Anybody have a miracle stuck in their back pocket?

[susan400]

I have been feeling sort of down because of the prospects for me clearing this virus are dwindling up.  Yes, I know, that I'm far from hopeless and that there's still time, and blah, blah, blah.   But, I've basically been told that I can't do any of the protease inhibitors.  I was thinking about trying to get into the Boceprevir trials, but I've been told, flat out, nobody will take me into a protease inhibitor trial because of my having been exposed to the Telaprevir in the Prove 3.  I'm like, 'Oh terrific, so I'm like scr*wed?'   Schering has told me this, the former trial nurse at my last study site has told me this.  Whenever I inquire about the possibility of any other non-responder trials, nobody has anything available to me.  I suppose that there is always hope that eventually there will be a polymerase non-responder trial, but whether or not that they will take me, is debatable.  Waiting for a couple of years for one of these new drugs to be FDA approved really doesn't help me much because I have no prescription drug insurance, so I wouldn't be able to pay for them.  So, I'm left with, do I just hope and pray that I progress none?  Since I've had bridging fibrosis for 7 years, is that even likely?  I am praying for a miracle because nothing I have tried has worked.  I'm not trying to make anybody feel bad, or to just be a negative old grouch, but I'm really feeling down about this.  I don't understand why I have been unable to clear!  

Susan400

[dointime]

New Study – 3 Antivirals, No Interferon:

Roche, InterMune, Inc, and Pharmasset jointly announced on November 10 a new study called INFORM-1 to evaluate the safety and antiviral activity of three antivirals – R7227 (ITMN-191) an HCV protease inhibitor, R7128 an HCV polymerase inhibitor and ribavirin.

This will be the first clinical trial combining three antiviral medications without the use of interferon as a possible treatment of hepatitis C.    

The study will evaluate the three antiviral medications in HCV genotype 1 treatment-naïve patients.  The clinical study will be conducted in Australia and New Zealand.  Hopefully, this first of its kind study for treating hepatitis C will usher in a new era that will include many combinations of antivirals to treat hepatitis C, and which may ultimately lead to therapies that do not contain interferon or ribavirin.

[dointime]

"It seems crucial to have some response to interferon in order to get well no matter what mixture your using"

Actually this is not necessarily true for the future, although it is propbably true for the next few years.  There is debate going on that it might be enough to reach SVR if it were possible to just stop viral replication 100% for enough time.  This should eventually become possible with a mixture of antivirals such as is used for HIV, or maybe a microRNA, without either interferon or ribavirin.

I don't want to give anybody false hope here as this option is probably about 10 years down the road, but I'm just trying to keep the door open for interferon non-responders.

I do agree that everybody should be checked for insulin resistance just in case as that does seem to play quite a large role in non-response.  Comeagain, do you think you could get the test done elsewhere?  

Just for the record, Susan I think you are a partial responder seeing as you do get a reduction in your VL, just not all the way to UND.  So if I were you I'd wait for 2 potent direct antivirals to become available, add alinia and double dose peginf. with the normal riba - and rescue drugs if needed.  I reckon that lot will kick viral @ss for you.

Dointime
        

[comeagain]

I think we all must try to remember when talking about new meds polymerase protease inhibitors etc. non of this work without soc and not everyone gets SVR on them and soc either.

It seems crucial to have some response to interferon in order to get well no matter what mixture your using

And since you have tryed so many times whether you gonna try polymeras in future or not, my guts tells me this IR question is real important for everyone that is about to treat on new drugs or  just soc and especially for us relapsers.

And we must realise that its not that few persons that have had a relapse and in my opinion  to go through with this tx even if it was 100% SVR  warrrantie is tuff as hell for a lot of us anyhow , and then knowing its a big chance you wont even make it.

Still go through with it, is  in my opinion the ultimate tribulation, thats why Susan what you have done is for me almust unbelievable, maybe its only Andiamo and a few others who have a clue to what youvé been facing , but i´m sure everyone with a heart in their body wants you to clear .

And to get your docs to do this does not seem easy I asked my NP to ask my doc if he could run such a test for me ( see if I was IR) , and his answer to that was its only fat people that needs to do that.

ca

[meki]

I don't have a miracle---- but I do have HOPE --- and a HUGE HUG!

HUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGGGGGGGGGGGG!!!!!!!!!


Love you!

Meki

[CoWriter]

"Off of treatment it's been running around 105 to 111, but no higher."  

"Since I'm not considered diabetic by my doctor, I really don't think that he'd put me on diabetic Type II sort of medicines."
-----------------------------

Let me explain something to you.....

What DECREASES INSULIN RESISTANCE???

