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TOPIC: TREATMENT RESISTANT TREATMENT

TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14233

GT 1a with Cirrhosis and Failed 4 previous interferon / Ribavirin treatment.
Has anyone done 24 weeks Sof ,Led & RIba followed by 12 weeks of Sof & Dac ?
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HCV Genotype 1a
2003 Relapsed Peg Interferon / Ribavirin
Pre treatment VL 2,000,000
ALT 65, AST 42, ALP 111, GGT 56
Bridging F3-4
Treatment -24 weeks - Sof , Led with 12 weeks Riba.
4 weeks VL <12 Detected ALP 89 , GGT 21 , ALT 17 , AST14
12 weeks VL Undetected ALP 96, GGT 22, ALT 20, AST 20
24 weeks VL Undetected ALP 83, GGT 20, ALT 21, AST 14
EOT 6th April 2016
SVR 5 weeks VL Undetected ALP 81, GGT 31, ALT 22, AST 20
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14246

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Daclatasvir will deal with the L31M RAV. Ledipasvir won't. For my money Sof + Dac is the way to go.

If you want to add in I would consider Simeprevir or Asunaprevir to attack the NS3/4A side of things.
YMMV
Last Edit: 3 years 4 months ago by DrJames.
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14295

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Are you asking if anyone has done more than 24 weeks treatment Michael?

I'm GT1a, did 12 weeks Sofo/Led and now doing 12 weeks Sofo/Dac, but I'm not sure if I've heard of anyone doing 36 weeks.

My very best wishes for your successful treatment this time, I can't imagine how 4 failed treatments must have felt and my heart goes out to you. You must be a strong one to deal with all that! Still, a whole new approach with this treatment hey - and looking very good for you at <12 4 weeks & now UND : +1: How long do you have to go?
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
Last Edit: 3 years 4 months ago by LondonGirl.
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14304

Hi London Girl,
I've done this post for a friend that is facing this decision.
She has already done 21 weeks of Sof, Led & Riba & has another 12 weeks of Sof & Led but as her LFT's are going up, she is very concerned that the virus needs another DAA to be sure.
Yes, she has done 4 failed 12 month treatments.
So she feels that these new DAA's are her last chance.
AUSTRALIAN
HCV Genotype 1a
2003 Relapsed Peg Interferon / Ribavirin
Pre treatment VL 2,000,000
ALT 65, AST 42, ALP 111, GGT 56
Bridging F3-4
Treatment -24 weeks - Sof , Led with 12 weeks Riba.
4 weeks VL <12 Detected ALP 89 , GGT 21 , ALT 17 , AST14
12 weeks VL Undetected ALP 96, GGT 22, ALT 20, AST 20
24 weeks VL Undetected ALP 83, GGT 20, ALT 21, AST 14
EOT 6th April 2016
SVR 5 weeks VL Undetected ALP 81, GGT 31, ALT 22, AST 20
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14322

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Ah apologies, brain-fog moment.

I can understand how your friend feels really wanting to do all she can this time around.
So, she has done 21 weeks Sofo/Led and is doing another 12 Sofo/Led on top? That's a long treatment period, maybe her liver is complaining regarding the amount of meds? but this is only a thought, with the Riba too, it must have been tough on her system.

All I can offer is my own experience which is I did Sofo/Led for 12 and am now in the next 12 with Sofo/DAC - I am also GT1a but treatment naive. What I can tell you, is that since I have changed to Sofo/Dac I feel much better and re-energised, it is only instinct and feeling better that tells me this medicine suits me better, so not a fact. It could be an absorption issue, or possibly genetic RAVS but on researching those, I don't seem to fit the picture as many seem to be connected with fatty liver etc and I am the opposite, I don't seem to absorb fat .properly. It's complex. There are some people who have issues with Sofo/Led from what I have read. Nearly all advise is geared towards fatty liver and very little regarding the opposite. Did your friend lose weight pre tx ? has weight-loss been an issue for her at any point? I started to put on a little weight during treatment with Sofo/Led and have a huge appetite on the Sofo/Dac - Just want to eat all the time! Really, I guess we don't really know why this happens, but can try small adjustments to address the issue. I am told there are less aborption issues with Sofo/Dac.

