Help. Am I taking the right meds?

This topic has 11 replies, 9 voices, and was last updated 9 years ago by panamajo.

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9 November 2015 at 7:53 am #3539
panamajo
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- Treatment Warrior
@panamajo
Need some advice please. I am a geno 1a stage 4 cirrhosis. This is my 5th time treating. I am on Sofo/Dac + Riba for 24 weeks. I just came across an article that say’s this regime is not recommended. Tomorrow I start my 4th week and go for a PCR the week after. I’m out here on a limb in Panama with not much help from any Dr. Although I did manage a script from him, but he has no real experience with Hep C., so I am playing my own Dr. and treating myself. Any help would be appreciated.

Joanne

http://hepatitiscnewdrugs.blogspot.com/2015/10/nice-recommends-daklinza-daclatasvir.html
9 November 2015 at 8:04 am #3540
emilio
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@emilio
Hi Jo

This is the right treatment for you, some are opting out of the riba. However, based on what I know and in relation to your fibrosis and tx experience, this is spot on for you. I’ve heard others say this and believe there are so old outdated recommendations floating about. 3 weeks in hey, I’m thinking you’d be clear or there abouts. Good luck and relax hey. Em
9 November 2015 at 8:09 am #3541
Paul-Jarman-facebook
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@paul-jarman-facebook
What Emilio said http://www.hepatitisc.uw.edu/pdf/treatment-infection/treatment-genotype-1/core-concept/all

Two time relapser.

SVR 4 achieved 12/16 at last
SVR 12 achieved 22/02/2017 The Bastard has been defeated

GT 3 – about 28 yrs with HCV
9 November 2015 at 8:47 am #3542
Chester
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@chester
Ditto.

I think the recommended/not recommended in that article pertains to $s not what is recommended from a purely medical point of view. But I think you may have misread the table too (not hard to do- it isn’t very clear).

To me it says that if you’re geno 1 with compensated cirrhosis and interferon ineligible/intolerant, then it is recommended.
9 November 2015 at 12:03 pm #3550
klhilde
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@klhilde
Me too.

If I remember right, before discounts to various insurers, in the US Harvoni is $94,500 … while Sovaldi alone is $84,000 and Daklinza is $60,000 for a total of $144,000.

Assuming a similar price ratio in England, and assuming the government is picking up the tab, they’ll advise for Harvoni. And I also wonder how old this recommendation is …. interferon is still on there, and it shouldn’t be!
9 November 2015 at 12:42 pm #3551
Paul-Jarman-facebook
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@paul-jarman-facebook
I was discussing this with my wife today that some approved drug recomendations being the more frugal option, not nesseserily the best.

Two time relapser.

SVR 4 achieved 12/16 at last
SVR 12 achieved 22/02/2017 The Bastard has been defeated

GT 3 – about 28 yrs with HCV
9 November 2015 at 12:56 pm #3554
tweakmax
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@tweakmax
There are a couple of people on fb group type 1a using sof + dac and even riba. Their results are quite good (undetectable at week 4) do continue with your treatment please. Refer to Dr freeman’s cheat sheet for monitoring if your gp do not know what to do
9 November 2015 at 6:10 pm #3575
Dr James
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@fixhepc
You are on a good treatment. See: http://www.hepatitisc.uw.edu/pdf/treatment-infection/treatment-genotype-1/core-concept/all and page 8/21 Personally I would be on 24 weeks Sof/Led for the reduced sides but 24 weeks Sof/Dac is equivalent and the Riba is a mild booster – don’t panic if you have to drop/reduce to dose of Riba.

Here are the stats about VL=0 versus time on treatment:

http://fixhepc.com/forum/experts-corner/287-viral-load-on-treatment-what-to-expect.html

YMMV
9 November 2015 at 8:26 pm #3578
dointime
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@dointime
The AASLD updated their guidelines recently:

http://www.hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed

dt
10 November 2015 at 4:16 am #3588
miko3
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@miko3
Thank you to all for posting the latest guidlines,and best wishes to PanamaJo on your journey,but there is something that puzzles me.
It seems the evidence is there that in this particular case sof dac riba for 24 wks is a recommended tx.
But one presumes that by wk 12 vl is 0, amd continuing for another 12 wks is a proven choice when cirrohsis is present.
But why add the riba for the extra 12wks.I would presume that by this time the continued use of riba , considering it is a very weak DAA is adding very little compared to the first 12wks of its use.When one considers the negative side effects of riba on the rest of the body,is its continued use justified?I have so far been unable to find any statistical evidence justifying its use beyond 12wks,or is just wild speculation that excessive overkill is best,without any real data.
If the data is there I would love someone to point to it.

Gen 1b 40yrs,tx naive, f3/f4.VL too high to quantify.
Started tx 12Oct.sof and riba India via greg.Dac from Mesochem.
4wk result virus not detected,all liver functions in normal ranges.
Only SE intermittent insomnia.Feel great and grateful otherwise
10 November 2015 at 4:39 am #3590
dointime
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@dointime
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20Flipped%20Classroom/CCO%20Slideset/HCV_Management_Slides.aspx

You need to register for free with this site to get the slides.

While this set of slides does not exactly answer your question, it does provide a lot of detail on the treatment of cirrhotics. All the slides I looked at showed that if ribavirin was used at all then it was used for 24 weeks. Maybe there is no good clinical reason for that, just the way the trials were designed that produced the data. I don’t know.

dt
10 November 2015 at 7:18 am #3593
panamajo
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@panamajo
Thank you, everyone, for responding. I feel much better now. I know I read reams of info before purchasing, but when I saw the article, panic set in. I was really hoping tp do 12 weeks of Riba, but think I will stay on it for the 24 weeks. The big Liver meeting is this weekend, so hopefully more data will be coming our way. Once again, thank you all!
Joanne
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