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Victrellis with food
Does Victrellis have to be taken with 20 g of fat like Incivek? If not why isn't Victrellis being prescribed more, I mean the fat requirement is somewhat burdensome right? They both have about the same cure rates, with Incivek a percent or two higher.
I notice a lot more people seem to be prescribed Incivek. Is that true or just my impression?
Reason I ask is I'm supposed to start Incivek possibly in a few weeks and the more I read about the stomach ailments and getting sick of the fatty food, the more I wonder about asking if Victrellis being an option.
I notice a lot more people seem to be prescribed Incivek. Is that true or just my impression?
Reason I ask is I'm supposed to start Incivek possibly in a few weeks and the more I read about the stomach ailments and getting sick of the fatty food, the more I wonder about asking if Victrellis being an option.
I'm waiting to swim at the pools till after tx. Last time I treated it was very hard on my skin and had to stop going. I still swim in the lake. Use a strong sunscreen and its not too bad, I use 100 spf on my face and 85spf every where else. I have a very faint rash but when I go in the sun w/o sunscreen within 5 mins. it gets red, swollen and itchy any longer and I suffer for a few days. Stomach problems come and go, I find nibbleing on something most of the time helps keep the pain down, keep trying different foods, my tummy will tolerate something this week and then not the next. Good luck, drink plenty of water!
Hi, I'm on week 5 just started victrelis with 4 week lead-in. Stomach problems and joint pain in old work injuries. I'm eager to start swimming once the pools open, but I was told to stay out of the sun. Will buy umbrella to take to pool. How do you handle the chlorine with dry skin from meds? Thanks so much, Ann
thanx for posting of info on lab timelines. i've been getting regular labs for cbc and cmc during this 4 week lead in; and charting the results. alt and ast are now in the normal range. I am anxious to see how i fare at week 4 w/ my VL.
Will we all become medical dictionaries?
Will we all become medical dictionaries?
The clinic I go to is only open tues and weds, and my Doctor will be out of her office next week. Now I really want to talk to her bout why I didn't see a VL load, on my 8 week labs.
My concern isn't treatment time, but I had read about another person on here, who's Pharmacy wouldn't realese her Triple Tx meds, without her 4 week VL. But next week will be week 12, and I did call the pharmacy, and they sent my next months' shipment, and took my co-pay, so I think I should be alright.
I am thinking that my Doctor has the 8 week results in her office, instead of my chart., and that I was UND, like at 4 weeks, but I like to keep copies of this stuff. I havent heard of people testing UND at week 4 and then dectectable at 8 weeks, before, but I have heard of break-thru relapse later in treatment.
I get really irritated with thses kind of errors, at any Doctors office, but in the long run, we are in the "Save our own a%* club", so when they couldn't find my 8 week result last tuesday, I should've advocated for myself, and demanded to speak to my Doctor about it!
My concern isn't treatment time, but I had read about another person on here, who's Pharmacy wouldn't realese her Triple Tx meds, without her 4 week VL. But next week will be week 12, and I did call the pharmacy, and they sent my next months' shipment, and took my co-pay, so I think I should be alright.
I am thinking that my Doctor has the 8 week results in her office, instead of my chart., and that I was UND, like at 4 weeks, but I like to keep copies of this stuff. I havent heard of people testing UND at week 4 and then dectectable at 8 weeks, before, but I have heard of break-thru relapse later in treatment.
I get really irritated with thses kind of errors, at any Doctors office, but in the long run, we are in the "Save our own a%* club", so when they couldn't find my 8 week result last tuesday, I should've advocated for myself, and demanded to speak to my Doctor about it!
My doctor gave me the choice of Vic or Inc. we went over all the pros and cons and she gave me a month to think about it. I, because of the fat intack with inc. went with Vic. Tx naive geno type 1, grade 2/2, I was und at week four and stayed that way all of tx. I ate small snack with pills ie: yogurt, milk, something light. Finished tx April 4 th. Good luck with you decision.
5.5 Laboratory Tests
HCV-RNA levels should be monitored at Treatment Weeks 4, 8, 12, and 24, at the end of treatment, during treatment follow-up, and for other time points as clinically indicated. Use of a sensitive real-time reverse-transcription polymerase chain reaction (RT-PCR) assay for monitoring HCV-RNA levels during treatment is recommended. The assay should have a lower limit of HCV-RNA quantification of equal to or less than 25 IU per mL, and a limit of HCV-RNA detection of approximately 10 to 15 IU per mL. For the purposes of assessing Response-Guided Therapy milestones, a confirmed “detectable but below limit of quantification” HCV-RNA result should not be considered equivalent to an “undetectable” HCV-RNA result.
