared with Group 1 had a decline in hemoglobin to less than 10 g/dL (9% vs 34%; P < 0.05).
• Fewer patients in Group 2 required ribavirin dose reduction (10% vs 40%) compared with Group 1 patients (P < 0.05).
• Despite this, SVR rates were not significantly different in Group 1 and Group 2 (19% vs 29%).
• However, the SVR rate was significantly greater (49%) in Group 3 (P < 0.05).
• This resulted from a significantly lower HCV relapse rate: 8% in Group 3 vs 38% in Groups 1 and 2 (P < 0.05).
Conclusion
"We conclude that using EPO in all subjects at the initiation of pegylated interferon and ribavirin treatment will not enhance SVR given the same starting dose of ribavirin," the researchers stated. "In contrast, a higher starting dose of ribavirin was associated with a lower relapse rate and higher rate of SVR."
08/24/07
In the IDEAL Study (sponsored by Schering-Plough), 3070 HCV genotype 1 patients were randomly assigned to receive 1.0 or 1.5 mcg/kg/week pegylated interferon alfa-2b (Schering-Plough's PegIntron) plus 800-1400 mg/day weight-adjusted ribavirin, or else 180 mcg/week pegylated interferon afa-2a (Roche's Pegasys) plus 1000-1200mg/day weight-adjusted ribavirin, all for 48 weeks.
As previously reported, patients who received Pegasys had a higher end-of-treatment (EOT) response rate, but those taking PegIntron had a lower relapse rate, so SVR rates ended up about the same. In the analysis presented at this year's EASL meeting, investigators looked at the relationship between anemia and sustained response. Anemia was defined as a hemoglobin level < 10 g/dL; 3023 patients had hemoglobin measurements at baseline and at least once during therapy. EPO use was permitted for anemic patients after protocol-defined ribavirin reductions.
Results
Overall, anemia occurred in 865 (28%) patients, 449 (52%) of whom used EPO. Among all patients, the mean maximum hemoglobin decline was 4 g/dL. The end-of-treatment response rate was significantly associated with the magnitude of hemoglobin decline (P 3 g/dL: EOT rate 61.6% (1386 out of 2250); Hemoglobin decline < 3 g/dL: EOT rate 41.8% (323 out of 773). \
The likelihood of sustained response was also significantly associated with the magnitude of hemoglobin decline (P 3 g/dL: SVR rate 43.7% (984 out of 2250); Hemoglobin decline < 3 g/dL: SVR rate 29.9% (231 out of 773).
Use of EPO was significantly associated with higher SVR rate among patients with an early onset of anemia, but not those with a later onset:
Anemia onset 4-8 weeks:
EPO use: SVR rate 47.6% (49 out of 103); No EPO: SVR rate 29.0% (18 out of 62)(P = 0.019).
Anemia onset > 8-12 weeks:
EPO use: SVR rate 47.4% (27 out of 57); No EPO: SVR rate 51.6% (32 out of 62)(P = 0.644).
Anemia onset > 12 weeks:
EPO use: SVR rate 57.8% (89 out of 154); No EPO: SVR rate 61.6% (130 out of 211)(P = 0.462).
Patients with early-onset anemia treated with EPO also had a lower rate of treatment discontinuation than those with later-onset anemia. Based on these findings, the investigators concluded, "Among HCV genotype 1-infected patients treated with [pegylated interferon/ribavirin], the magnitude of hemoglobin decline is strongly associated with the likelihood of SVR." "The effect of EPO varied by time to anemia; no benefit was observed for patients who became anemic after treatment week 8," they continued.
"These data suggest that hemoglobin decline may be a pharmacodynamic marker of treatment effectiveness and that the primary effect of EPO was to prevent treatment discontinuation in patients with early anemia."
