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Hep C Discussion Forum -> On Treatment -> Harvoni vs Viekira Pak + Ribavirin - Which would you choose?
Post Info TOPIC: Harvoni vs Viekira Pak + Ribavirin - Which would you choose?
mallani


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RE: Harvoni vs Viekira Pak + Ribavirin - Which would you choose?
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Hi Jaded,

This is sconan's thread so I'll be brief. NS-5A is an unstable site, and the few treatment failures on either Harvoni or Viekira-Pak may have RAV's that carry resistance to the NS-5A inhibitors. Many have been documented. What is not sure at this time, is how long they persist, and what impact they may have on retreatment with another NS-5A inhibitor.

The Sovaldi part of Harvoni is not a problem, as any RAV's are transient so Sovaldi may be re-used.

Sorry sconan.



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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
Jaded


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mallani wrote:

Hi Jaded,

Not too sure whether retreatment with Harvoni is possible in those few who fail Viekira Pak. The problem lies in the NS-5A inhibitors- Ombitasvir and Ledipasvir. So far, nobody is willing to say whether RAV's at this site may be  persistent. The same RAV's are found in Ombitasvir, Ledipasvir and Daclatasvir treatment failures. The other elements of Viekira Pak are OK.

It's just something to bear in mind. Cheers.

 Are you saying that after cessation of the drug that the NS-5A blockers will still have an effect or that now the virus is resistant?



-- Edited by Jaded on Friday 24th of April 2015 03:54:47 AM

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64 year old EOT 10-28-15,SVR24 April 21 2016  ALT-12/AST-23 June '19 - fibroscan 6.9 F-0 July '19
mallani


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Hi Jaded,

Not too sure whether retreatment with Harvoni is possible in those few who fail Viekira Pak. The problem lies in the NS-5A inhibitors- Ombitasvir and Ledipasvir. So far, nobody is willing to say whether RAV's at this site may be  persistent. The same RAV's are found in Ombitasvir, Ledipasvir and Daclatasvir treatment failures. The other elements of Viekira Pak are OK.

It's just something to bear in mind. 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
Jaded


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I did 2 trials back to back 19 years ago...1st 4 months of Interferon with marginal improvement and then a year with interferon and ribavirin without much better results (I to am 1a). I can't say that I had as easy a time tolerating it as you. But to answer your question...the Viekira Pak + Ribavirin won't cost you a dime and seems to be effective and you can start right away so I'd do it without hesitation. That way if it does not work for you (which is unlikely) you will then be ready to do the Harvoni treatment shortly after. Now you have double the chances in the same period.

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64 year old EOT 10-28-15,SVR24 April 21 2016  ALT-12/AST-23 June '19 - fibroscan 6.9 F-0 July '19
lonewolf


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Wow, 72 weeks of interferon and Riba. If you made it through that these new protocols should be gravy for you. I was scheduled to take Harvoni but after my Dr. saw my high viral load of over 21 million he opted for the Viekira+Ribavirin. Opinions seem to vary here on whether a high viral load has anything to do with treatment success. My Dr. says it does so I have to go with him. Anyways, I was undetected in 26 days so I'm not at all unhappy about the change. I wouldn't hesitate to go with the VK+Riba and I'm happy now with my Dr's decision but, of course, the choice is all yours.



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55 yo male-Genotype 1A  Started treatment 3-5-15 Viekira Pak+Ribavirin 12 weeks. Less than stage 1 fibrosis.  Previously treatment naïve. VL- SOT-21.8 million/ml  Log 10IU/ml-7.34, VL-4wks-UND, VL-7wks-UND

Greg
mallani


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Hi and welcome sconan.

It would be useful to know your age, fibrosis state, VL. ALT etc and how long you may have had HCV.

Like Tig, I wonder why you did 72 weeks of Interferon/ Riba.

If your new proposed treatment is only 12 weeks, I presume you have been shown to be non-cirrhotic.

There were many causes for relapse on Interferon/ Riba. Some patients were not interferon sensitive and may not have had the CC allele at IL28B. Others may not have had adequate blood levels of Ribavirin. The fact that you had few symptoms makes me suspect Ribavirin may not be suitable for you.

Personally, I'd go for Harvoni. It doesn't have an antiprotease and I'm a bit anti-antiprotease (even though one got me my SVR!). You're correct- SVR rates will be similar. 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
Tig


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Hello Sconan,

Welcome to the forum, I'm glad you found us. Lots of friendly, knowledgeable people here to help.

Were I in your shoes, I'd probably do the VP +Riba trial. It's a very effective protocol and it sounds like you've already done your homework. Either one of these protocols is a cake walk compared to the old treatments. The fact that you didn't have any issues after 72 weeks of Int/RIBA is a sign that medications don't seem to bother you much! Why did you have to do 72 weeks? Can you give us a little more info on your history? What were your latest labs and fibrosis score if I may inquire? That will help us provide better informed opinions. You can add that to your signature line if interested.

The ease and savings that a trial can offer are quite a benefit. The fact that you'll be entering an advanced Phase 3 trial, on an already approved protocol, seems like an easy choice. The pill burden will be higher and twice a day, but it's nothing you can't handle. Keep us informed and if you have any questions, just let us know.



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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sconan


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Hi All,

 

I'm seeking some opinions. I was treated for Hep C 1a about 3 years ago using Interferon and Ribavirin for 72 weeks. After 4 weeks, I wasn't showing much change and it took another 4 weeks to really start going in the right direction. At end of treatment I was undetectable, but relapsed at EOT + 12 week mark. I didn't really have any major side effects aside from fatigue and some irritability.

 

I am slated to start treatment with Harvoni in approximately six months (Oct 2015), since it's taking a while to work through the backlog at Kaiser. However, I recently got a call from Kaiser about doing a clinical trial using Viekira Pak + Ribavirin starting in a few weeks. Both treatments would run 12 weeks.

 

From what I can see, it looks like Viekira Pak + Ribavirin has a 1-2.5% advantage in other trials for relapsed patients with no cirrhosis. (See Sapphire I, Sapphire II, Pearl II) vs Harvoni.

 

Since I think I can tolerate the ribavirin side effects and can start earlier, coupled with the slight increase in SVR, I'm leaning towards doing the trial. I'd love to hear some other opinions.

 



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