Hep C Discussion Forum

mindovermatter · Veteran Member

RE: Gen 3, RVR and relapse

mallani · Guru

Hi M-o-M,

With any of the DAA's that target a replication site on the viral structure, a small mutation may cause the DAA to become ineffective. This is why a DAA cannot be used as monotherapy. Previously, Peg and Riba were used to control these resistant mutations (RAVs). These days, adding one or two different DAAs that target different viral replication sites allows patients to avoid Interferon.

Peg and Riba are not DAAs. They have a complex action which has been discussed elsewhere. They continue to work with the wild-type structure and all mutations. With DAAs, patient relapse due to RAVs in most cases. With SOC (Peg and Riba), patients relapse or fail to become Undetected because the drugs are ineffective. Blood tests in SOC relapsers, show that the wild-type strain remains as the dominant structure. Cheers.

Zlikster · Guru

Hi Mom,

Interferon was hitting/supressing my bone marrow hard, so my neutrophiles production was really weak. I went down as low as 0.2 neu. Official Pegintron dosage guidance is: if Neu 05-0.7 (10*9/L) reduce interferon 50%, if <0.5 stop with interferon! But you can push it more, as Malcolm wisely advised me, i wish i could have persuaded my hepa to go even lower or continue using Neupogen shots.

I was tho obtaining Neupogen shots on my own (since my insurance couldn't afford it), which helped (10x Neu jump for 3-4days) but my hepa said enough and lowered my Interferon dosage from 120mcg to 60mcg for last 2-3shots without Neupogen. Neutrophiles again plumeted to 0.2-0.3 even on reduced dose. I was also fighting with her not to reduce Ribavirin, but she reduced from 1000mg to 800mg when my Hgb went below 110 (i was trying to push it for <100). Thing is, push yourself to the max, length of the tx is important. Try not to get reduced dosage of Interferon and Ribavirin and do full 24weeks. It will pay off i am sure! And don't worry, recovery is pretty fast afterwards.

best

mindovermatter · Veteran Member

Hi Zlikster, Malcom and Jill,

Thanks for your replies

Zlikster,

I have read several of your posts and I admire how you maintain a positive outlook and always sound upbeat.

I am sure you are going to slay this with your next round of treatment.

If you do not mind buddy, may I know why you had an interferon reduction.

I have read about Ribavarin dose being reduced but never heard about Interferon being reduced during tx.

Malcolm,

You mention not having to worry about resistant viruses in your post. Could you please explain it because I could not understand that part of your post. Thanks

mindovermatter · Veteran Member

Good luck Gracie,

I am very hopeful you would be UND!

I am sending good karma your way!

-- Edited by mindovermatter on Friday 24th of January 2014 07:38:20 AM

Gracie · Guru

Good Luck M-O-M on your upcoming fourth week blood test. Mine is tomorrow and I doubt I'll sleep tonight. Even though I won't find out for a couple of weeks. We've got this!

mallani · Guru

Hi MoM,

Sorry for my typo- 24 weeks treatment duration is correct. The problem with Peg/Riba for Geno 3 is that you are either sensitive or not. Some factors have been identified that make Rx success less likely. These are- male sex, older age, long history of disease, high viral load, fatty liver, high BMI, non-CC genotype at IL28B etc. The time needed to become Undet. is also important, with the RVR patients doing the best. As there are no resistant variants to worry about, if you're not Undet. by week 12 you're not going to obtain SVR. Also, if you relapse after the usual 24 weeks, it is unlikely whether increased treatment length or re-treatment will do any better. Cheers.

Zlikster · Guru

Hi MoM, fellow GT3 :)

24 week indeed it is, even if it is UND @ 4w i would suggest you to go for full 24w and not 16w (if you get it as an option cause of RVR). I was (almost) detectable @ 4w (41 UI/ml), then UND until 1month post tx when i have relapsed. Maybe cause i had 23weeks instead 24w or cause of interferon dose reduction. Who knows, in any case i suggest you push yourself to the max and do not allow any dose reduction (Riba espec.)

all the best

Cinnamon Girl · Guru

Hi M-over-M, yes that is correct, the standard Peg/Riba treatment for gen 3 is 24 weeks and not 28. I was genotype 3a myself and I did the same treatment.

Your 4 week viral load test result will give you a good indication of how well you are responding to the treatment, so best of luck!

mindovermatter · Veteran Member

Thank you all, for your replies. Also, why are some people saying soc is 28 weeks for gt 3?

I am under the impression that it is 24 weeks. My doctor said it would be 6 months of treatment and I assumed it would be 24 weeks and not 28.

Please correct me if I am wrong.

garfield · Veteran Member

Cinnamon Girl wrote:
Hi Garfield, Tig, and Mindovermatter, just to clarify...
...Sovaldi is indeed a DAA and is now available in the US for all genotypes. The treatment duration for gen 3 is 24 weeks, following the data gathered from clinical trials.
Mindovermatter is located in India, where the only currently available treatment option for gen 3 is the peg/riba combo.
Hope that helps.

and also in the European Countries (EU).

In germany therapies with Sovaldi had started in Dezember 2013 for self payers, for all the others therapy will start in about two weeks.

Tig · Admin

Hello,

i just realized the information I quoted was in error and I offer my strongest apology to you for the confusion Garfield. I can't even locate the same information I listed below. My MEDSCAPE LOGIN must be unhappy too, it won't allow me in today.

I need to quit researching in the middle of the night I guess. The new DAA medications are indeed for GT 2 and 3's, among others. They aren't available in many countries yet, and as Jill and MoM mentioned, they aren't available in India at this time. They are however working on copyright changes to offer these medications at significant savings.

