TO JmJm530

[copyman]

hey jmjm, i was hoping to get your take on my post below titled "thoughts about this type of tx". since i will be starting soon i'm looking at all possibilities. thanks

[jmjm530]

I actually saw your post early this morning but hoped others would chime in. Dr. Cecil can be a very sensitive subject here and I assume that's why many who IMO don't believe with his titering up approach regarding peg haven't posted.

The short answer is that just about every recent study and hepatologist I'm familiar with believes you should hit the virus early and hard with Peg and Riba with the intent to get non detectible as early as possible.

I'll also add that I disagree both from anecdotal evidence here as well as my own personal experience that a full dose of Peg early in treatment is problematic in terms of side effects. Riba maybe, but not peg.

As to induction therapy, the article cited can be confusing to someone new to the subject because Cecil is really talking about two things. First, comparing his titering up approach to normal dosing, and second a discussion about induction therapy (double dosing) which is different and which most of us are not, or haven't been on.

That said, a fairly recent study suggests that induction therapy (double dosing) only has slightly more sides than single dosing with similar drop out rates. From my own personal experience of double dosing Peg for three weeks, I again found no problem with the Peg, just with the riba.

Here's two relates reports regarding induction therapy for relapsers which reinterates what I've just stated. I believe there are also ongoing or recently completed trials re induction therapy for non-responders but I don't have links to them.

http://www.natap.org/2005/AASLD/aasld_36.htm *
http://www.natap.org/2005/AASLD/aasld_56.htm *

Again, and more specific to your question, IMO the best approach is standard dosing not the Cecil approach of titering up the Peg. Double dosing (induction therapy) again is an entirely different animal and appears to have promise for difficult to treat patient populations and/or relapsers.

All the best luck with your treatment, whichever road you take.

-- Jim

* Not included here, but the 4-week non-detectible figures were even more dramatic with induction therapy than with normal dosing. Source: Clinical Options Website (See module: "Doc eye for the hep Guy". Free registration required.
http://www.clinicaloptions.com/Hepatitis.aspx

[jmjm530]

Fourth paragraph from bottom should read in part:

...I believe there are also ongoing or recently completed trials re induction therapy for *treatment naive* patients but I don't have links to them.

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I'll also again add that I was reluctant to get into another Dr. Cecil discussion and I won't. However, you asked me a question and I felt you deserved an answer as I see it.

[jmjm530]

One last time on that paragraph. Hopefully, as they say, the third time will be a charm :)

...Here's two related reports regarding induction therapy for *non-responders* which reinterates what I've just stated. I believe there are also ongoing or recently completed trials re induction therapy for *treatment naive populations* but I don't have links to them....

[jmjm530]

Thanks to Sunspot, I just found a recent thread on Dr. Cecil. It seems that a number of people did chime in on the topic then, so maybe they just didn't see your more recent post. I feel for what you're going through as the time preceding treatment can be very stressful.

Here's the link to the previous post:
http://www.medhelp.org/forums/Hepatitis/messages/42246.html

Be well.

-- Jim