Hep C Discussion Forum

Members Login
Username 
 
Password 
    Remember Me  
Chatbox
Please log in to join the chat!
Hep C Discussion Forum -> On Treatment -> Riba reduction!
Post Info TOPIC: Riba reduction!
ivan


Member

Status: Offline
Posts: 13
Date:
RE: Riba reduction!
Permalink  
 

Malcolm

my bad concerning 8wk undect.   draw VL @4wk but results unknown till 7-8wk so my intention was continue dual tx until wk 8.  today hepa told me he arranged for Victrelis 1st month free and we'd begin Vic on week 5.  OK, fine, said I'll take Vic 1mo and if wk4 results show undect. drop Vic and continue dual for duration. 

Hepa didn't disagree but didn't agree (perhaps didn't know what to say).  He did go on about 75% SVR w/Vic and 55% w/dual (thinking >55% if undect. @4wk, correct?).  If'n u were my doc would you allow patient to swing this???? (Doc can't be sued in CR!) 

Sunday after Mass, my adventure begins



__________________

ivan

 

geno 1a,  grd1 stg1 (2007) 35+yrs  tx naïve 2yrs of Cyoglobulinemia  neuropathy complications
mallani


Guru

Status: Offline
Posts: 3398
Date:
Permalink  
 

Hi Ivan,

The 4 week Peg/Riba leadin with Victrelis is still a bit of a mystery. The main consensus is that Victrelis works better dealing with a lower VL than Incivek. The good thing with the leadin is that you can decide whether you're Interferon sensitive, which bodes well for SVR.  When I started, we were looking for a 2 log drop in VL in 4 weeks, then hopefully Undet at 8 weeks, after 4 weeks of Victrelis. Luckily I achieved that and that was classified as a Victrelis RVR. I'm not sure why your doc would want to do 8 weeks leadin.  If you are extremely lucky, you'll be Undet. at 4 weeks with the Peg and Riba, in which case you don't need Victrelis! Let us know how you go. Cheers.



__________________

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
ivan


Member

Status: Offline
Posts: 13
Date:
Permalink  
 

hmmm  thought 70% SVR with triple tx was published/projected Boceprevir SVR rate.  

Malcom I have a more urgent question for which I seek your valued opinion.  Next week I'll begin double therapy Riba+PegInterferon.  Victrelis is difficult to obtain here and hepa believes since I'm tx naïve even if it was READILY available he wants to see what kind of VL log drop I get after 8weeks. Probably should add that last weeks biopsy continues to show Stage 1 Grade 1 but the reactive Cyrogolubulin development (2% HCV patients afflicted) rapidly continues and I'll lose my feet and perhaps my hands if I don't purse tx.  We can source Victrelis but more expensive then USA so if I decide (w/your help) to pursue triple perhaps I need to quit CR and going back to USA for whatever time left God gives me.

Did you know you're doing Gods work!!



__________________

ivan

 

geno 1a,  grd1 stg1 (2007) 35+yrs  tx naïve 2yrs of Cyoglobulinemia  neuropathy complications
hepCFREEwanab


Veteran Member

Status: Offline
Posts: 89
Date:
Permalink  
 

Ivan, thank you so much for this info!  You have no idea how it calmed me down!

Mena



__________________

Genotype 1b, V/L  0! Finally got rid of the Dragon after 24 wks. of Harvoni.

EOT 5/10/15   - 4 wks. UND, 12 wks UND, 24 wks. UND!!! 
mallani


Guru

Status: Offline
Posts: 3398
Date:
Permalink  
 

Hi Ivan,

This is a link to the Merck study you referred to. I am intrigued by 2 things. The study group is quite young and the SVR figures of ~70% are not that impressive. They also do not specify the amount of Riba dose reduction , and how long it was reduced for. It interests me, as my Hepatologist was a firm believer in the 80/80 rule, i.e. you need to be on 80% of the recommended dose for 80% of the treatment duration.  As a result, I spent most of my 48 weeks with a Hb of between 8 and 8.5 and he refused to drop my 1,200 mgms of Riba. I dropped my Hb to 7.1 by the end and obviously had extreme lethargy.  His reasoning was that I needed the full dose as I was cirrhotic, and would have considered a reduction if I was not!  I chose not to have Procrit, having seen some problems it causes.