Tig

Cinnamon Girl · Guru

Hi Garfield, Tig, and Mindovermatter, just to clarify...

...Sovaldi is indeed a DAA and is now available in the US for all genotypes. The treatment duration for gen 3 is 24 weeks, following the data gathered from clinical trials.

Mindovermatter is located in India, where the only currently available treatment option for gen 3 is the peg/riba combo.

Hope that helps.

garfield · Veteran Member

Tig56 wrote:
For GT 3's, DAA's aren't a consideration anyway. They aren't used in GT 2/3. The only therapy available is the Peg/Ribavirin combination.

Sovaldi isn't a DAA in your opinion ????????, what do you tell ????????? or is this posting not from january 2014 than sorry

-- Edited by garfield on Tuesday 21st of January 2014 02:51:19 PM

Tig · Admin

Take a look at this 2011 Medscape article. It's still accurate and explains more of this topic. The only therapy currently available in your area is the Peg/Ribavirin combination. This article goes into depth on the rates of SVR following a 4 week RVR. Many clinical trials concentrated on 12 and 24 week treatment lengths. The associated SVR rates will surprise you at their similarities in many of the trials. I hope this article answers some questions and reassures you of your current length of treatment. Have faith my friend, we have to have faith!

http://www.medscape.com/viewarticle/739955

Tig

-- Edited by Tig56 on Tuesday 21st of January 2014 03:59:41 PM

mindovermatter · Veteran Member

Thank you all for your replies. Although, it is a bit presumptuous of me to think that I will be UND at the end of week 4.

My line of reasoning is that , I want to undergo treatment only once. If that means being treated for a longer duration so be it. It would be so anti-climactic to attain RVR and then not attain SVR.

I didn't really know that it was actually possible to attain RVR and not attain SVR, but I read a couple of posts from fairly young people, inntheir thirties, with little liver damage who did very well on SOC, attained RVR and did not attain SVR.

It just made me afraid. I understand, its all a little premature to talk about at this point. I have not even tested for week 4 viral load so all this at present, is just conjecture.

In my part of the world, DAAs will not be available for the next 4-5 years, at least. So this is just the one chance that I have got. And I want to make the most out of it.

I will post my week 4 results, and then discuss that with you guys.

mallani · Guru

Hi m-o-m,

Previous research has shown that 28 weeks is the optimum treatment duration for Geno 3. 36 weeks and 48 weeks were trialled some years ago, and with SOC, it was shown that extra treatment duration did not affect SVR percentage. There is still some debate about the merits of retreatment, in those who relapse. Most agree it is a waste of time ( this is only with Peg/Riba, or SOC). Although a 4 week Undetected is a good indicator of SVR, many patients aren't Undet. until week 12, and still achieve SVR. Take your meds on time and hopefully you can remain on the full dosage. Best of luck.

Tig · Admin

Hi M-o-M,

I have to agree with Jill. RVR is a very strong indicator of success, but as she mentioned the rates of relapse while low after that, do exist. There is also something else you have to consider, because some others do, cost. Insurance and/or health agencies are paying attention to your case, lab tests and they have members that understand the treatment algorithms. It's their job to control expenditures and they do, trust me. Of course your doctor, if in agreement with you, could request the extension. If denied, you can appeal the ruling. If you're going to consider this, you better get started now. Appeals if necessary, can be lengthy and unless you can afford to pay out of pocket through any appeal process, find out well ahead of time. There's no understanding insurance companies, sometimes they'll instantly approve a complicated procedure or treatment that nobody has heard of but initially deny a compound leg fracture!! Go figure...

I believe you'll be fine and understand how easy it is to over analyze when there is different information to be found everywhere! I know because I did it too! My friends here convinced me to not worry over every different opinion. I can only offer you the same good advice. Best to you!

Tig

smccune · Veteran Member

Hi Mindovermatter, I too have geno 3a and just took #18 interferon injection Friday night. I do not have cirrhosis and have been UNDET since wk 4. The doctor has assured me that I most likely will achieve SVR with the 24 wk treatment. My blood tests have leveled off and actually starting to improve. Side effects have changed week to week, but are getting much better. I have 6 more weeks, but now I am actually starting to wonder what I will do with my weekends once I am actually normal again...lol. Hang in there. The time goes so fast. And yes, good luck with wk 4 tests. biggrin

Cinnamon Girl · Guru

Hi Mindovermatter. You`re young, tx naive, and without significant liver damage, so I don`t imagine you`ll have much to worry about. Relapse is a possibility with any genotype but the odds are definitely in your favour and 24 weeks should be long enough for you to clear the virus, especially if you achieve RVR. It`s the standard peg/riba tx duration for genotype 3 when tx naive, and without cirrhosis.

Try not to worry, and best of luck with your 4 week results! smile

mindovermatter · Veteran Member

Hi members,

I am presently undergoing peg, riba treatment for GT 3. I am currently 20 days into treatment.

I will have my week 4 VL test in about a week's time.

If it is UND should I go for the standard six months or should I insist that the treatment be for 36 weeks instead.

I am asking this because I have read a couple of cases of GT 3, on this forum itself who had RVR but relapsed soon after treatment.

I am 30 about to be 31 in a month and looking to get married.

I want to get rid of this beast once and for all. I do not want to enter into marriage before slaying this beast.

If at all I do attain RVR, should I still insist on a longer duration of treatment. Would that be of any help in attaining SVR ?

-- Edited by mindovermatter on Sunday 19th of January 2014 12:19:51 PM

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