telaprevir or boceprevir?

[CU97]

When the new drugs (telaprevir and boceprevir) become available next year, would you get them immediately and which drug would you use? How should people decide? or simply heed the doctor's recommendation?

[spityface]

i have hep c stage f2 and have the virus for a minimum of 40 years. I have had no treatment (my choice) and am doing well. Now I have been diagnosed with lymphoma low grade b cell and am not sure if i want to do chemo as the risk of liver toxicity is so high. anyone have experienced this catch 22 situation>

[B666]

I don't think Telapravir (or Boceprevir) will be out for a while. I contacted Vertex for the last three years and each time it was later this year or next year. It still isn't out yet. I wouldn't expect it for another three years. I hope I'm wrong.

If I had the choice, I'd rather add a polymerase inhibitor to the mix also. http://www.clinicaltrials.gov/ct2/show/study/NCT00987337?term=polymerase+inhibitor&rank=10#locn

[Magnum]

Your quote "So, out of the 2, it's a no-brainer for me.  I'll take the risk of anemia + Boceprevir..., if I'm able to even get it".

Spoke with my Gastro today and I ran the info I received on the fact that Telaprevir being proposed on a fast-track to the FDA, will most likely be released before Boce. His thought was to treat with whichever comes out first.

I was pleasantly surprised from my last blood work that all the numbers went down to the lowest in two years, AST, ALT, MELD and Alpha Fetaprotein. Whatever caused it, the doc said to continue doing it.

For those interested, this is my regiment daily: One glass of pure grapefruit juice, 2000iu Vitamin D3, 1000mg Milk Thistle, 1000mg Wild Alaskan Salmon Fish Oil with Omega3, Alpha Lipoic Acid (three times weekly at 100mg each capsule), Multi Vitamin (no iron).

He specifically said it’s very important to keep one’s weight down...

Susan, in my case I will probably go along with you and wait a little longer for Boce, since through 4 failed treatments I never had the Anemia problem. Then again, I never had rash either. Decisions, decisions, decisions... Stay tuned...

Magnum  

[nygirl7]

Totally an argument against watching and waiting too long. I consider myself very lucky.

[willing]

thanks for posting that - thoroughly depressing but good to know about. I had never seen  results showing such a strong effect ( 80% relapse, 10% SVR rates ) those look almost too bad to be believable...

[willing]

good to see your posts again. And yes, I think you're quite right. As things stand, high ifn sensitivity as reflected in soc RVR  (odds of SVR mid 80s and above) trumps overall naive tx averages for both 1st gen PIs (mid 70s ). Particularly in countries (Canada, EU ) that need to make across the board cost-benefit decisions, it seems hard to justify the added cost and risk of a PI  when one's outlook is already so strong.  It'll be interesting to see whether inscos in the US also try to limit access to those who RVR by the end of lead-in.  On the other hand, if your are a SOC RVR and add a PI it seems likely your odds will improve further, particularly if you are mulling using the RVR as basis for reduced tx length.

[Cory255]

" If you clear in the first 4 weeks of TX, you are responsive to interferon and do not need to add a PI with all its extra side effects and risks. "

I diagree, and I think that's a bad idea.  RVR simply increases your odds of success, just because you respond to interferon that does not mean you do not NEED TO ADD A PI.  It simply means you responded to interferon and your odds of successs are increased.  Triple therapy is better and increases your odds to give you the best shot at treating.

[mikesimon]

I think they'll both use a lead in - in time.

[CU97]

I believe both boceprevir and telaprevir are effective treatments based on the data we have seen so far. Ultimately, it may come down to which side effect you are willing to tolerate, rash for telaprevir or anemia for boceprevir?

With regard to whether you need a PI or not, my advice is to take a IL28 test.  If you are the CC genotype, you may not need a PI to achieve SVR. If you are not, the addition of a PI can certainly help.  I think the IL28 test is actually commercially available from the Lab Corp now.

[Trish77]

Foo, thank you for posting that.  Those are some significant results.  It revives the fight I've had to set aside for awhile that funding to repeat treatment is worth providing here in Canada and that funding for early stage treatment is worth providing.  They make you fight for it if you are early stage liver damage.  Imagine that.  Thank you again for posting that.  

Trish

[Trish77]

Telaprevir's rash has always concerned me.  Boceprevir's side effects seem less debilitating than Telaprevir's rash.  I do understand that the rash is treatable however I also understand that the rash is far from fun and I think I might want to go to Boceprevir to avoid that.  

Comments from those who have been through Telaprevir and dealt with that?

[Trish77]

Newleaf:  "Of course this depends upon whether you actually need a protease inhibitor to clear the virus.  I vote for boceprevir since it has a 4 week lead-in before starting the PI.  If you clear in the first 4 weeks of TX, you are responsive to interferon and do not need to add a PI with all its extra side effects and risks."

I think it's inaccurate to say that you have NO need of a PI.  There is not 100% SVR with an RVR.  Certainly it raises odds considerably however it's, well, irresponsible... to those in the smaller percentages who don't clear even with RVR to say that it means no PI is needed.  What it does mean is that you have a greater shot at SVR without a PI than someone who does not have RVR and without a PI.  

There is also the variable that RVR is only 4 weeks into treatment.  Anything can happen along the way that interferes with dosage adherence.  You can have RVR but be hit hard with side effects or low HGB or ANC and be hit with dosage reductions or outright withdrawal from treatment.  It can happen.  RVR is not home free.  It's only one milestone along the way albeit a significant one.