I was also advised to take Digestive enzymes - I take them the opposite end of the day to Sofo/Dac with my main meal, I feel these have really helped, but again, it's just a feeling and not a fact.

During treatment I got a chest infection and had to take antibiotics, a course of probiotics (taken again at the opposite end of the day to the meds) may have corrected something or other and I felt they really helped me too. I believe Riba can upset the digestive system, stomach area, maybe she could get advise on these things? I read somewhere on Twitter just yesterday (so a new thing) that antibiotics can mess up the absorption of medicines and are particularly not recommended on the Abbvie treatments (but could they also affect other treatments too?) . Did your friend have to take antibiotics at any point?

Well, I can only offer small things that may or may not help, but may be of interest. to your friend. I wish her every success this time around, please let me know how she progresses and send her all my best.

lg
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
Last Edit: 3 years 4 months ago by LondonGirl.
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14347

Thanks London Girl,
I've passed these comments onto her.

I hope the Sof & Dac are giving you good results.
Have you done another VL ?
AUSTRALIAN
HCV Genotype 1a
2003 Relapsed Peg Interferon / Ribavirin
Pre treatment VL 2,000,000
ALT 65, AST 42, ALP 111, GGT 56
Bridging F3-4
Treatment -24 weeks - Sof , Led with 12 weeks Riba.
4 weeks VL <12 Detected ALP 89 , GGT 21 , ALT 17 , AST14
12 weeks VL Undetected ALP 96, GGT 22, ALT 20, AST 20
24 weeks VL Undetected ALP 83, GGT 20, ALT 21, AST 14
EOT 6th April 2016
SVR 5 weeks VL Undetected ALP 81, GGT 31, ALT 22, AST 20
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14348

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Hi Michael, Just picked up the form from GP for next VL test, hopefully early next week to check out the latest. I must confess to having some nerves ;)

Will post as soon as ......
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14352

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I'm Geno 1a stage 4 and have previously treated 4 times. I just finished my 5th round of treatment last week with 24 weeks of SOV/DAC + RIBA. I go for my PCR in mid July. Praying that I clear!
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14354

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to those who treated before
#flower I pray also that this works for you #flower
gt 1a VL 6m
F2/3 FibroScan - 9KPa in 2011 and 7KPa in 2015
sof/dac 10 December for 12 weeks
pre tx alt 85 ast 51
4 wk alt 34 ast 31 UND <35
8 wk alt 29 ast 32 UND <15
12wk alt 25 ast 25 EOT 3.3.16
SVR24 UND KPa5.3 F0 in normal range
I am well
.forever grateful to fixhepc
Last Edit: 3 years 4 months ago by pat1.
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TREATMENT RESISTANT TREATMENT 3 years 4 months ago #14362

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Thank you Pat1 you know this means so much to me, your uplifting kindness and understanding of the other tx is so appreciated. There are not words for what we all tried to achieve yet failed. and it is so thoughtful of you to uplift that inbuilt anxiety now that none of us ever knew would be the legacy. It is there all the time sadly, and so I have to be very strong minded and spirited to get on top, all sorts of strategies, breathing , thought distraction oh so many techniques...
Ariel #love #love #love
Gen 1a
Peg/inf/riba 2012(!) stop @ Wk 43 potassium low +issues (rlps week 4 post tx, VL120,000) scnds eg. adenomas.
pre sof/led VL 240,000 Fibsc F0
Day 25 <30
Day 32 UND
Week 10 UND
EOT UND ALT11AST17GGT19
SVR4 UND ALT10 AST16 GGT13
SVR8 UND ALT <9 AST16 GGT15
SVR12 UND ALT14 AST19 GGT12 Bili 5
EOT +18 ALT13 AST20 GGT9 Bili 5
EOT +21 ALT11AST15
Cured SVR12
Dysplasia Adenomas RemvdAug '16
SVR24 UND ALT11AST16
ColonoscopyClear Nov17
LumpectomyClear ‘18
LithotripsyCytoscopyBiopsy 4/18
Last Edit: 3 years 4 months ago by Ariel.
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TREATMENT RESISTANT TREATMENT 3 years 1 month ago #18462