Johns Hopkins University School of Medicine, Baltimore, MD; Virginia Commonwealth University Medical Centeru, Richmond, VA; Beth Israel Deaconess Liver Center, Boston, MA; University of Pennsylvania Health System, Philadelphia, PA; McCone Endoscopy Center, Alexandria, VA; Clinical Center for Liver Diseases, Dallas, TX; Thomas Jefferson University, Philadelphia, PA; Brooke Army Medical Center, Fort Sam Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Duke Clinical Research Institute, Durham, NC. 5/22/09
Reference M Sulkowski, M Shiffman, N Afdhal, and others. Hemoglobin Decline Is Associated With SVR among HCV Genotype 1-Infected Persons Treated with Peginterferon (Peg)/Ribavirin (RBV): Analysis from the IDEAL Study. 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009). Copenhagen, Denmark. April 22-26, 2009.
Reference ML Shiffman, J Salvatore, S Hubbard, and others. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology 46(2): 371-379. August 2007.
available to me
- historically we know that Riba was what increased SVR rates
before Riba SVR rates were a lot poorer
- we have data that showed Riba at higher doses even as IV
is "safe" other than the usual toxicity , principally anemia ect..
- we have some data that shows better SVR with higher Riba
- I find many tx`ers who have been around the block who believe
they did not SVR the first time because they were underdosed
- we have evidence that weight based Riba dosing brings higher
SVR than flat dosing because heavier people get underdosed
with flat dosing
Doing Riba dosing based on HgB requires good monitoring.
I started out weekly CBC , than bi monthly ,than monthly
It is a lot of work and definately requires personal engagement.
Not everybody`s cup of tea
Here are some more studies a friend had posted:
Use of Epoetin (EPO) to Manage Anemia in Chronic Hepatitis C Patients Treated with Pegylated Interferon plus Ribavirin
Successful treatment of chronic hepatitis C with pegylated interferon plus ribavirin is often limited by anemia. An adequate amount of ribavirin reduces the risk of post-treatment HCV relapse, but the incidence of anemia rises with higher ribavirin doses.
As reported in the August 2007 issue of Hepatology, researchers conducted a study to determine whether using erythropoietin, or epoetin alpha (EPO), with or without a higher dose of ribavirin, could enhance sustained virological response (SVR) rates.
They randomized 150 treatment-naive patients (36% African-American) with chronic genotype 1 hepatitis C into 3 treatment groups:
• Group 1: pegylated interferon alpha-2b (PegIntron) 1.5 mcg/kg/week + weight-based ribavirin 13.3 mg/kg/day (800-1400 mg/day);
• Group 2: pegylated interferon + weight-based ribavirin + EPO (40,000 U/week);
• Group 3: pegylated interferon + high-dose weight-based ribavirin (15.2 mg/kg/day; 1000-1600 mg/day) + EPO (40,000 U/week).
In groups 2 and 3, EPO was started at the onset of therapy in order to maintain hemoglobin levels between 12 and 15 g/dL. When required, the ribavirin dose was reduced by 200-mg steps.
Results
• A significantly smaller percentage of patients in Group 2 compared with Group 1 had a decline in hemoglobin to less than 10 g/dL (9% vs 34%; P < 0.05).
• Fewer patients in Group 2 required ribavirin dose reduction (10% vs 40%) compared with Group 1 patients (P < 0.05).
• Despite this, SVR rates were not significantly different in Group 1 and Group 2 (19% vs 29%).
• However, the SVR rate was significantly greater (49%) in Group 3 (P < 0.05).
• This resulted from a significantly lower HCV relapse rate: 8% in Group 3 vs 38% in Groups 1 and 2 (P < 0.05).
Conclusion
"We conclude that using EPO in all subjects at the initiation of pegylated interferon and ribavirin treatment will not enhance SVR given the same starting dose of ribavirin," the researchers stated. "In contrast, a higher starting dose of ribavirin was associated with a lower relapse rate and higher rate of SVR."
08/24/07
In the IDEAL Study (sponsored by Schering-Plough), 3070 HCV genotype 1 patients were randomly assigned to receive 1.0 or 1.5 mcg/kg/week pegylated interferon alfa-2b (Schering-Plough's PegIntron) plus 800-1400 mg/day weight-adjusted ribavirin, or else 180 mcg/week pegylated interferon afa-2a (Roche's Pegasys) plus 1000-1200mg/day weight-adjusted ribavirin, all for 48 weeks.