If I were treating when PI's become available, I would do a PI even with an RVR to make sure as much as possible that this is a one-time shot.  If you had financial / insurance issues or some situation that made a PI difficult to obtain, then an RVR is a comfort in that case.  However, I would strive to include the PI in the same way that I would add Alinia or whatever I could to hedge myself as close to that SVR as I could.

Trish

[Magnum]

Where are we going?

magnum

[spectda]

Here we go again!

[Scottieeee]

Well Im a hep c 2b surviver. I went to the chinese medicine first and and reduced my viral levels from 3,200,000 to  420,000. Then took interferon and riboviron for 6mths. I was just tested again and still clean today 10 years laters. I do believe that if you can reduce your viral load first before using any of these drugs you stand a far better chance of getting rid of this terrible virus. I also had a neighbor that had hep c 1a and is still clean today using the same theropy I used. Just some helpful hints    Scott Miller ***@****

[Trinity4]

Good luck with biopsy next week Brent.  Please keep us posted.

I'll be having one done in November myself.

Here's hoping that long treatment we did has kept the fibrosis chaos at bay.

Trin

[foofighter]

http://www.natap.org/2010/HCV/080610_02.htm

RVR ppv stats from the Chariot study:

A marked step-wise decline in SVR was evident by fibrosis stage: F0 (70%); F1 (60%); F2 (51%); F3 (31%); F4 (10%) (p<0.0001).

Early virological responses were lower among F3/4 patients, including rapid virological response (RVR) (21% vs. 34% for F3/4 and F0-2, respectively) (p=0.0072), and the RVR positive predictive value was also lower (63% vs. 80%).

Virological relapse rates were similar in early disease stages (F0, 16%; F1, 23%; F2, 26%), but increased markedly in advanced fibrosis (F3, 50%; F4, 80%) (p<0.0001). Cumulative PEG-IFNα-2a and ribavirin doses were similar among patients with F3/4 and F0-2 within treatment arms through week 4, 8, 12, and week 24.

[IAmTheWalrus]

I think it has to be decided case-by-case. Your voting options show no choice for making the most appropriate decision for the case. In my case, if my biopsy next week still shows no fibrosis, I MIGHT wait longer even though Telaprevir of Bocepravir become available. If the biopsy shows progression of fibrosis, I believe I will treat as soon as I can on one or the other.

[susan400]

If for some reason, I'm unable to get Boceprevir, I won't treat w/Telaprevir.  I'll just have to sit around and wait for some else to come along.   For one thing, as I've said before, I had the severe rash after only 2 wks on Telaprevir and my doctor and I both agree that is an indicator that I would have a problem with it, since it came on so strongly so early on.  There is a slight risk with Stevens-Johnson syndrome w/the Telaprevir rash and it's one I'm not willing to take since I already would have the resistance issues to deal with on top of it.  So, out of the 2, it's a no-brainer for me.  I'll take the risk of anemia + Boceprevir..., if I'm able to even get it.

Susan400

[nygirl7]

Back to the original question since we all know that RVR does not necessarily mean SVR anyway...........if Telapravir comes out first, as expected, I believe that most doctors are going to go this route (I read an article which I will try to find again with the question asked of the doctors and the overwhelming majority said Tela vs. Boce) and that will vastly limit the option of people to take Boce whether they prefer it or not.  You know how doctors are about this stuff and they will use whatever their practice uses that is tied in with the hospital they are under.

Certainly with the great increase in the rate of success with these new drugs if I had the choice I would add one without doubt. But we didn't have the choice back then and many of us ended up having to extend treatment or retreat or are waiting for them to come out to retreat - why go through that if you do not need to?

Less time better odds yes I am on board with that 100% as it can also help cut down on the problems that some of us developed due to the extensions and retreatments.

[child24angel]

"If you clear in the first 4 weeks of TX, you are responsive to interferon and do not need to add a PI with all its extra side effects and risks


For all those who are eagerly waiting to treat with
Teleprevir or Boceprevir, I would not make such a bold statement.

Give it your best shot...RVR or not, especially non
responders. I would suggest to use the newer PI's ....RVR or not.
(just my opinion)

Some people who have reached RVR at week four have relapsed
at the end of TX with standard SOC.

[Trinity4]

Oh please, we all know RVR increases the odds of SVR, I do not deny that and to provide a study it pointless because that is not what I  questioned.  We also all know it does not ensure SVR.  It is a fact of life with HCV and treatment that RVR is not a guarantee of SVR which is why I point out .  RVR doesn't mean pastel colors and fairy dust and people need the FACTS not incorrect information when they read something as dangerous as the comment you made below.

"If you clear in the first 4 weeks of TX, you are responsive to interferon and do not need to add a PI with all its extra side effects and risks."

You boldly state if a person clears in 4 weeks they DO NOT NEED to add a PI.  What do you base this on?  There is no mention of an opinion, you're just flat out telling them to forget about adding the PI so it's YOU who need to provide a link to a study that supports that statement.  
.

[newleaf10]

Why would you choose to point out the unusual occurrence of a patient achieving rapid virus response and NOT achieving SVR?  It happens but that is uncommon.  RVR is one of the best predictors of a positive response to treatment (SVR). There were at least 4 very highly regarded studies that presented the information.

If you have a link to a study that says otherwise, please post it.  

[Trinity4]

My statement was not an opinion, it was fact based unlike yours.  Contraire,  I don't worry because I'm quite confident I provide correct information which can help people make the best decision about moving forward due to having solid facts, not just an opinion.