and by the way my friend was UND as soon as he started Olysio, so good try at the end
Isiscat2011 said
Sep 12, 2014
Dzdayscomin wrote:
Isiscat
I would think you would be fine going with the new Doc as I'm sure there are other docs in the group that are there to advise and guide. After all it's not the doc it's the meds that do the job.
On another note to this I switched my primary care doc to a whole different clinic and have a young doc that specializes in adults with chronic illness and he has been spectacular, they are very proactive and the knowledge is very recent to them as opposed to someone that is getting old and tired of work just like we all do in our jobs.....for me it was an excellent switch and very refreshing to have the upbeat vigor and willingness to listen to the experience that only patients can provide.
They view us as great resources to advance in their knowledge of the disease and tx of them, so in my case its a win win situation.
I'm sure you are right, Duane. I actually like the young one very much and was planning to stick with her. I started second guessing my decision after another doc told me that he would choose the nationally renowned guy, hands down, even if it meant waiting a while longer.
The young have the energy and passion while the old have the experience and wisdom. Both can be effective.
I am a firm believe that the right doc counts even with good tx drugs. The doc can make the difference in whether or not tx is extended, for example, if that is indicated. Certainly if things take a nose dive the right (or wrong) doc can affect the outcome. I'd actually be comfortable treating with any of the docs at either liver center because collectively both have an incredible amount of HCV experience.
The first doc isn't even set up in his new digs yet and I'm not planning to wait. I want to get this show on the road!!
Isiscat2011 said
Sep 12, 2014
Thank you, Gary. Results depend on the DAAs used and the individual. Adding a 3rd DAA will be necessary for some but not for most using the S/L or S/D combo. And, adding a 3rd will not guarantee SVR for everyone either.
Also, using 3 DAAs that all have low barriers to RAVs would not necessarily produce better results. The question is how to know who will respond best to which DAAs and there are no definite rules at this point. In the future we will see more individualized tx plans but we aren't there yet.
If it was "impossible" for the virus to survive when 3 DAAs are used then nobody would have ever relapsed on a 3 DAA combo, and clearly many people have, as demonstrated by clinical trials.
Dzdayscomin said
Sep 12, 2014
Isiscat2011 wrote:
Matt Chris wrote:
BTW, Isiscat have you thought about what (DAA's) approach you will be selecting?
I'm planning on starting the S/L combo in October. Haven't discussed using a third yet.
Unfortunately, the amazing Hepatologist who was my doc has left to join another liver center, so my new doc is a young physician who completed her hepatology fellowship under him. Another doc I know recommended that I follow the first doc to his new location, but this would delay tx by at least a couple of months, so I may 6 continue with the less experienced doc. What do you think? What are your plans, Matt?
Isiscat
I would think you would be fine going with the new Doc as I'm sure there are other docs in the group that are there to advise and guide. After all it's not the doc it's the meds that do the job.
On another note to this I switched my primary care doc to a whole different clinic and have a young doc that specializes in adults with chronic illness and he has been spectacular, they are very proactive and the knowledge is very recent to them as opposed to someone that is getting old and tired of work just like we all do in our jobs.....for me it was an excellent switch and very refreshing to have the upbeat vigor and willingness to listen to the experience that only patients can provide.
They view us as great resources to advance in their knowledge of the disease and tx of them, so in my case its a win win situation.
BigPharma said
Sep 12, 2014
Matt,
thanks for also supporting the idea adding simeprevir. Moreover all 3 DAAs were tried together in pairs and showed good results.
As one of my friend's doc said virus in triple therapy will need to jump 3 fences which will be impossible for the virus because it is almost impossible to jump 2 fences for the virus already
I wish to all here to get this DAAs very soon and to be cured once and for all.
Good luck Matt, good luck Isiscat in your upcoming therapy very soon.
Gary
Matt Chris said
Sep 12, 2014
Isiscat2011 wrote:
I'm planning on starting the S/L combo in October. Haven't discussed using a third yet.
I'm with you on the S/L combo its the best choice for GT1's with or without cirrhosis. My Dr. did recommend Ribavirin as well for the whole 24 weeks. He said that its helps with RAV's suppression and many other benefits for cirrhotics. I am also investigating Abbvie's new re-treatment protocol that will be coming out as well, so in the next two months we should be in treatment if all goes well. This last six months has been a long wait, as I can well imagine you have felt the same way.
matt
Isiscat2011 said
Sep 12, 2014
Matt Chris wrote:
BTW, Isiscat have you thought about what (DAA's) approach you will be selecting?
I'm planning on starting the S/L combo in October. Haven't discussed using a third yet.
Unfortunately, the amazing Hepatologist who was my doc has left to join another liver center, so my new doc is a young physician who completed her hepatology fellowship under him. Another doc I know recommended that I follow the first doc to his new location, but this would delay tx by at least a couple of months, so I may just continue with the less experienced doc. What do you think? What are your plans, Matt?
