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!

[pooh55811]

I am sorry treatment did not work for you.

From your history of your previous treatment, you were a null-responder the first 2 treatments you had. I know dropping from 1,000,000 to 300,000 seems like a lot, but it is not even a 1 log drop. Therefore, when you did the triple medication treatment, you should have treated for 48 weeks with the Interferon, Ribavirin, and Incivek. It is too late to go back and redo the treatment with 48 weeks now. You may have resistant strains. It also appears you may not respond that well to Interferon.

Also, when you say you were Detectable for the virus at 24 weeks, do you mean you had were Detectable at the end of 24 weeks of treatment (right when you finished treatment) OR did you mean you had were Detectable at 24 weeks AFTER finishing treatment?.

The FDA is reviewing some new drugs for Hepatitis C. One of the new treatments for Hep C Genotype 1 is Sofosbuvir, Ribavirin, and Interferon, but it is only for the treatment naive (never treated). This combination may be approved in early 2014. New drug treatments for treatment experienced patients may be approved several months later or in 2015.  There are several new drugs in the pipeline. Eventually there will be something for you.

Have you had a liver biopsy to determine your liver fibrosis stage? If not, you may wish to ask your doctor about getting a liver biopsy. The liver enzymes (AST and ALT) can be normal even if you have liver damage. They are not good gauges of liver fibrosis stage.

Your doctor should have known from your history that you should have treated for 48 weeks with the triple medication treatment. It is the protocol. What type of doctor are you seeing? I would suggest getting a Hepatologist to treat you. A Hepatologist will know what new treatments will be available and will also know the correct treatment regimens (including the length of time you will need to treat considering your history).

Link to treatment guidelines:

http://www.treatmentactiongroup.org/hcv/factsheets/incivek-telaprevir

This article also discusses several factors related to treatment.

Best of luck.

[Aeschines]

What is the "wild" genotype virus?

[Aeschines]

I am lucky on the liver damage. My doctor say I have almost none. My liver readings are: AST (SGOT)  28  (Normal range: 0-40 IU/L i); and my  ALT (SGPT) is  28 (Normal range:  0-44 IU/L). Don't ask why cause I do not know.  I've had the virus for almost 20 yrs. I was recently treated for 24 weeks. Could my doctor's options he mentioned be  doing the same treatment for 48 weeks this time? After all, we had it to 0. Maybe if we kept hammering it, it would have gone. How long have you been out of treatment? Have you had your 6 mth. test yet? I find out what these options are on 11-12.

[ceanothus]

I'm so sorry to hear that you relapsed! Your genotype and your three separate treatments are the same as mine, but I was cured by this last tx with incivek. Did you treat for 24 weeks or 48? Do you know the stage of your liver damage?

I'm not an expert on the next generation of treatments, but from what I've heard I believe you may have to wait a while before trying to treat again. I think that the next new treatments to be approved will only be for those who are treatment-naive, and I think there is some kind of issue with one of the next new drugs being another protease inhibitor, so there is concern about viral resistance in those who have recently used Telaprivir or Boceprivir. Those issues should fade with time though, as studies have shown that even when an individual's virus has mutated to a resistant form, resistance  fades after 18 months of no exposure to the PI's and the virus reverts to the wild genotype virus. I would post the link to that study but I'm writing from my iPad and its hard to find those links without losing everything I've already typed!

I hope someone else can give you better information about the next treatment options. I do want to encourage you anyway, as I know the rate of study has really picked up in the last few years, and new things are coming out a lot faster than they used to.

[Aeschines]

I am genotype 1a. I took interf. & ribav in 2006. My viral load went down to 300Gs IU from over 1 million IUs and that was it. Then a year later I used pegalated interf. & ribav. A little better result, (Down to 200Gs IU). In 2012 I took pegasys (pegalated interferon alfa-2a), copegasys ribav.  & Invivek (telaprevir). In 4 wks my viral load went from over 1 million IUs to  0. At 12 weeks (while still on meds) I was till at 0. However at my 6 mths checkup it was back at 510Gs IU.

What is next?  Does anyone know. I go back to my doctor on 11-12-13 and he said  we have a few additional options.

[Aeschines]

I am genotype 1a. I took interf. & ribav in 2006. My viral load went down to 300Gs IU from over 1 million IUs and that was it. Then a year later I used pegalated interf. & ribav. A little better result, (Down to 200Gs IU). In 2012 I took pegasys (pegalated interferon alfa-2a), copegasys ribav.  & Invivek (telaprevir). In 4 wks my viral load went from over 1 million IUs to  0. At 12 weeks (while still on meds) I was till at 0. However at my 6 mths checkup it was back at 510Gs IU.

What is next?  Does anyone know. I go back to my doctor on 11-12-13 and he said  we have a few additional options.