Complete blood count (with white blood cell differential counts) must be conducted in all patients prior to initiating VICTRELIS combination therapy. Complete blood counts should be obtained at Treatment Weeks 4, 8, and 12, and should be monitored closely at other time points, as clinically appropriate.
Refer to the Package Inserts for peginterferon alfa and ribavirin, including pregnancy testing requirements.
Add VICTRELIS 800 mg (four 200-mg capsules) orally three times daily (every 7-9 hours) to peginterferon alfa and ribavirin regimen after 4 weeks of treatment. Based on the patient's HCV-RNA levels at Treatment Week (TW) 8, TW12 and TW24, use the following Response-Guided Therapy (RGT) guidelines to determine duration of treatment (see Table 1).
Table 1
Duration of Therapy Using Response-Guided Therapy (RGT)
Previously Untreated Patients (HCV-RNA Results) At Treatment Week 8 Undetectable At Treatment Week 24 Undetectable
RECOMMENDATION Complete three-medicine regimen at TW28.
(HCV-RNA Results) At Treatment Week 8 Detectable At Treatment Week 24 Undetectable RECOMMENDATION
1. Continue all three medicines and finish through TW36; and then
2. Administer peginterferon alfa and ribavirin and finish through
TW48.
Previous Partial Responders or Relapsers
(HCV-RNA Results) At Treatment Week 8 Undetectable At Treatment Week 24 Undetectable RECOMMENDATION
Complete three-medicine regimen at TW36.
(HCV-RNA Results) At Treatment Week 8 Detectable At Treatment Week 24 Undetectable RECOMMENDATION
1. Continue all three medicines and finish through TW36; and then
2. Administer peginterferon alfa and ribavirin and finish through
TW48.
TREATMENT FUTILITY
If the patient has HCV-RNA results greater than or equal to 100 IU/mL at TW12, then discontinue three-medicine regimen.
If the patient has confirmed, detectable HCV-RNA at TW24, then discontinue three-medicine regimen.
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf
HCV-RNA levels should be monitored at Treatment Weeks 4, 8, 12, and 24, at the end of treatment, during treatment follow-up, and for other time points as clinically indicated. Use of a sensitive real-time reverse-transcription polymerase chain reaction (RT-PCR) assay for monitoring HCV-RNA levels during treatment is recommended. The assay should have a lower limit of HCV-RNA quantification of equal to or less than 25 IU per mL, and a limit of HCV-RNA detection of approximately 10 to 15 IU per mL. For the purposes of assessing Response-Guided Therapy milestones, a confirmed “detectable but below limit of quantification” HCV-RNA result should not be considered equivalent to an “undetectable” HCV-RNA result.
Complete blood count (with white blood cell differential counts) must be conducted in all patients prior to initiating VICTRELIS combination therapy. Complete blood counts should be obtained at Treatment Weeks 4, 8, and 12, and should be monitored closely at other time points, as clinically appropriate.
Refer to the Package Inserts for peginterferon alfa and ribavirin, including pregnancy testing requirements.
Add VICTRELIS 800 mg (four 200-mg capsules) orally three times daily (every 7-9 hours) to peginterferon alfa and ribavirin regimen after 4 weeks of treatment. Based on the patient's HCV-RNA levels at Treatment Week (TW) 8, TW12 and TW24, use the following Response-Guided Therapy (RGT) guidelines to determine duration of treatment (see Table 1).
Table 1
Duration of Therapy Using Response-Guided Therapy (RGT)
Previously Untreated Patients (HCV-RNA Results) At Treatment Week 8 Undetectable At Treatment Week 24 Undetectable
RECOMMENDATION Complete three-medicine regimen at TW28.
(HCV-RNA Results) At Treatment Week 8 Detectable At Treatment Week 24 Undetectable RECOMMENDATION
1. Continue all three medicines and finish through TW36; and then
2. Administer peginterferon alfa and ribavirin and finish through
TW48.
Previous Partial Responders or Relapsers
(HCV-RNA Results) At Treatment Week 8 Undetectable At Treatment Week 24 Undetectable RECOMMENDATION
Complete three-medicine regimen at TW36.
(HCV-RNA Results) At Treatment Week 8 Detectable At Treatment Week 24 Undetectable RECOMMENDATION
1. Continue all three medicines and finish through TW36; and then
2. Administer peginterferon alfa and ribavirin and finish through
TW48.
TREATMENT FUTILITY
If the patient has HCV-RNA results greater than or equal to 100 IU/mL at TW12, then discontinue three-medicine regimen.
