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Hep C Discussion Forum -> On Treatment -> why no lead in time on Incivic?
Post Info TOPIC: why no lead in time on Incivic?
hepcat60


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RE: why no lead in time on Incivic?
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My doctor chose the Invevik in my case with 48 week total treat,ewmt since I am cirrhotic.  She chose the Invivik since we would know to continue or stop at 12 weeks and would not have to endure unecessary time on the drugs.  I was Und at 2 weeks through 48 weeks.  



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Hep C 1a since probably 1981.  Incivek, riba and interferon-48 weeks.  UND at weeks 2-4-6-8-10-12-16-20-24.  Previously Interferon alone for 6 months non-responder.  SVR 48 weeks 12/11/14
mallani


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Hi John,

The early trials used a 4 week leadin of Peg/ Riba for both Incivek and Victrelis. Then they did a trial without the leadin, and found that, for the Incivek patients, the 4 week undetected rate was the same. Incivek is a more potent drug initially, and can deal with a high VL.  Victrelis is slow but steady, and works best when the initial VL is cut down by the leadin.  After 4 weeks on each drug, the Undetected rates are the same i.e. after 4 weeks of Peg/Riba/Incivek, and after 4 weeks of leadin + 4 weeks of Peg/Riba/Victrelis.  I'm surprised the VA gave that advice to your doctor.  They were pretty vocal about preferring Victrelis a year ago.

Incivek is so toxic, it can only be used for 12 weeks. Victrelis is 'gentler' and can be tolerated for 44 weeks, although it adds to the Riba induced anaemia. My doc showed me a paper comparing the two in cirrhosis. Victrelis had a higher SVR in patients that did 48 weeks. From memory, this was about ~80% vs ~75% in patients with an RVR.  This is because the cirrhotic liver requires long term perfusion of drugs, and it was thought that exposure to all 3 drugs was the way to go. I'll try to find the paper, but I think it was from a conference my doc attended.  He will not use Incivek for cirrhotics but that's only his opinion.

Anyway, if VA are paying, you don't have a choice. If you get an RVR, your chances are pretty good. Cheers.



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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
newmex


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I am 2 weeks into the lead in phase of 4 weeks for Victrelis. The plan was 4 weeks lead in then 44 weeks of peg/riba/victrelis.. Went to doc today and nurse told me doc got a report from VA saying Incivic has higher rates of response in VA treatment (for cirrhotic)and they are going to continue the 4 weeks lead in, put me on Incivic for 12 weeks, then finish up the 48 weeks on peg /riba. Am just wondering if this is accepted protocol. Cant find any info on why no lead in phase on Incivic but don't want to do any thing to lessen chances. Any one have views on this?  



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John
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