Dec 26, 2013
My husband saw his hepatologist for a routine follow up (labs, imaging, check up) earlier this month on 12/5/13. His Ultrasound results were stable (no change, normal size, benign cyst unchanged, no sign of ascites, no sign of liver cancer). Kidney function is good. White count is good. INR=1, Alb=3.6, Bili is good. She gave him a MELD score of 6, which is about where it's been for the past five years. Since he has Hep C and Cirrhosis, and has previously treated and failed 3 times (2007=Interferon and Ribavirin; 2010=Consensus Interferon and 1400 mg Ribavirin; 2012=Triple Tx with Incivek), the newly approved treatment meds are not for him. She discussed the possibility of treating him with sofosbuvir, ribavirin, and interferon "off label", but with his recent diagnosis of serous retinopathy, there could be risk to treat with interferon again. She also discussed the possibility of combining simeprevir and sofosbuvir, which would again be an "off label" treatment and would require special consideration for prior treatment failures with higher risk factors. She seemed to feel that the best option might be to wait for sofosbuvir and ledipasvir combined with ribavirin, which she hopes will be approved about December, 2014. In the meantime, his liver is still well compensated. she will see him again in June, 2014, for another ultrasound, lab work, and ultrasound. He is still on the UW's study radar to be called if any appropriate clinical studies come up in our area. In the meantime, she is in communication with his retina specialist to see if he would advise or advise against another interferon based treatment (e.g. sofosbuvir, ribavirin, and interferon "off label") given his retinopathy. If he advises against, then I think she plans to request special permission to consider treating with simeprevir and sofosbuvir "off label", but if she doesn't feel that will benefit him, if I'm understanding correctly, she will wait until sofosbuvir combined with ledipasvir is approved end of 2014.