If the patient has confirmed, detectable HCV-RNA at TW24, then discontinue three-medicine regimen.
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf
Hey there,
I'm doing the boceprevir by choice. I was concerned of the possibility of severe rash. I do swim a lot. My doc got right on board.
As far as labs go, with boceprevir weeks 8 and 12; muy importante. Will be adding third drug soon.
I'm doing the boceprevir by choice. I was concerned of the possibility of severe rash. I do swim a lot. My doc got right on board.
As far as labs go, with boceprevir weeks 8 and 12; muy importante. Will be adding third drug soon.
I have noticed my Doc prescribes the Incivek more frequently, to non-treatment naives, and I bet there may be some literature on that subject.
I was treatment naive, which might be why my Doctor chose Victrelis.
I have rly sensitive skin, so a rash, and butt symptoms would rly be hard on me, I'm really anal retentive, and diarrhea is like my biggest fear.
I tend to eat alot of fat, with the Victrelis also, to coat my stomach.
I keep Half-n-Half (cream) around, if I cant eat food, with the meds, and then the whole milk yogurts. I was on a peanut-butter kick, for calories (I'm not hungry much either on this triple tx) but can no longer stand the site of th P.B.
When I get sick of the yogurt, I drink Kefir. Sometimes I whip the cream up into whipped cream, try to switch it around, etc. Also, an avacado and cheese sandwhich, eggs in the morning, you can do it!
I was treatment naive, which might be why my Doctor chose Victrelis.
I have rly sensitive skin, so a rash, and butt symptoms would rly be hard on me, I'm really anal retentive, and diarrhea is like my biggest fear.
I tend to eat alot of fat, with the Victrelis also, to coat my stomach.
I keep Half-n-Half (cream) around, if I cant eat food, with the meds, and then the whole milk yogurts. I was on a peanut-butter kick, for calories (I'm not hungry much either on this triple tx) but can no longer stand the site of th P.B.
When I get sick of the yogurt, I drink Kefir. Sometimes I whip the cream up into whipped cream, try to switch it around, etc. Also, an avacado and cheese sandwhich, eggs in the morning, you can do it!
i'm gonna start my second round in a couple of months. my hep dr said that he wants me to take Incivek, because he said he feels it is a bit stronger than Victrelis....( sorry but that name reminds me of Vitalis, the hair stuff ).
i don't know how i am gonna deal with the 20g's of fat each day. i barely ate while on SOC.
good luck bill
i don't know how i am gonna deal with the 20g's of fat each day. i barely ate while on SOC.
good luck bill
I treated and now SVR with VIC. For me the burning butt syndrome, rash, and fat intake would keep me far away from the INC..... Good luck with what ever you decide.
I'm just getting treatment from my Doctor, I'm not in a Research Study, although they conduct studies as well, at the clinic I go to.
This is a great article. I glossed over it and like the way they compare/contrast the two PI's.
__________________________________
As far as the VIC goes, I trust my doctor's choice for me but to be honest I am glad I did not have to take the leap of faith required to believe I would be UND after the first few weeks taking solely taking Peg & Riba. It didn't work the first time around at 12 weeks and I just don't feel that lucky.
__________________________________
As far as the VIC goes, I trust my doctor's choice for me but to be honest I am glad I did not have to take the leap of faith required to believe I would be UND after the first few weeks taking solely taking Peg & Riba. It didn't work the first time around at 12 weeks and I just don't feel that lucky.
I'm sure if I had been detectable at my 8 week labs, the Doc would have told me! I see her once a week, and she is a very competant Doctor, who specializes in treating Hep C, she's The Pro!
• Your healthcare provider should do blood tests before you start treatment, at weeks 4, 8, 12, and 24, and at other times as needed during treatment, to see how well the medicines are working and to check for side effects.
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_mg.pdf
"but if I hadn't been UND at 4 weeks, it would be longer on that PI"
Victrelis protocol states you have to be undetctable at week 8 (4 week lead in plus 4 weeks of victrelis) to qualify for 28 wk treatment duration
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf .
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_mg.pdf
"but if I hadn't been UND at 4 weeks, it would be longer on that PI"
Victrelis protocol states you have to be undetctable at week 8 (4 week lead in plus 4 weeks of victrelis) to qualify for 28 wk treatment duration
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf .
Of course, the Doctor may have the 8 week lab, I only asked the nurse, who looked in my chart...sometimes my labs get misplaced at this place, but my Doc would have told me if there was a change in the game plan~
Hmm, strange, because my Doc went by the 4 week UND, and isn't testing me until 12 weeks, now, and same thing with ninjamonkey, who is on Vic as well.