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Also geno 1a stage 4-lifetime non responder-finally cleared on sovaldi-olysio,relapsed.Did 24 weeks of just harvoni after that,cleared,relapsed.Now im finishing month 3 of 4 months of Zepatier and ribavirin.NUmbers are very good except I cant clear.1st bloodwork I went down to 18,0000 and 2nd bloodwork showed quantification went up to 32,000.Frustrating part is the numbers will go right back up to the roof once I stop and I cant qualify for any trials because my platelets get too low and my bilirubin gets too high.My family needs me,I would sell my soul to find the right medication.
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TREATMENT RESISTANT TREATMENT 3 years 1 month ago #18466

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May need the nuke to get cleared: sofosbuvir
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TREATMENT RESISTANT TREATMENT 3 years 1 month ago #18468

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Ya, I'm not a doctor, but I gotta agree with tweakmax ... Zepatier is an NS5A inhibitor paired with an NS3/4A protease inhibitor ... so should maybe have an NS5B inhibitor to make it fully effective.

Edit: I repeat that I'm not a doctor ... and I haven't memorized the RAVs and their specific drug relationships, but if by chance your RAVs are related to Sofosbuvir resistance, you might check to see if they are also resistant to Dasabuvir.

And you might want to check this thread:
fixhepc.com/forum/daa-access/471-mesoche...-of-sof-dac-led.html
Last Edit: 3 years 1 month ago by klhilde.
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TREATMENT RESISTANT TREATMENT 3 years 1 month ago #18614

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Ya, I'm not a doctor, but I gotta agree with tweakmax ... Zepatier is an NS5A inhibitor paired with an NS3/4A protease inhibitor ... so should maybe have an NS5B inhibitor to make it fully effective.

I am a doctor, and you are both right. Zepatier + Sofosbuvir is a sensible 3D (3 drug regimen) that targets NS3/4A, NS5A and NS5B. According to the Liverpool interactions checker there are no drug-drug interactions to worry about so it should work well.

Other 3D combinations for GT1 that can be source at affordable prices would be

Sofosbuvir + Daclatasvir + Simeprevir
Sofosbuvir + Daclatasvir + Asunaprevir

The Sof+Dac would be generic. The Simeprevir and Asunaprevir would be originator but from Egypt and Russia.
YMMV
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TREATMENT RESISTANT TREATMENT 3 years 1 month ago #18929

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Hi Michael,

How is your friend doing?

I was UND between 2-4 weeks on the Sofo/Dac. Dr Freeman recommended I add Sunprevir for 4 weeks towards EOT. I'm waiting on VL result taken at 24 weeks. Feeling rather 'drugged' but very manageable. I do hope your friend listens to the advise from Dr F on this site and hope all is well with her.

LG
GT1a Dec14 F2/8.7 VL 900000-2.5M
Jan16 Hepcivir-L MonkMed/Redemption
Baseline: VL 913575 Alt 76 Platelets low
Wk2 VL1157 Alt 23
DET Wk 8 VL 32 Alt19 'In the slow lane'
June16 Fibro 5.7 F0/1 LIF 1.5
Wk 11 VL<12 Alt 13 Det/Unq
Extending tx 12 wks Mylan Sofo/Dac MonkMed
Wk 14 VL <12 Det/Unq
Wk 16 VL UNDETECTED
Wk 22 + 4 Wks Sunprevir FixHepC
Wk 24 UNDETECTED Alt 13
Wk 12 post tx SVR12 Wk 26 SVR24
Thank-you Tim, Dr Debasis @ MonkMed & Dr Freeman @ Fix HepC
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