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Hep C Discussion Forum -> General Discussion -> Incivik vs Victrelis revisited
Post Info TOPIC: Incivik vs Victrelis revisited
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RE: Incivik vs Victrelis revisited
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Ouch! I should read more closely. I always assumed both protease inhibitors ran twelve weeks, with extensions on Victrelis under certain circumstances. I never dreamed every Victrelis user had to go 24 weeks on the stuff, minimum. All comments about grumpiness withdrawn, with heartfelt apology. If I had been forced to do the triple schedule for 24 weeks, even with sugar pills, I would have gone postal. The sore butt and itchiness and fatigue and lost appetite were bad, but the worst part was having to deal with the issue three times a day, every day, including Christmas Day, and my birthday, without fail, and without straying more than an hour from schedule. I was so happy to get back to a "morning/evening" sort of schedule. The length of the Victrelis protocol is certainly something to be considered. Alan

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Geno 1A  Started Pegasys/Ribavirin/Incivek Nov. 20, 2011 .  Completed July 28, 2012 (36 weeks). For a treatment history, see:  https://jshare.johnshopkins.edu/xythoswfs/webview/_xy-9921874_1

SVR on January 14, 2013!!
hrsetrdr


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It's interesting how we all can look at the same set of informaton but have such widely differing perspectives. As a Victrelis  lab rat I see my treatment as being much less "brutal" than that of the Incivik folks.  True, there is a four(my case- five) week lead-in, and am required to take Victrelis to the very end of the treatment(28 weeks for me, if all goes well).   The Incivik patients are fortunate to only be required to go 12 weeks<?> and then drop back to Pegasys & Ribavirin, but the rash they suffer in addition to the anorectal tribulations sound to me to be sooo much more of a burdon.   

As for the grumpness- I'm always grumpy anyway so I can't tell the difference.        Seriously, I'm not taking an AD at the moment and feel as well as can be expected.   I did order some of the NADH that Karen mentioned; maybe that'll make me feel less like Lewis Black  and maybe alot more like George Clooney. Will see what the wife says... biggrin



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"hrsetrdr"=Tim

Treatment halted on Aug.8,2012 due to vision problem.  6 month post tx labs

Aug.2013 SVR

Be strong when you are weak, brave when you are scared, and humble when you are victorious.
- Unknown

 

 
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I would have to vote for Incivek, based on what I have seen and read here, and on my own experience. The Incivek side effects are a real test of a person's strength. It is really the hardest thing I ever did. But after twelve weeks I could put it down. Almost everyone on Victrelis has a four week lead in, then twelve weeks of triple, and twelve more just peg/riba. Many are on Procrit and/ or Neupogen for most of the time, indicating they are taking a beating. And forgive me for saying it, but some of them get real grumpy. I recall three uncontollable rages on this forum. All involved Victrelis. However, it must be said that both protocols are getting excellent results. It could be that the status of the patient regarding past non-response, relapse, etc. may be the biggest single element to influence a decision. I was not given a choice. My doc prescribed Incivek. Alan

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Geno 1A  Started Pegasys/Ribavirin/Incivek Nov. 20, 2011 .  Completed July 28, 2012 (36 weeks). For a treatment history, see:  https://jshare.johnshopkins.edu/xythoswfs/webview/_xy-9921874_1

SVR on January 14, 2013!!
mallani


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Sorry Alan, but the standard protocol for Victrelis is Peg and Riba for 4 weeks, then Peg. Riba and Vict. for 24 weeks. For 36 weeks, Peg. and Riba for 4 weeks, then 32 weeks of Victrelis. The length of exposure to Victrelis is dramatic compared to only 12 weeks of Incivik. Obviously grumpiness is surfacing in me. With Vict. there is no relief in sight. At 19 weeks, my Sx are gradually getting worsefurious



-- Edited by mallani on Monday 23rd of July 2012 12:52:48 PM

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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Karen


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Hi Malcolm,

Thanks for starting this post.  The category breakdown is great..

When I was not accepted into the 7977 trial, my doctor emailed stating there are others to come.  For me, shared knowledge and experience is the best way to make an educated decision when the time comes.  As more and more treatment options become available-it is important to know as much about these drugs and how they compare (side effects, mutation (my concern), outcome, duration, costs etc), as possible.  As an advocate for my own health choices, I want to be able to choose based on my own personal circumstances and for the best possible outcome...

This informations is priceless-It would be great to have a trial comparison post.. 

Sorry I cannot contribute but I will keep following.  

Love this forum and the people in it!!!! 



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Geno Type A1- VL 16.2m - F1-F2 Moderate Fibrosis - Started treatment 4/16/13 Sofosbuvir/Ledipasvir 6 months -  UND week 4 (5/14/13) - EOT 10/1/13 - 12wk blood draw 12/20/13 UND - 24wk/final blood draw March 2014
mallani


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Hi all, This has been discussed before. I would be grateful for any input. The reason for bringing this up again is to make sure my facts are correct. A number of HCV patients here are following my progress- none are cirrhotic, and are willing to wait for further trials. I have already been asked whether I would recommend Victrelis. This is my understanding of why Incivik outsells Victrelis by more than 3:1.

Vertex marketed Incivik as a more powerful protease inhibitor, with better SVR's from the trials, a shorter treatment protocol (and patient acceptance), and improvement in Sx after the first 12 weeks.

Merck had the problem of the perception it was less potent, had to be taken for longer with a lead-in, the trial SVR's were not as good, and the anaemia was reportedly more severe.

Potency: If Incivik is more potent, the rate of Undetecteds should be much higher after 4 weeks treatment. In fact the rate is pretty similar (47%) after 4 weeks of either Incivik or Victrelis. Does Victrelis require the leadin to reduce the VL? I have never seen this in any papers.

Trial SVR's: A good example of manipulation can be seen in the Incivik Realize-2 Trial, when previous nonresponders were excluded. Also, trial data does not necessarily translate into clinical practice.

Treatment Duration and Protocol: Incivik has a much easier protocol, and is only taken for 12 weeks. Victrelis has the leadin, followed by 24 weeks of antiprotease. For me, taking 18 capsules a day at precise times is a real pain, paricularly with the brain fog we get. Patients surely would prefer Tx for 24 weeks instead of 28.

Side Effects: The Incivik rash and anorectal problems and fat requirement seem to be the reason for many forum posts. I am not aware that the anaemia from Victrelis is more severe. From my experience, hepatologists are not really interested in Sx. unless they are lifethreatening. The only figures I have seen suggest similar percentages of Tx stoppage due to Sx from each drug, which surprises me.

Leadin: My doc gave the leadin with Victrelis as one of the reasons he preferred it. He wanted to know interferon sensitivity, which becomes obvious after the 4 week leadin. Why does Incivik not have a leadin?. Trials were done with and without leadin, and the SVR rates were similar.

Drug-resistant Mutations: The antiproteases cannot be used as monotherapy, as resistant mutations develop rapidly. Treatment failure after Incivik means the patient cannot be retreated with Victrelis. I have been told the the shorter exposure to Incivik reduces the risk of these mutations, but have not seen any papers confirming this.

Cost: This is obviously of little concern to the Prescribing Physician. Victrelis is cheaper, which is probably why it is preferred by Insurance Companies and the VA.

If patients are given a choice of drugs, heaven help them. Patients who have achieved SVR from either drug would undoubtedly prefer their drug. I remain confused . Please help if you have any further data.



-- Edited by mallani on Saturday 21st of July 2012 02:47:38 PM



-- Edited by mallani on Saturday 21st of July 2012 04:29:35 PM

__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
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