It was kind of hard to add the Boceprevir, after knowing that my body responded so nicely to just the SOC~ as soon as the Vic was introduced, my teeth started to taste so gross. But if the Victrelis will give me the upper edge, in remaining SVR, then I agree that it is needed.
My AST/ALT were also back to normal at 4 week and 8 week blood work, (they had been sky high pre-treatment) will see what my VL is next week is 12 week test.
It was kind of hard to add the Boceprevir, after knowing that my body responded so nicely to just the SOC~ as soon as the Vic was introduced, my teeth started to taste so gross. But if the Victrelis will give me the upper edge, in remaining SVR, then I agree that it is needed.
My AST/ALT were also back to normal at 4 week and 8 week blood work, (they had been sky high pre-treatment) will see what my VL is next week is 12 week test.
I suppose another factor is seeing how a treatment naive person responds, just to the SOC side of things,in the 4 week lead in. But I think I remember you mentioning in another post, that you already treated once before?
Hi Bill ..many factors are usually weighed when doctors and patients alike make this desicion.
Good luck with your treatment..
Will
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02718.x/full
Selecting a paradigm for treatment of HCV
The factors used to select a protease inhibitor include efficacy, the duration of protease inhibitor administration, the total duration of therapy, the adverse event profile and cost. The efficacy of these two agents is summarized in Table 2. For treatment naïve patients, the rates of SVR appear very similar in patients who achieve a RVR (89–96%) and in patients with a delayed virological response who become HCV RNA negative more than 4 weeks after the initiation of the protease inhibitor (64–75%). A similar percentage of treatment naïve patients achieve a RVR (56–60%) and can be treated for a shorter duration. When divided by IL28B status, SVR rates also appear to be quite similar [23, 24]. Response rates are more difficult to compare in the retreatment population because true non-responders were not evaluated in the RESPOND-2 study. However, if one accepts that patients who are IFN insensitive during the lead-in are biologically similar to non-responders [4] than similar rates of SVR are observed during retreatment as well.
Good luck with your treatment..
Will
http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02718.x/full
Selecting a paradigm for treatment of HCV
The factors used to select a protease inhibitor include efficacy, the duration of protease inhibitor administration, the total duration of therapy, the adverse event profile and cost. The efficacy of these two agents is summarized in Table 2. For treatment naïve patients, the rates of SVR appear very similar in patients who achieve a RVR (89–96%) and in patients with a delayed virological response who become HCV RNA negative more than 4 weeks after the initiation of the protease inhibitor (64–75%). A similar percentage of treatment naïve patients achieve a RVR (56–60%) and can be treated for a shorter duration. When divided by IL28B status, SVR rates also appear to be quite similar [23, 24]. Response rates are more difficult to compare in the retreatment population because true non-responders were not evaluated in the RESPOND-2 study. However, if one accepts that patients who are IFN insensitive during the lead-in are biologically similar to non-responders [4] than similar rates of SVR are observed during retreatment as well.
Victrelis protocol states you have to be undetctable at week 8 (4 week lead in plus 4 weeks of victrelis) to qualify for 28 wk treatment duration
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf
Hi Bill200, that is a good question! My Doctor weighs a few things: if a person has cirrhosis, then 12 weeks on a PI (the Incivek dosage time frame) may be easier then the amount of time spent on Victrelis: I had a 4 week lead in with the weekly Inf shot, and daily Riba dose (1200 mgs daily) and then I had a VL test which had me at UND, so I then went on to be sentenced to 24 weeks on Victrelis~ but if I hadn't been UND at 4 weeks, it would be longer on that PI.
I'm at Stage @ Fibrosis, so I seem to be tolerating the Boceprevir well. No rash, no stomach problems, only Boceprevir Breathe...it gives me a bad taste in my mouth.
I have to admit, when I hear the Incivek stories, I am always so glad I am BoceprevirGal!
I'm at Stage @ Fibrosis, so I seem to be tolerating the Boceprevir well. No rash, no stomach problems, only Boceprevir Breathe...it gives me a bad taste in my mouth.
I have to admit, when I hear the Incivek stories, I am always so glad I am BoceprevirGal!
I think doctor preference is a factor. One physician may feel Incivek is more effective or has fewer severe side effects and the other physician may feel Vic is more effective and has fewer side effects. Patient health status and liver status may also play a role in the decision. Patient preference may also play a role.
Another factor is that a person takes Inc. for 12 weeks only whereas a patient has to take Vic much longer ...
