TOPIC: Ledipasvir or Daclatasvir

So I've been reading up at it seems like Daclatasvir works better than Ledipasvir.

What do you guys reckon?

TIA

Hi Mark,

As I guess you might be expecting the answer is "It depends".

1. It depends on your genotype
2. It depends on your budget
3. It depends on whether you want large scale trial evidence (Ledipasvir has higher numbers and more accurate statistics than Daclatasvir)

It's an important decision and worth careful consideration. The problem at the moment is that Daclatasvir trial size is typically n=100 which gives an error range of +/- 10%. Even with Ledipasvir and trial sizes circa n=1000 the margin of error is still +/- 3% fixhepc.com/getting-treated/major-clinic...html#margin-of-error.

The bottom line is that they both appear good, and both work for most of the people most of the time.

Hi Mark

While there's much more data associated with ledipasvir in combo with sofosbruvir, daclatsavir has been trialled with a cohort of hard to treats, tx experienced and co-infected HIV (Ally 2). I rate both of them and have decided on the dalatasvir and will assess a 4 weeks. i haven't done this based on cost but more to do with the good data associated with no ribavirin. Flip a coin maybe? Em

Yes, if you look at Daclatasvir it is recommended for all types, including 2 and 3. Like ledipasvir it's an NS5A inhibitor so you could intuit it's a better one.

The ALLY-2 trial in HIV co-infected patients is impressive, but the numbers remain small so it could be random statistical margin of error, or it could be real.

Time will tell. I would be surprised if Daclatasvir ended up being shown to be inferior, but..... the jury is still out.

After looking at the data I'm going with sof/dac. And not really for financial reasons, I had thought of hitting it hard with sof/dac/led/rib.
I'll know in another week or so what my liver looks like and I'll skip the rib if it looks like I don't really need it. And I've got a bit of an agenda now.

So Mr. Time, here's what you can do to help humanity .... and I'm serious.

In the US dac is only approved for type 3. Gilead has been unwilling to participate in trials with BMS ... not in their financial interest.
Essentially BMS is limited here to a small subset of HCV patients. As I understand, in Europe sof/dac is approved across all types, but just how many countries are following the US lead on this? I don't know, but my understanding is that most of Gileads income so far has been in the US anyway. BMS seems content to not price compete and take their type 3 profits.

Let's push them.

If the results are as good as anticipated, and if enough of us are tracked by our good doctor here, and if he publishes his results, that uncertainty statistic drops ...... BMS just might decide to price compete. The Indian generic makers might decide to make sof/dac tabs hitting Gileads royalties. AbbVie might decide they have to price compete or miss out entirely.

What do you say?

Hi Klhide, I assume by your recent post that you're a 1a/1b hey. The sof/dac looks as good as any option and in my opinion I can't see anything in the research which indicates better results with ribavirin? I'm thinking I will watch my results and extend another 6 weeks if needed, out to say 18 weeks but will depend on my which week I become UND. In all the discussion and anticipation around which, what and who in regard to the latests DAAs there is one thing people should watch closely.....'sofosbruvir' who owns it and who is controlling the market? And who if anyone would not be compromised by the US lead pharma lobby? China maybe! Em

Just noticed that I never replied .... yes, I'm 1a. I put more details in my trip thread.

At this point I'm going to go with whatever I can get my hands on .... sourcing this stuff is taking much longer than I had expected or scheduled for.

I am getting used to waiting

Good things will come if we wait

Problem is, I'm on my trip and the clock is ticking.

Dr Freeman can't ship to me out of country, and Australia is a more expensive place than my trip was budgeted for.
If I'm going to have to go to China or Bangladesh or India to get the drugs myself, I need to know soon.

Also, my employer won't let me stay on leave forever .... I gotta do this now.

Bangladesh or India.

Results of twinvir will be out soon.

where are you located now?

I'm in a hotel about 3/4 mile from Dr. Freeman's office. He told me a couple days ago he should know what's going on with Twinvir by tomorrow afternoon.

You are in good hands.

Doctor freeman is very knowledgeable! Better than some gastro doctors i have seen

Pop in again tomorrow afternoon when I get back from this wedding and I will route you through an availability zone with the right contact on your way home. You should be able to pick up in transit and I will be able to confirm the manufacturer is good by the time you get home.

Just a curious question here:

If mesochem ledipasvir is 1100 usd, and twinvir is sof + led for 1100 usd, is it possible that there are different grades of led api available in the market? How they manage to keep the price low? ( assuming the sof + led they use work when the test results are out )