Matt Chris said
Sep 12, 2014
Hey Isiscat
I believe your first suspicion is correct regarding Gary, he is not in the USA.
After all this time most HCV Doctors and research is in agreement that a multiple DAA approach to treatment is better because of the ability to control Rav's during treatment.
BTW, Isiscat have you thought about what (DAA's) approach you will be selecting?
matt
-- Edited by Matt Chris on Friday 12th of September 2014 04:48:09 PM
Isiscat2011 said
Sep 12, 2014
BigPharma wrote:
my friend received "go ahead" from 2 diffrent doctors
What does this mean? US docs cannot prescribe daclatasvir. If this is a clinical trial the trial protocol dictates what participants receive.
BigPharma said
Sep 12, 2014
no more comments?
my friend received "go ahead" from 2 diffrent doctors
Isiscat2011 said
Sep 11, 2014
Daclatasvir is not FDA approved so it can only be used in the US in clinical trials. I am assuming you and your friend are either not in the US or you are participants in a clinical trial. In clinical trials the parameters for what drugs are used are already established. They won't add another DAA mid treatment just because he asks for it.
There are a number of combos using 3 DAAs but I am unaware of any studies utilizing the three you mentioned together: Sovaldi/Declatasvir/Olysio. That doesn't mean this trio is not being tested somewhere but I have not read of any such trial or trial results.
A physician would be unable to prescribe this trio -- even off label --at least in the US.
In summary, what you are suggesting cannot be done at this time.
BigPharma said
Sep 11, 2014
Hello friends,
I was reading somewhere (may be here on this forum) that someone did a therapy with sofosbuvir & daclatasvir or sofosbuvir & simeprevir.(I dont remember exactly)
He/She had very low VL on week 4 ( less than 15 IU) . But the problem was he/she had the same VL on week 6 ( less than 15 IU) and on week 8 (less than 15 IU)!
So decline has stopped and he/she was not achieving UND!
And his/her doctor decided to add third inhibitor simeprevir or daclatasvir to the therapy (I don't remember which depending on his protocol) and after that at week 9 he finally got UND! I might be wrong with numbers a bit , but the idea is the same: adding third inhibitor if decline stopped.
The reason I am asking my friend is doing the same therapy as me with daclatasvir and sofosbuvir and he achieved UND at week 4 with test sensitivity 60 IU, but he made another RNA test on the same day with sensitivity 10 IU and it showed detected. It continued on week 5 detected ( 10 IU) and at 6 week ( 10 IU) so decline stopped. He is desperate to add third inhibitor simeprevir and go with this for the remaining 6 weeks .
I blame myself that I did not save the link and the only way now to ask you your opinion on it or maybe you have some references, because I want to show it to my fellow traveller in the therapy. In fact threre are some trials with three inhibitors and it showed good results with shorter duration of treatment.
What do you think about it ? May be some references , some thoughts about the idea ?
To be more specific about my friend's results:
week 0 : 1,800,000 IU; 1B; TG/CT
week 1: 1,300 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg)
week 2: 410 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg)
week 3: <100 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg)
week 4: <60 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg)
week 5: <25 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg)
week 6: <25 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg)
week 7: <25 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg + Simeprevir 150 mg) adding Simeprevir 150 mg
week 8: <25 IU (Sofosbuvir 400 mg + Daclatasvir 60 mg + Simeprevir 150 mg)
week 9: UND (Sofosbuvir 400 mg + Daclatasvir 60 mg + Simeprevir 150 mg)
week 10: UND ( Daclatasvir 60 mg + Simeprevir 150 mg + Ribavirin 1000 mg) omiting Sofosbuvir adding Ribavirin
week 11: UND (Daclatasvir 60 mg + Simeprevir 150 mg + Ribavirin 1000 mg )
13 week ( Daclatasvir 60 mg + Simeprevir 150 mg + Ribavirin 1000 mg) - omitting sofosbuvir from week 10 due to cerebrovascular side effects
... still on therapy ,doctor decided to go 24 weeks, but so far on scheme : DAC + SIM + RIB
This topic might be helpful for those who cannot achive UND on double therapy after 4 weeks and VL is still really low but doesn't move
-- Edited by BigPharma on Thursday 23rd of October 2014 08:14:54 AM
-- Edited by BigPharma on Thursday 23rd of October 2014 08:16:18 AM
-- Edited by BigPharma on Thursday 23rd of October 2014 08:17:34 AM
Nevertheless the trial started:
http://www.pipelinereview.com/index.php/2014101055685/Small-Molecules/Medivir-Phase-II-IMPACT-Study-Initiated-to-Evaluate-Simeprevir-in-Combination-with-Sofosbuvir-and-Daclatasvir-to-Treat-Genotype-1-and-4-Hepatitis-C-Patients.html
and by the way my friend was UND as soon as he started Olysio, so good try at the end
Thank you, Gary. Results depend on the DAAs used and the individual. Adding a 3rd DAA will be necessary for some but not for most using the S/L or S/D combo. And, adding a 3rd will not guarantee SVR for everyone either.
