is triple therapy (incivek) the right prescription?

[OC]

I'm genotype 1a and was a non responder in 2002, I took peg/intron A (scheering-plough) with ribavirin.

Now my hepatologist is prescribing the triple therapy (pegasus - ribavirin) with incivek.

My question is, if i failed on peg/intron A with ribavirin before is this the right prescription?

thanks!

[ceanothus]

I'm sorry to have to say this, but your doctor really screwed up your treatment. You clearly should have treated for 48 weeks, not 24, and even worse is that he reduced your dosage of Incivek! It is totally against the rules of treatment to reduce that particular drug. The interferon and the ribavirin can both be dose-reduced if necessary, but never the Incivek. The top priority in treating with that drug is to keep the dose as even as possible for the entire 12 weeks, which is why it also has to be taken faithfully every 8 hours (with leeway being no more than 9 hours or less than 7 hours, and why its so important to take it within 20 minutes after eating food with at least 20 grams of fat. All of these are critical to maintaining a pretty even level of the drug in your bloodstream for the entire 12 weeks. The Hepatitis C virus is very good at mutating into a drug-resistant form, and any drop in the level of Incivek in your bloodstream gives it an opening to do that mutating. Once it does mutate, the resistant form quickly multiplies and treatment becomes futile. There was at least one study indicating that once all the drugs are stopped the virus slowly reverts back to its original form and after 18 months it will once again respond to the protease inhibitors, so hopefully that study has been repeated and confirmed and you will be eligible to treat with this class of drugs again in about 18 months. I hope you will find a much better informed doctor to handle your liver care and future treatment. I am so sorry this happened to you, but, sadly, you are not the first person on this forum who had a doctor screw up their treatment. I'm very glad that at least it sounds like your liver is still in pretty good shape, although you can't really be sure without having had a biopsy in the last few years. Please try to find a good hepatologist and see what he recommends for you. This is too important to trust to a doctor who has messed it up once already. Best wishes!

[pooh55811]

Oops, the last link in my previous post was supposed to be this one,  is a link that shows you the results of the various trials with Sofosbuvir, Ledipasvir, and Ribavirin:

http://www.gilead.com/news/press-releases/2013/5/gilead-reports-interim-data-from-phase-2-lonestar-study

[pooh55811]

Before I respond to your most recent questions, let me point out one other thing. I noticed you said you were still Detectable at week 4 and were not Undetectable until week 12. That would have been another reason that you should have done 48 weeks of treatment, not 24 weeks. If one is treating with Incivek and one is still Detectable at week 4, then, according to the recommended protocol, one must treat for 48 weeks. I was in that category. I was still Detectable at week 4 (Interferon, Ribavirin, and Incivek) and I had to treat for 48 weeks. I did attain SVR (cure) after that 48 weeks of treatment.

Now to your most recent question:

If one fails treatment or stops treatment with the triple med treatment of Interferon, Ribavirin, and Incivek, it is not recommended to retreat with the same regimen (Interferon, Ribavirin, and Incivek or Interferon, Ribavirin, and Boceprevir). You have resistant variants now and it takes a while for them to revert back to the wild type HCV virus. If you try to retreat with the same medication, the treatment will most likely fail.

It is possible that you would have attained SVR (cure) if you had treated for the recommended amount of time (48 weeks) for your situation (previous non-responder).  That would have been your best shot at cure with the triple medication regiment. It is also possible that, as a previous non-responder, treatment may not have worked even if you had treated for 48 weeks. Previous non-responders do have a lower rate of cure with the triple med treatment than do those who either never treated before or were previous relapsers or partial responders. You had two reasons why you should have treated for 48 weeks (still Detectable at week 4 and also a previous non-responder). Unfortunately, since you did only 24 weeks of treatment you will never know if you would have attained SVR (cure) had you treated for 48 weeks.

I think if I were you, I would find a knowledgeable and experienced Hepatologist to treat me. A Hepatotlogist should know the correct protocols, should be up to date on new treatments as they become available, and should know about any new trials that may be open to you.  I would also get a liver biopsy and have more testing done to ascertain more about your Genotype and other testing concerning your particular viral strain. I know you said you are Genotype 1a. It would also be good to know your IL28B gene (CC, CT, or TT). For more information on the IL28B gene see the following link:

http://www.treatmentactiongroup.org/hcv/factsheets/il28b

I know it is very discouraging and devastating that you relapsed. However, new drugs are on the way and, hopefully, there will be a new treatment regimen for you sometime late next year or early 2015.

I know it is no consolation, but there are several people on the forum in the same situation as you are in, having relapsed or not succeeded at triple med treatment. They are waiting for the new meds. As soon as new meds become available, there will be many posts concerning them.

There is also a woman who failed triple med treatment a couple of years ago, participated in the ION 2 trial and attained SVR (cure). She did 12 weeks with Sofosbuvir, Ledipasvir, and Ribavirin. You may wish to read her post here:

http://www.medhelp.org/posts/Hepatitis-C/Starting-Sofosbuvir-GS-5885/show/1875802#post_9588922

And here is a link that shows you the results of the various trials with Sofosbuvir, Ledipasvir, and Ribavirin.

http://www.medhelp.org/posts/Hepatitis-C/Starting-Sofosbuvir-GS-5885/show/1875802#post_9588922

Stay on the forum. There will be many more posts in the future about these new drugs and when they will become available.

[Aeschines]

Of course, I meant the treatment I did for 24 weeks, i.e., Incivek, Ribav. & interferon

[Aeschines]

So I would have a poor chance at success if I were to treat again with Incivek for 48 weeks?

[pooh55811]

This link takes you to a site which may be helpful. You can see in the first part of the article there is a chart which shows you the different classes of Direct Acting Antivirals. You can also see that Simeprevir is in the same class as Telaprevir and Boceprevir. That is why there could be some resistance issues if one has already taken Telaprevir or Boceprevir. However, Sofosbuvir and Ledispavir, as well as several other new drugs, are in different classes of Direct Acting Antivirals. There should be no resistance issues with them in terms of having previously taken Telaprevir.

http://www.hepatitis.va.gov/provider/topics/DAA-update.asp

Here are a couple of links to some good articles about the new drugs and you wil be able to do some comparisons:

http://www.natap.org/2013/HCV/050313_02.htm

http://www.natap.org/hcv.htm

http://www.natap.org/2013/EASL/EASL_87.htm