"The treatment period is longer with boceprevir. Boceprevir requires a four-week lead-in with pegylated interferon and ribavirin, which lowers the virus level modestly before boceprevir is added for 24 or 32 weeks. Telaprevir therapy is started at the same time as the pegylated interferon and ribavirin and given for 12 weeks as triple therapy. The pegylated interferon and ribavirin are continued for either 12 or 26 weeks thereafter. "
"The costs of the two therapies are similar, provided patients remain on the drugs as long as permitted. The price of telaprevir is $49,200 for the course of treatment, and boceprevir costs between $26,400 and $48,400 for the full course. Those prices do not include the cost of pegylated interferon and ribavirin."
Here is a link to a good article which talks about both of them and does some comparisons:
http://hepatitiscnewdrugs.blogspot.com/2011/08/use-of-new-hcv-protease-inhibitors-not.html
Another factor is that a person takes Inc. for 12 weeks only whereas a patient has to take Vic much longer ...
"The treatment period is longer with boceprevir. Boceprevir requires a four-week lead-in with pegylated interferon and ribavirin, which lowers the virus level modestly before boceprevir is added for 24 or 32 weeks. Telaprevir therapy is started at the same time as the pegylated interferon and ribavirin and given for 12 weeks as triple therapy. The pegylated interferon and ribavirin are continued for either 12 or 26 weeks thereafter. "
"The costs of the two therapies are similar, provided patients remain on the drugs as long as permitted. The price of telaprevir is $49,200 for the course of treatment, and boceprevir costs between $26,400 and $48,400 for the full course. Those prices do not include the cost of pegylated interferon and ribavirin."
Here is a link to a good article which talks about both of them and does some comparisons:
http://hepatitiscnewdrugs.blogspot.com/2011/08/use-of-new-hcv-protease-inhibitors-not.html
How should I take VICTRELIS?
• Take VICTRELIS exactly as your healthcare provider tells you. Your healthcare provider will tell you how much to take and when to take it.
• Take VICTRELIS with food (a meal or light snack).
• VICTRELIS is packaged into single daily-use bottles. Each bottle has your entire day’s worth of medicine. Make sure you are taking the correct amount of medicine each time.
• If you miss a dose of VICTRELIS and it is less than 2 hours before the next dose, the missed dose should be skipped.
• If you miss a dose of VICTRELIS and it is more than 2 hours before the next dose, take the missed dose with food. Take your next dose at your normal time and continue the normal dosing schedule. Do not double the next dose. If you have questions about what to do, call your healthcare provider.
• Your healthcare provider should do blood tests before you start treatment, at weeks 4, 8, 12, and 24, and at other times as needed during treatment, to see how well the medicines are working and to check for side effects.
• If you take too much VICTRELIS, call your healthcare provider or go to the nearest hospital emergency room right away.
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_mg.pdf
The costs of the two therapies are similar, provided patients remain on the drugs as long as permitted. The price of telaprevir is $49,200 for the course of treatment, and boceprevir costs between $26,400 and $48,400 for the full course. Those prices do not include the cost of pegylated interferon and ribavirin.
http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=August+2011&i_id=758&a_id=18855
• Take VICTRELIS exactly as your healthcare provider tells you. Your healthcare provider will tell you how much to take and when to take it.
• Take VICTRELIS with food (a meal or light snack).
• VICTRELIS is packaged into single daily-use bottles. Each bottle has your entire day’s worth of medicine. Make sure you are taking the correct amount of medicine each time.
• If you miss a dose of VICTRELIS and it is less than 2 hours before the next dose, the missed dose should be skipped.
• If you miss a dose of VICTRELIS and it is more than 2 hours before the next dose, take the missed dose with food. Take your next dose at your normal time and continue the normal dosing schedule. Do not double the next dose. If you have questions about what to do, call your healthcare provider.
• Your healthcare provider should do blood tests before you start treatment, at weeks 4, 8, 12, and 24, and at other times as needed during treatment, to see how well the medicines are working and to check for side effects.
• If you take too much VICTRELIS, call your healthcare provider or go to the nearest hospital emergency room right away.
http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_mg.pdf
The costs of the two therapies are similar, provided patients remain on the drugs as long as permitted. The price of telaprevir is $49,200 for the course of treatment, and boceprevir costs between $26,400 and $48,400 for the full course. Those prices do not include the cost of pegylated interferon and ribavirin.
http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=August+2011&i_id=758&a_id=18855
No, Vic doesn't have to be taken with all that disgusting fat the Incivek does. The more I read about Vic I am wondering why it is not prescribed more often. Vic was $1,500/month with my Insurance company and the Incivek was close to $15,000!! The two PI's have a lot in common. Maybe one of our resident experts can weigh in.
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