It remains an interesting topic, but may be of less interest if the new antivirals can do their job without Riba. Cheers.

 http://clinicaltrials.gov/ct2/show/results/NCT01023035?sect=X125#all



-- Edited by mallani on Thursday 15th of August 2013 04:02:47 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
ivan


Member

Status: Offline
Posts: 13
Date:
Permalink  
 

Aug 6 the gastrojournal published white paper concerning riba reduction effecting SVR.  Bottom line was up to 50% reduction did not affect SVR.  Note study was under Victrelis triple therapy but perhaps can be carried over w/Incevic.  Not sure how to post article link but below is part of it.

Boceprevir-Related Anemia in Patients with Chronic HCV Genotype 1 Infection

Patients (n=687) received 4 weeks of peginterferon and ribavirin followed by 24 or 44 weeks of boceprevir (800 mg, 3 times each day) plus peginterferon and ribavirin. Patients who became anemic (levels of hemoglobin approximately 10 g/dL) during the study treatment period (n=500) were assigned to groups that were managed by ribavirin dose reduction (n=249) or erythropoietin therapy (n=251).

Rates of SVR were comparable between patients whose anemia was managed by ribavirin dose reduction (71.5%) vs erythropoietin therapy (70.9%), regardless of the timing of the first intervention to manage anemia or the magnitude of ribavirin dose reduction. There was a threshold for the effect on rate of SVR: patients who received <50% of the total mg of ribavirin assigned by the protocol had a significantly lower rate of SVR (P<.0001) than those who received 50%. Among patients who did not develop anemia, the rate of SVR was 40.1%. Eleven thromboembolic adverse events were reported, in 9 of 295 patients who received erythropoietin, compared to 1 of 392 patients who did not receive erythropoietin.

Reduction of ribavirin dose can be the primary approach for management of anemia in patients receiving peginterferon, ribavirin, and boceprevir for HCV infection. Reduction in ribavirin dose throughout the course of triple therapy does not affect rates of SVR. However, it is important that the patient receives at least 50% of the total amount (mg) of ribavirin assigned by response-guided therapy.ClinicalTrials.gov number, NCT01023035.



__________________

ivan

 

geno 1a,  grd1 stg1 (2007) 35+yrs  tx naïve 2yrs of Cyoglobulinemia  neuropathy complications
Dillo


Senior Member

Status: Offline
Posts: 227
Date:
Permalink  
 

My Ribavirin was reduced to 400mg because HGB was so low and my kidneys weren't reacting well to it.  When I asked the Doc he said don't worry about it, I was at the lowest dose, it was still making me anemic so it was doing it's job. They usually reduce the dose to what your body can handle.

 



__________________

GT 1a Started triple tx with Incivek, Pegasys, and Riba 2-6-2013. UND at 4,6,12,23,& 24 wks EOT 7-26-2013. Probably had Hep C for 20-30 years. Don't really know when I got it.

hepCFREEwanab


Veteran Member

Status: Offline
Posts: 89
Date:
Permalink  
 

When the blood test showed that Angelo's hemoglobin level was low, the Doctor reduced his riba by half...down to 600 mg. in the am.

It's already been a week and he said to continue this was till further notice.

I am so worried that this prolonged reduction may impact on the treatment success.

Can the virus break through again and come back detectable?

We should be getting the procrit since it finally was approved by the insurance.

 

I can't wait till this is over....

Mena



__________________

Genotype 1b, V/L  0! Finally got rid of the Dragon after 24 wks. of Harvoni.

EOT 5/10/15   - 4 wks. UND, 12 wks UND, 24 wks. UND!!! 
lucy


Senior Member

Status: Offline
Posts: 115
Date:
Permalink  
 

I had the same situation for Riba reduction. I took reduction Riba with 600mg ( 400mg in the morning , 200mg in the evening) till the end of treatment

My Dr. told me don't worry about that.

Best wishes

Lucy



-- Edited by lucy on Wednesday 14th of August 2013 04:35:56 PM

__________________

 1b, start triple treatment(incivek) on Feb 5, 2013.  UND@ 4,12,24 wks. EOT Aug 6, 2013
Page 1 of 1  sorted by
 
Quick Reply

Please log in to post quick replies.
Hep C Discussion Forum -> On Treatment -> Riba reduction!
Legal Disclaimer:

THIS FORUM, IT'S OWNERS, ADMINISTRATORS, MODERATORS AND MEMBERS DO NOT AT ANY TIME GIVE MEDICAL ADVICE AND IN ALL CASES REFER ANYONE HERE TO SEEK APPROPRIATE MEDICAL ADVICE FROM THEIR DOCTOR.