As previously reported, patients who received Pegasys had a higher end-of-treatment (EOT) response rate, but those taking PegIntron had a lower relapse rate, so SVR rates ended up about the same. In the analysis presented at this year's EASL meeting, investigators looked at the relationship between anemia and sustained response. Anemia was defined as a hemoglobin level < 10 g/dL; 3023 patients had hemoglobin measurements at baseline and at least once during therapy. EPO use was permitted for anemic patients after protocol-defined ribavirin reductions.
Results
Overall, anemia occurred in 865 (28%) patients, 449 (52%) of whom used EPO. Among all patients, the mean maximum hemoglobin decline was 4 g/dL. The end-of-treatment response rate was significantly associated with the magnitude of hemoglobin decline (P 3 g/dL: EOT rate 61.6% (1386 out of 2250); Hemoglobin decline < 3 g/dL: EOT rate 41.8% (323 out of 773). \
The likelihood of sustained response was also significantly associated with the magnitude of hemoglobin decline (P 3 g/dL: SVR rate 43.7% (984 out of 2250); Hemoglobin decline < 3 g/dL: SVR rate 29.9% (231 out of 773).
Use of EPO was significantly associated with higher SVR rate among patients with an early onset of anemia, but not those with a later onset:
Anemia onset 4-8 weeks:
EPO use: SVR rate 47.6% (49 out of 103); No EPO: SVR rate 29.0% (18 out of 62)(P = 0.019).
Anemia onset > 8-12 weeks:
EPO use: SVR rate 47.4% (27 out of 57); No EPO: SVR rate 51.6% (32 out of 62)(P = 0.644).
Anemia onset > 12 weeks:
EPO use: SVR rate 57.8% (89 out of 154); No EPO: SVR rate 61.6% (130 out of 211)(P = 0.462).
Patients with early-onset anemia treated with EPO also had a lower rate of treatment discontinuation than those with later-onset anemia. Based on these findings, the investigators concluded, "Among HCV genotype 1-infected patients treated with [pegylated interferon/ribavirin], the magnitude of hemoglobin decline is strongly associated with the likelihood of SVR." "The effect of EPO varied by time to anemia; no benefit was observed for patients who became anemic after treatment week 8," they continued.
"These data suggest that hemoglobin decline may be a pharmacodynamic marker of treatment effectiveness and that the primary effect of EPO was to prevent treatment discontinuation in patients with early anemia."
Johns Hopkins University School of Medicine, Baltimore, MD; Virginia Commonwealth University Medical Centeru, Richmond, VA; Beth Israel Deaconess Liver Center, Boston, MA; University of Pennsylvania Health System, Philadelphia, PA; McCone Endoscopy Center, Alexandria, VA; Clinical Center for Liver Diseases, Dallas, TX; Thomas Jefferson University, Philadelphia, PA; Brooke Army Medical Center, Fort Sam Houston, TX; Schering-Plough Research Institute, Kenilworth, NJ; Duke Clinical Research Institute, Durham, NC. 5/22/09
Reference M Sulkowski, M Shiffman, N Afdhal, and others. Hemoglobin Decline Is Associated With SVR among HCV Genotype 1-Infected Persons Treated with Peginterferon (Peg)/Ribavirin (RBV): Analysis from the IDEAL Study. 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009). Copenhagen, Denmark. April 22-26, 2009.
Reference ML Shiffman, J Salvatore, S Hubbard, and others. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology 46(2): 371-379. August 2007.
bali: many thanks for the rbv detailed info and slides; I had seen the win-R results but not the graph from Manns et al. There doesn't seem to be much data above 17 but the slope is pretty clear. Had no idea you were in the 21mg/kg neighborhood!! Given the stable Hgb that looks like the right call, but pretty far past the beaten path. Is this dosing as prescribed or based on your personal judgment? In my case it will be the latter, which makes for more frequent CBCs.