Also, using 3 DAAs that all have low barriers to RAVs would not necessarily produce better results. The question is how to know who will respond best to which DAAs and there are no definite rules at this point. In the future we will see more individualized tx plans but we aren't there yet.
If it was "impossible" for the virus to survive when 3 DAAs are used then nobody would have ever relapsed on a 3 DAA combo, and clearly many people have, as demonstrated by clinical trials.
Isiscat
I would think you would be fine going with the new Doc as I'm sure there are other docs in the group that are there to advise and guide. After all it's not the doc it's the meds that do the job.
On another note to this I switched my primary care doc to a whole different clinic and have a young doc that specializes in adults with chronic illness and he has been spectacular, they are very proactive and the knowledge is very recent to them as opposed to someone that is getting old and tired of work just like we all do in our jobs.....for me it was an excellent switch and very refreshing to have the upbeat vigor and willingness to listen to the experience that only patients can provide.
They view us as great resources to advance in their knowledge of the disease and tx of them, so in my case its a win win situation.
Matt,
thanks for also supporting the idea adding simeprevir. Moreover all 3 DAAs were tried together in pairs and showed good results.
As one of my friend's doc said virus in triple therapy will need to jump 3 fences which will be impossible for the virus because it is almost impossible to jump 2 fences for the virus already
I wish to all here to get this DAAs very soon and to be cured once and for all.
Good luck Matt, good luck Isiscat in your upcoming therapy very soon.
Gary
I'm with you on the S/L combo its the best choice for GT1's with or without cirrhosis. My Dr. did recommend Ribavirin as well for the whole 24 weeks. He said that its helps with RAV's suppression and many other benefits for cirrhotics. I am also investigating Abbvie's new re-treatment protocol that will be coming out as well, so in the next two months we should be in treatment if all goes well. This last six months has been a long wait, as I can well imagine you have felt the same way.
matt
I'm planning on starting the S/L combo in October. Haven't discussed using a third yet.
Unfortunately, the amazing Hepatologist who was my doc has left to join another liver center, so my new doc is a young physician who completed her hepatology fellowship under him. Another doc I know recommended that I follow the first doc to his new location, but this would delay tx by at least a couple of months, so I may just continue with the less experienced doc. What do you think? What are your plans, Matt?
Hey Isiscat
I believe your first suspicion is correct regarding Gary, he is not in the USA.
After all this time most HCV Doctors and research is in agreement that a multiple DAA approach to treatment is better because of the ability to control Rav's during treatment.
BTW, Isiscat have you thought about what (DAA's) approach you will be selecting?
matt
-- Edited by Matt Chris on Friday 12th of September 2014 04:48:09 PM
What does this mean? US docs cannot prescribe daclatasvir. If this is a clinical trial the trial protocol dictates what participants receive.
no more comments?
my friend received "go ahead" from 2 diffrent doctors
Daclatasvir is not FDA approved so it can only be used in the US in clinical trials. I am assuming you and your friend are either not in the US or you are participants in a clinical trial. In clinical trials the parameters for what drugs are used are already established. They won't add another DAA mid treatment just because he asks for it.
There are a number of combos using 3 DAAs but I am unaware of any studies utilizing the three you mentioned together: Sovaldi/Declatasvir/Olysio. That doesn't mean this trio is not being tested somewhere but I have not read of any such trial or trial results.
A physician would be unable to prescribe this trio -- even off label --at least in the US.
In summary, what you are suggesting cannot be done at this time.
Hello friends,
I was reading somewhere (may be here on this forum) that someone did a therapy with sofosbuvir & daclatasvir or sofosbuvir & simeprevir.(I dont remember exactly)
He/She had very low VL on week 4 ( less than 15 IU) . But the problem was he/she had the same VL on week 6 ( less than 15 IU) and on week 8 (less than 15 IU)!
So decline has stopped and he/she was not achieving UND!
And his/her doctor decided to add third inhibitor simeprevir or daclatasvir to the therapy (I don't remember which depending on his protocol) and after that at week 9 he finally got UND! I might be wrong with numbers a bit , but the idea is the same: adding third inhibitor if decline stopped.
The reason I am asking my friend is doing the same therapy as me with daclatasvir and sofosbuvir and he achieved UND at week 4 with test sensitivity 60 IU, but he made another RNA test on the same day with sensitivity 10 IU and it showed detected. It continued on week 5 detected ( 10 IU) and at 6 week ( 10 IU) so decline stopped. He is desperate to add third inhibitor simeprevir and go with this for the remaining 6 weeks .
I blame myself that I did not save the link and the only way now to ask you your opinion on it or maybe you have some references, because I want to show it to my fellow traveller in the therapy. In fact threre are some trials with three inhibitors and it showed good results with shorter duration of treatment.
What do you think about it ? May be some references , some thoughts about the idea ?
Gary