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?

[copyman]

your voting is not clear. the new drugs will be in addition to peg/riba. the way your poll looks is like it will be taken alone. Just wanted to clarify for any newbies that might stumble across this.

my vote would be to add telaprevir to the present drugs. telaprevir offers a shorter course (6 months) of therapy instead of 1 yr

[jusjames]

6 months is for naive customers only though , i think ?

[jusjames]

is Bocep for 12 wks as well , or is it in the mix for the whole duration ?

[CU97]

thanks for the clarification. I believe 6 month is only for naive. To jusjames, I think bocep is 24 weeks at least.

[nygirl7]

You mean hopefully if/when the new drugs are approved....some of us thought they would be approved years ago already. So it really depends where you stand as to liver damage and if you do have time to wait and see if they pan out.

[eureka254]

I remember this time last year thinking it might be available by next month... but some people are talking about it being still a year out or more. For my husband who's still treating, (with cirrhosis and HCC) if time is on his side, it will be to add either one as soon as one becomes available -- in his case, it'll be whichever comes to market first.

[CU97]

Both Vertex and Merck have said they will apply for marketing approval by year-end and if they get the priority review (6 months), I am optismistic that at least one drug should hit the market by June, 2011 when your husband can start treatment.

[susan400]

For me, it's Boceprevir, but all of it depends on whether or not I have any money to pay for it, or any insurance that will be willing to cover it, or any indigent drug company coverage.  No way to pay..., then, no Bocep for me..

Susan400

[Bali05]

as a geno 4 I am thinking of Telaprevir as a back up plan.
but it would be "off label" for geno 4 as discussed with my Hep
and based on C210 study

It all depends on your individual situation

Still not that happy about the possibility of ending up with some very resistant strain
if Tela does not work. Someting you don`t have with straight SOC.
With minimal liver damage and other positive predictors such as IL28b being CC I am not
sure if I would`nt give straight SOC a  try first and keep Tela/Boc. for back up.
Most people now eagerly awaiting release of new meds failed SOC previously
It surely gets more complicated once those drugs are a reality.

[CU97]

thanks to all who voted.  But I can not see the results somehow. Does anyone see it?

[Trinity4]

16%  stick to peg/riba
41%  (10) telaprevir
41%  (10) boceprevir

[jusjames]

but bali you are on tx already , so why redo SOC if you relapse which is so unlikely as the success for g4 is good roughly the same as G3 ,

[newleaf10]

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.

[Magnum]

Dr.  Robert Gish, the renowned Hepatologist / Liver Transplant Director has evaluated me and sent me a complete analysis. He is well aware of both Telaprevir and Boceprevir. In his opinion (I have early Cirrhosis), he feels the best route would be Telaprevir. His direct quote:

"Telaprevir would be my primary choice in his care and management, due to my current interpretations".

So there it is...

Magnum

[Trinity4]

"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."

As usual, I do not understand where you get your information from.  RVR with SOC does NOT guarantee SVR.  I have seen those on this forum who have failed SOC with RVR.  You are giving people the wrong impression with no clinical data to back your statements which may discourage them from use of a protease inhibitor.   That is dangerous.

Trinity  

[newleaf10]

What do you mean as usual?  I used to post on the forum back when I was sick and then getting over chemo but I don't think you were on the forum then.  I guess you just like objecting to the posts of people who don't share your own opinions.  It really is okay for forum members to be exposed to the opinions of others.  Try not to worry so much.

[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.  

[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]

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.  
.

[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.

[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.

[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

[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.

[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.