trin: lucky you. I switched from coffee to tea years ago because of insomnia and am having trouble getting back on the java bandwagon. Coffee's beneficial effect on HCC and fibrosis progression has been documented for a while, but that's the first time I've seen any reference to tx outcome. Note this was HALT-C however, so "more than double the SVR rate" is in the neighborhood of 25% vs 11%. Good luck with your upcoming bx. If it looks like further waiting is not such a good idea, it's worth taking a look at the "long-lead-in" approach.
eureka : thanks - though I'm not sure ntz and high dose rbv count as bigger guns. Maybe sling shots with new and improved rubber bands...
trin: lucky you. I switched from coffee to tea years ago because of insomnia and am having trouble getting back on the java bandwagon. Coffee's beneficial effect on HCC and fibrosis progression has been documented for a while, but that's the first time I've seen any reference to tx outcome. Note this was HALT-C however, so "more than double the SVR rate" is in the neighborhood of 25% vs 11%. Good luck with your upcoming bx. If it looks like further waiting is not such a good idea, it's worth taking a look at the "long-lead-in" approach.
eureka : thanks - though I'm not sure ntz and high dose rbv count as bigger guns. Maybe sling shots with new and improved rubber bands...
i was talking about powerpoint slides and never posted the link , duhhh so much for brianfog
here it is slide 67,68 regarding riba
www.projectsinknowledge.com/Activity//slides/1965.ppt
here it is slide 67,68 regarding riba
www.projectsinknowledge.com/Activity//slides/1965.ppt
thanks willing,
with all your prep I don`t see why you would not get into the RVR neighbourhood.
What about running IL28b beforehand ?
How did your HgB hold up last time and at what dosage ?
I wanted a >3g drop by wk4 and had to go up to 2400mg to get that.
My HgB did not move much during predose even though I predosed 5 weeks cumulative
average 18.36mg/kg
You need a powerpoint viewer for this but if you can open it go to slide #67and #68
It has a multi geno graph that shows evidence of higher SVR with higher Riba
and importance of Riba adherence.
I am currently on wk21 .My cumulative average Rib since INF is now 21.24mg/kg
and my Hbg is stable between 10-11g dosing btw. 1400-1600mg.
We are all different and it is my believe that the so called "Standard of Care"
will be replaced by much more personalized tx in the near future.
.
with all your prep I don`t see why you would not get into the RVR neighbourhood.
What about running IL28b beforehand ?
How did your HgB hold up last time and at what dosage ?
I wanted a >3g drop by wk4 and had to go up to 2400mg to get that.
My HgB did not move much during predose even though I predosed 5 weeks cumulative
average 18.36mg/kg
You need a powerpoint viewer for this but if you can open it go to slide #67and #68
It has a multi geno graph that shows evidence of higher SVR with higher Riba
and importance of Riba adherence.
I am currently on wk21 .My cumulative average Rib since INF is now 21.24mg/kg
and my Hbg is stable between 10-11g dosing btw. 1400-1600mg.
We are all different and it is my believe that the so called "Standard of Care"
will be replaced by much more personalized tx in the near future.
.
Still is eureka. I'll wait for the results of biopsy in November and then decide how I want move forward. If they keep dragging their feet with PI's and the fibrosis has progressed, I might just go down that road.
Trin
Trin
Always encouraging to see continually declining numbers, and it seems like you're tolerating the Alinia well so far -- I'm wishing you the best of luck! My husband's experience with 4 wk pre-dose was actually a 1-log jump in vl, but he still had a greater than 3 log drop after 4 weeks of SOC+ntz. If you get the RVR at 4 weeks, I'm wondering if you are you planning on the 48 or the 72 innings?
orleans: Whoa, is all I can say -- and congrats.
CoWriter: Too bad it caused CS upsets, but great that he still got to SVR.
willing: Congratulations on the coverage, and my best wishes to you on this new round with bigger guns! Being that you're not planning a cookie-cutter regimen having those extra vl's will certainly be useful in tweaking things as you go along. In the meantime, I won't ask, but good luck with your gravel and tank too...
Trinity4: was infergen ever in consideration?
orleans: Whoa, is all I can say -- and congrats.
