Aa
i was a non-responder in 2002,
and i'm going to try the new triple therapy (telaprevir/peg intron) soon.
my question is, [if] (and i'm remaining totally positive), the new triple therapy doesn't work, would that preclude me from trying any of the polymerase inhibitors or interferon free therapies that are on the horizon?
thanks!
my question is, [if] (and i'm remaining totally positive), the new triple therapy doesn't work, would that preclude me from trying any of the polymerase inhibitors or interferon free therapies that are on the horizon?
thanks!
There is one more factor that I don't think was mentioned. For null responders with cirrhosis, the 29% SVR drops to 13%.
Also, for the question on resistance, it would not preclude you from polymerase but there is a chance that there would be crossover resistance to any of the other protease inhibitors. Even though Vertex has some data on resistance no one has good data yet on what happens regarding resistance once the person actually goes back on the drugs. There are apparently patients who look like resistance is gone, but once the patient goes back on treatment resistance can reappear.
Genotype 1a patients have a lower barrier to resistance than do 1b patients.The data can be seen in the Sprint 2 and Respond 2 trials with boceprevir.
Also, for the question on resistance, it would not preclude you from polymerase but there is a chance that there would be crossover resistance to any of the other protease inhibitors. Even though Vertex has some data on resistance no one has good data yet on what happens regarding resistance once the person actually goes back on the drugs. There are apparently patients who look like resistance is gone, but once the patient goes back on treatment resistance can reappear.
Genotype 1a patients have a lower barrier to resistance than do 1b patients.The data can be seen in the Sprint 2 and Respond 2 trials with boceprevir.
Thanks for the great info on the differences between the non responder and null responder.
I was not aware that Null responder is a subgroup of Non responder.
I was not aware that Null responder is a subgroup of Non responder.
HectorSF - yes that is what i was treated with. (thanks for your ever so informing posts)
On the side issue of what type of responder you were...
"i only had a 1 log drop"
If you only had a 1 log drop at week 12 you were a "null-responder".
A "non responder" is someone who during treatment never became undetectable. Non responders are broken down into 2 subgroups "null responders" and "partial responders". Clinical trial data will show the differences in treatment response of these two types of responders separately, as these is quite a difference between the two types of responders.
For example:
"Results From Phase 3 REALIZE Study Showed Telaprevir-Based Therapy Significantly Improved SVR (Viral Cure) Rates in People Whose Prior Treatment For Hepatitis C Was Unsuccessful"
http://www.natap.org/2011/EASL/EASL_10.htm
"Among those in the simultaneous start arm of REALIZE, 83 percent (121/145) of prior relapsers, 59 percent (29/49) of prior partial responders and 29 percent (21/72) of null responders achieved viral cures compared to 24 percent (16/68), 15 percent (4/27) and 5 percent (2/37), respectively, who received pegylated-interferon and ribavirin."
Definitions:
Prior Null Responder: Defined as a person who achieved a less than 2 log10 reduction in HCV RNA at week 12 of a prior course of therapy.
Prior Partial Responder: Defined as a person who achieved at least a 2 log in10 reduction in HCV RNA at week 12, but whose hepatitis C virus never became undetectable by week 24 of a prior course of therapy.
Prior Relapser: Defined as a person whose hepatitis C virus was undetectable at the completion of at least 42 weeks of a prior course of therapy but whose virus became detectable during the follow-up period.
Andiamo1 - The standard of care as of 2002 is weekly subcutaneous PEG-IFN alpha given in combination with daily oral ribavirin. I hope that is what OC was treated with.
Good luck with your treatment!
Hector
"i only had a 1 log drop"
If you only had a 1 log drop at week 12 you were a "null-responder".
A "non responder" is someone who during treatment never became undetectable. Non responders are broken down into 2 subgroups "null responders" and "partial responders". Clinical trial data will show the differences in treatment response of these two types of responders separately, as these is quite a difference between the two types of responders.
For example:
"Results From Phase 3 REALIZE Study Showed Telaprevir-Based Therapy Significantly Improved SVR (Viral Cure) Rates in People Whose Prior Treatment For Hepatitis C Was Unsuccessful"
http://www.natap.org/2011/EASL/EASL_10.htm
"Among those in the simultaneous start arm of REALIZE, 83 percent (121/145) of prior relapsers, 59 percent (29/49) of prior partial responders and 29 percent (21/72) of null responders achieved viral cures compared to 24 percent (16/68), 15 percent (4/27) and 5 percent (2/37), respectively, who received pegylated-interferon and ribavirin."
Definitions:
Prior Null Responder: Defined as a person who achieved a less than 2 log10 reduction in HCV RNA at week 12 of a prior course of therapy.
Prior Partial Responder: Defined as a person who achieved at least a 2 log in10 reduction in HCV RNA at week 12, but whose hepatitis C virus never became undetectable by week 24 of a prior course of therapy.
Prior Relapser: Defined as a person whose hepatitis C virus was undetectable at the completion of at least 42 weeks of a prior course of therapy but whose virus became detectable during the follow-up period.
Andiamo1 - The standard of care as of 2002 is weekly subcutaneous PEG-IFN alpha given in combination with daily oral ribavirin. I hope that is what OC was treated with.
Good luck with your treatment!
Hector
andiamo1:
120MCG KIT, inject 0.5ml weekly – rebetol 200MG (2x am/3x pm)
burned74:
thanks will read that in the morning!
120MCG KIT, inject 0.5ml weekly – rebetol 200MG (2x am/3x pm)
burned74:
thanks will read that in the morning!
here is a link for some info on the study that I was referring to.
http://www.natap.org/2010/AASLD/AASLD_66.htm
http://www.natap.org/2010/AASLD/AASLD_66.htm
What was the dosage of your drugs in 2002. I don't remember when pegylated interferon started to be used. Were you treated with peg interferon and weight based Riba dosing?
To answer your question, failing with triple therapy will not preclude you from trying the polymerase drugs. It may not even preclude you from trying the polymerase inhibitors in combo with protease inhibitors. Vertex has lots of data on the development of mutant strains and their long term viability. Most people that don't clear with triple therapy, revert to a population of dominant wild type virus once the protease inhibitor is stopped.
To answer your question, failing with triple therapy will not preclude you from trying the polymerase drugs. It may not even preclude you from trying the polymerase inhibitors in combo with protease inhibitors. Vertex has lots of data on the development of mutant strains and their long term viability. Most people that don't clear with triple therapy, revert to a population of dominant wild type virus once the protease inhibitor is stopped.
Google around for the study, but I read one study that showed that, for those that used Incivek and did not achieve SVR, the non resistant virons had disappeared in 90 per cent of the non responders within 3 years.
I am a NR as well and that's what I am doing this fall
I am a NR as well and that's what I am doing this fall
i only had a 1 log drop, down to 70,600...but at the time they only measured to >850000...just had a biopsy in june and it said, stage 2-3, grade 2-3...i can post the entire report if you want to see it.
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