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Avatar universal

pre-dosing ribavirin advice

I have a friend who is about to start tx after relapsing the first time. This person is considering pre-dosing ribavirin and wondering how long to predose and how much to take. There are some older threads about it but nothing recent so I am hoping for some more current info, opinions and recommendations. The person is stage 3 of course determined to do everything it takes.

tx will be with telaprevir triple therapy.
1rst treatment I believe became und late, I believe week 14 but not positive.
treated 72 weeks relapsed
had minimal drop in hgb (12.1 to 11.3)
took 1000 mg riba, weight 115, 18.8 mg per kilo

Thanks so much for the help,
Dave
28 Responses
96938 tn?1189803458
I pre-dosed for a week at the full dose.   If I were to go back in time I might have stretched it out to 10 days.
96938 tn?1189803458
I think Gauf and Bali pre-dosed riba also.  Maybe Spacecoast too.
223152 tn?1346981971
I think it may be a good idea.  I am considering it myself but how long would depend on whether a doctor would rx it.
frijole
Avatar universal
Hi - the following was cited before on this board.  don't know who posted it. perhaps it will be useful
eric

Helper T cell cytokine response to ribavirin priming before combined treatment with interferon alpha and ribavirin for patients with chronic hepatitis C

Norihiro Furusyoa, b, , , Norihiko Kubob, Kazuhiro Toyodab, Hiroaki Takeokab, Shigeki Nabeshimaa, Masayuki Murataa, Makoto Nakamutac and Jun Hayashia, b
aDepartment of General Medicine, Kyushu University Hospital, Higashi-Ku, Fukuoka 812-8582, Japan
bDepartment of Environmental Medicine and Infectious Diseases, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
cDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Received 28 May 2004;  accepted 6 April 2005.  Available online 12 May 2005.
Abstract
The viral genotype and serum viral level influence the response to interferon (IFN) treatment in patients with chronic hepatitis C virus (HCV) viremia. The aim of this study was to investigate a possible relationship between early virological response and helper T (Th) cell cytokine expansion by 4 weeks of ribavirin (RIB) alone followed by IFN and RIB combined in patients with genotype 1b and a high HCV RNA level, patients reported not to respond well to IFN treatment. Eighty-one patients with genotype 1b and a high HCV RNA level, over 100 international unit per milliliter (KIU/mL) (by Amplicor HCV Monitor), were assigned to two groups: Group A (N = 40) with a 4-week RIB administration followed by a 24-week combination treatment, and Group B (N = 41) with a 24-week combination treatment only. Blood was obtained from each patient on the following schedule: at Baseline (4 weeks before day 0), on day 0 (initiation day of the RIB and IFN combination treatment), weeks 4 (4 weeks after the start of the combination treatment), and at the end of the combination treatment. Flow cytometry was used to investigate sequential changes of IFN-γ producing (Th1) and interleukin-4 producing (Th2) cells from whole blood samples after stimulation with PMA and ionomycin. Serum HCV RNA clearances were 32.5% at week 4, 43.2% at week 8, 85.7% at the end of the combination treatment, and 22.9% within the 24-week follow-up in Group A; and 17.1%, 27.0%, 66.7% and 19.4% in Group B, respectively. The mean Th1/Th2 ratio significantly increased from 15.9 at baseline to 17.6 at day 0 with a decrease of Th2 cells, and then significantly decreased from 17.6 at day 0 to 15.5 at week 4 in Group A, while there was no significant change in Group B between baseline and day 0. In Group A, 13 patients with HCV RNA clearance within 4 weeks had a significantly increased Th1/Th2 ratio, from 14.0 at baseline to 22.1 at day 0, and then a significantly decreased ratio, from 22.1 at day 0 to 15.0 at week 4, while the others had no significant change in the ratio. RIB administration preceding combined treatment of RIB with IFN was more effective in Th2 cell expansion than the usual combined treatment of IFN with RIB and led to a relatively early virological clearance in chronic hepatitis C patients with genotype 1b and a high HCV RNA level.
Avatar universal
I also think tapering off the meds at the end of TX is just as important. Especially with the interferon. A hepatologist put it to me this way, "it gives your immune system time to get use to working on it's own". Of course this was a theory of his and he would never admit it publically. I figured it made sense and wouldn't hurt so I did it. I tapered off over a month lowering the ML of the shot, 3/4, 1/2, 1/4, 1/8 doses weekly. This was done after the FULL TX was over. This was an added month.

Best of luck
979080 tn?1323437239
http://www.hivandhepatitis.com/2010_conference/aasld/docs/1214_2010_a.html
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