CoWriter: Too bad it caused CS upsets, but great that he still got to SVR.
willing: Congratulations on the coverage, and my best wishes to you on this new round with bigger guns! Being that you're not planning a cookie-cutter regimen having those extra vl's will certainly be useful in tweaking things as you go along. In the meantime, I won't ask, but good luck with your gravel and tank too...
Trinity4: was infergen ever in consideration?
Wow the coffee thing is interesting. I've always drank LOTS of coffee and it sure didn't push me to SVR. I responded to inf and remained UND for 57 weeks but it wasn't sustainable even with 3+ cups daily. What I do think or hope coffee is doing is helping to keep the fibrosis from advancing as quickly.
Trin
Trin
sounds like the right plan. Your hepa's estimate is in good agreement with the data from
http://www.ncbi.nlm.nih.gov/pubmed/19091819
(always reassuring to double-check Dr's estimates) so the outlook is good. In the unlikely case something hits the fan there should be better options for g4 than tela.
if I got in the RVR neighborhood (didn't get close last time) I wouldn't try to sweeten the odds further. That's why I'm very interested in measuring early VL changes this time. If tela approval pushes out past July, I'll have the choice of (a) continuing to tread water and extend soc until tela availability (b) shorten the 12w of tela (c) nevermind the PI, stop at 48 and hope real hard.
BTW another AASLD'10 abstract worth looking at is 224: "Coffee is associated with virologic response in chronic Hepatitis C (CHC): Findings from the Hepatitis C Long-Term Treatment against Cirrhosis Trial (HALT-C). "
Those drinking three cups or more had more than twice the SVR rate of those not drinking coffee. This based on a survey before going into tx, so it may not help to phase it in later (and they give no clues about whether a frappucino beats a soy latte or what size mugs were involved)
http://www.ncbi.nlm.nih.gov/pubmed/19091819
(always reassuring to double-check Dr's estimates) so the outlook is good. In the unlikely case something hits the fan there should be better options for g4 than tela.
if I got in the RVR neighborhood (didn't get close last time) I wouldn't try to sweeten the odds further. That's why I'm very interested in measuring early VL changes this time. If tela approval pushes out past July, I'll have the choice of (a) continuing to tread water and extend soc until tela availability (b) shorten the 12w of tela (c) nevermind the PI, stop at 48 and hope real hard.
BTW another AASLD'10 abstract worth looking at is 224: "Coffee is associated with virologic response in chronic Hepatitis C (CHC): Findings from the Hepatitis C Long-Term Treatment against Cirrhosis Trial (HALT-C). "
Those drinking three cups or more had more than twice the SVR rate of those not drinking coffee. This based on a survey before going into tx, so it may not help to phase it in later (and they give no clues about whether a frappucino beats a soy latte or what size mugs were involved)
forgot to mention the 80% SVR worse case prognosis does not include
pre/high dose Rib yet so I am cautiously optimistic about better than
worse case.
pre/high dose Rib yet so I am cautiously optimistic about better than
worse case.
thanks,
I am very aware of C210 even before I started tx.
I would not add it to the tail end nor would I use it if it were available right now.
According to my famous hepatologist @ wk12 meeting my odds for SVR are 80% WORSE CASE !!!
Since there is no 100% , I am very happy with my results and I would not change
a thing.
Tela can create resistant strains. I would only use it if I had no other option and my odds for SVR were very low.
I would have to relapse first to go down that path .
I am very aware of C210 even before I started tx.
I would not add it to the tail end nor would I use it if it were available right now.
According to my famous hepatologist @ wk12 meeting my odds for SVR are 80% WORSE CASE !!!
Since there is no 100% , I am very happy with my results and I would not change
a thing.
Tela can create resistant strains. I would only use it if I had no other option and my odds for SVR were very low.
I would have to relapse first to go down that path .