1.  Exercise.
2.  Gradual weight loss if you're obese. (quick weight loss can cause insulin resistance)
3.  Getting rid of the Hepatitis C virus.
4.  Medications like Metformin, Avandia and Actos

(Sometimes weight and exercise alone are not enough to decrease insulin resistance because the Hep C virus keeps causing it)

Medications like Metformin (or Avandia) decrease insulin resistance......they're "insulin sensitizers".  In other words, they help make the cells in your body more sensitive to insulin. BUT they DO NOT make the pancreas produce more insulin, so they won't make your blood sugar come down 20 points of whatever.  They don't do that.

On the other hand, medications like Glyburide or Glipizide (called sulfanylureas) stimulate the pancreas to produce more insulin.  That's the kind of medications that will make your blood sugar come down.  When you take that kind of medication, you are told to always carry sugar with you in case your blood sugar goes down too low.

When you use Metformin you don't have to carry sugar with you because it will NOT  cause your sugar to go down too low.  


Let me explain to you what Metformin and Avandia do....

When you eat a meal, the food goes from the mouth to the stomach where it turns into liquid sugar. From the stomach and intestines, the sugar is quickly absorbed into the blood.

****Metformin helps by making the sugar slow down a little so it's not absorbed into the blood so fast.


When the sugar goes inside the muscle cells....the muscles use the sugar as energy.

****Metformin helps the muscles use the sugar a little faster.


During the night, the liver gives you a bunch of sugar.  (This is the biggest problem for anybody with Hepatitis C.  The Hep C virus causes large amounts of sugar to be disgorged from the liver).

****Metformin tells the liver not to give you so much.


So Metformin helps....but it doesn't make the pancreas produce more insulin. So it's not going to make the blood sugar come down 50 or 60 points. It doesn't do that.

Think of it this way......

If insulin is like keys....and some of those keys get rusty and don't work.....then Metformin is like oil you put on the key holes so the keys work better.

And if you can do that....if you can decrease the insulin resistance, then your chances of SVR with SOC will increase.

Because starting treatment with a fasting blood sugar of 105-111 is like defeating yourself before you even start.  

You asked for an answer as to why you've failed tx so many times and CS gave it to you.  What you do with it is up to you.

It would be hard to convince your doctor...yes, I'm sure it would.

Co


Sources:

"Insulin-Resistance in Chronic Hepatitis C patients: New Predictor of Sustained Virological Response Independent of HCV Genotype and Liver Fibrosis Stage."

http://aasld.scientificposters.com/epsAbstract.cfm?id=37

"Insulin resistance and hepatitis C."

http://www.ncbi.nlm.nih.gov/pubmed/1713 ... d_RVDocSum

"Insulin Resistance and Hyperinsulinemia. Is hyperinsulinemia the cart or the horse? "

http://care.diabetesjournals.org/cgi/co ... type=HWCIT

"Hepatitis C and insulin resistance: steatosis, fibrosis and non-response."

http://scielo.isciii.es/scielo.php?pid= ... ci_arttext

"Incidence of type 2 diabetes mellitus and glucose abnormalities in patients with chronic hepatitis C infection by response to treatment: results of a cohort study."

http://www.ncbi.nlm.nih.gov/pubmed/1870 ... d_RVDocSum

"Hepatitis C virus infection enhances insulin resistance induced by visceral fat accumulation."

http://aasld.scientificposters.com/epsAbstract.cfm?id=6

"Steatosis, Insulin resistance, Iron overload, Fibrosis and Viral load as negative factors affecting Early (EVR) and Sustained (SVR) Virological Response in patients with Chronic Hepatitis C treated with peginterferon and ribavirin"

http://aasld.scientificposters.com/epsAbstract.cfm?id=36

"Therapies to Manage Insulin Resistance Improve Response to Interferon-based Therapy in Chronic Hepatitis C Patients."

http://www.hivandhepatitis.com/2008icr/aasld/docs/112108_a.html

"Viral Kinetic Response to 12 Week Treatment with Rosiglitazone (Avandia) in Chronic Hepatitis C, Genotype 1 Patients Who Are Previous Relapsers or Nonresponders to Pegylated Interferon and Ribavirin."

http://aasld.scientificposters.com/epsAbstract.cfm?id=3

"In Chronic Hepatitis C (HCV), Pretreatment with Thiazolidinediones (TZDs) or Metformin Decreases Insulin Resistance (IR) and HCV Viral Load and Increases Early Virologic Response (EVR)."

http://aasld.scientificposters.com/epsAbstract.cfm?id=5

[merryBe]

hey, this miracle just showed up in sweden, check it out:

http://www.medhelp.org/posts/show/699038