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Post Info TOPIC: Harvoni vs Epclusa or Mavyret usage rates and follow up testing


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RE: Harvoni vs Epclusa or Mavyret usage rates and follow up testing
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our doc has us on the 6 months forever plan for ultrasound and maybe viral load and afp marker.

all my labs are only $10. copay per visit, so i'll get what ever else i need at one of the visits too. and the U/S = $40.

my ins will only do harvi unless it's a retreat, so i'm planning on this being the magic bullet for good.



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GT1a for 36yrs .Started Intron-A in 96' for 2.5mo-VL still too high.taken off.

3.6.18:Alpha 2-Macroglobulins, Qn=400/high. A1 activity.  f3@60: fibrosur bloodtst. TumrMrk=norm. enz=mostly norm.VL=3,933,000 

.sot=5.1.18>Harvoni>[8wks]: 4WEEKS=UND. 



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Hello lamassu

Sounds like from what you say, you are being treated by a knowlegable physician following the guidelines for your follow-up.Possibly he/she just didn't mention it ,however an ultrasound is also recommended on an ongoing basis when the AFP marker is done (given the F3 fibrosis,just to keep an eye on any possible structual change).

Also,as you mention many Physicians are doing the EOT 12 VL and then calling it a day,However there are many others that given the study done a couple of years ago (linked below)that still want to do the EOT 24VL.

They found that of 3004 patients treated that there were 12 that had VL show up between WK. 12 and 24. They deemed that 7 of these turned out to be Re-infections,however that 5 were relapses. Very small number ,however it may be something you personally would want to chat with your physician about.

Good luck the rest of the journey.

https://www.ncbi.nlm.nih.gov/pubmed/27737953



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I had an interesting chat with my hepatologist today on follow up after ending Epclusa treatment 9 days ago. He said the fatigue I had during treatment with Epclusa generally affects his older patients but there are exceptions. He also told me to consider myself cured until proven otherwise. If relapse occurs it usually happens at EOT + 4 to 5 weeks but there is no need for another viral load until 12 weeks post treatment.

He says the DAA field is changing fast and if the Hep C virus is still undetectable by Hep C RNA Quant RT-PCR at EOT + 12 weeks he no longer routinely checks viral load 6 months post-treatment.

He did emphasize the increased risk for liver cancer and recommends regular AFB tumor marker testing, also an occasional upper gastrointestinal endoscopy to check for esophageal varices for older patients like me who were F3 on FibroScan.

He mainly prescribes Epclusa and Mavyret now. Occasionally Harvoni for genotype 1 if insurance mandates. Vosevi for salvage treatment only. At $26,400 for 8 weeks of treatment in the US patients without insurance now have a (relatively) affordable option. In my case my Medicare advantage plan covered 12 weeks of Epclusa (but not Mavyret) so my co-pay was $6100.

Edit: @willbb was right I just forgot to mention regular ultrasounds were advised. Will find out the intervals on my next visit to my dr in three months after the 12 week viral load results.



-- Edited by lamassu on Saturday 9th of June 2018 03:39:01 PM

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Male, 65, Dx 1990, GT 2a/2c. Pre-treatment VL 11,500,000, ALT 10, AST 18, Fibroscan F3, 12.4 kPa. Rx 12 weeks Epclusa, SOT Mar 8, 2018, EOT May 30, 2018. Week 2 VL 50, ALT 12, AST 21. Week 10 VL not detected, ALT 12, AST 18.

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