Co:
>It's supposed to prevent relapse....so it makes no sense stopping it at week 12.
as far as I know, the only documented evidence for NTZ's hcv-suppressive mechanism is enhanced activation (phosphorylation) of eif2A and PKR:
http://www.ncbi.nlm.nih.gov/pubmed/19664635
So, not unlike the SAMe/Stat1 story, the effect is to keep two key molecules in busy-bee mode but, unlike STAT1, on the ifn effector rather than ifn signaling side. How/why would this mechanism be limited to relapse? Also note that in the Basu study relapse rate was 0% with 12w NTZ, though whether that was due to the high dose rbv or ntz is not clear.
all: looks like the AASLD abstracts are available on 10/1 as promised - get'em while they're there..
Bali:check out the text for abstract 828 (Activity of Telaprevir Monotherapy or in Combination with Peginterferon-alfa-2a and Ribavirin in Treatment-naïve Genotype 4 Hepatitis-C Patients: Final Results of Study C210 ). They claim "TVR in combination with PR had greater activity against HCV G4 than PR alone," though the SVR rates don't seem to support this. Still, it may be worth thinking about adding tvr at the tail end of your tx if it's out by then.
>It's supposed to prevent relapse....so it makes no sense stopping it at week 12.
as far as I know, the only documented evidence for NTZ's hcv-suppressive mechanism is enhanced activation (phosphorylation) of eif2A and PKR:
http://www.ncbi.nlm.nih.gov/pubmed/19664635
So, not unlike the SAMe/Stat1 story, the effect is to keep two key molecules in busy-bee mode but, unlike STAT1, on the ifn effector rather than ifn signaling side. How/why would this mechanism be limited to relapse? Also note that in the Basu study relapse rate was 0% with 12w NTZ, though whether that was due to the high dose rbv or ntz is not clear.
all: looks like the AASLD abstracts are available on 10/1 as promised - get'em while they're there..
Bali:check out the text for abstract 828 (Activity of Telaprevir Monotherapy or in Combination with Peginterferon-alfa-2a and Ribavirin in Treatment-naïve Genotype 4 Hepatitis-C Patients: Final Results of Study C210 ). They claim "TVR in combination with PR had greater activity against HCV G4 than PR alone," though the SVR rates don't seem to support this. Still, it may be worth thinking about adding tvr at the tail end of your tx if it's out by then.
The diarrhea started at week 8 and nothing worked to make it stop....immodium, lomotil, probiotics. He tried restarting it later and the same thing happened.
It's supposed to prevent relapse....so it makes no sense stopping it at week 12.
Are you taking probiotics?
Co
It's supposed to prevent relapse....so it makes no sense stopping it at week 12.
Are you taking probiotics?
Co
Thanks - not quite "on the road again" but getting close. Major obstacle with my tx planning at the moment is getting a few tons of 3/4"" gravel delivered and driving to Fresno in search of a 1500 gallon septic tank (don't ask). But as far as tx, I'm planning to stick pretty close to the Basu protocol. Only twists will be the 1600 SAMe and probably dividing my weekly pegasys dose into twice weekly shots. Am still holding out dim hopes of access to IV-SIL (the iv-infusion milk-thistle product) but it's not looking likely.
congrats to the ntz approval , still remember how it felt a year ago
when i got my first script.
yes CS had a bad time with it but that is a rarity.
What is your tx plan at this point ?
when i got my first script.
yes CS had a bad time with it but that is a rarity.
What is your tx plan at this point ?
definitely planning on both pre-dose and high/riba. Will start at 17mg/kg and adjust as needed. NTZ seems generally, but not universally, well-tolerated. CS had a devil of a time with it. If there are no problems will re-evaluate at w12. Going to pharmacy with the rx is easy - what I was worried about was whether at checkout they would ask for the full cost ($1400) or the insco copay($40). Life is good - they covered it. Took 1st pill and no allergy evident. Dr. also agreed, in principle, to additional testing. Since not sure whether PI will/won't overlap am curious about measuring 1st/2nd phase decline and so would like tests at (0, 12, 24, 48, 72)h and (7, 14, 21, 28)d after 1st ifn. No need for any of these to be high-sensitivity but he may still balk at that much testing. Backup plan is to draw my own and keep at -80.
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