Welcome, Guest
Username: Password: Remember me

TOPIC: Expert Opinions On Retreatment

Expert Opinions On Retreatment 3 years 7 months ago #13663

  • DrJames
  • DrJames's Avatar
  • Offline
  • Platinum Member
  • Posts: 1864
  • Thank you received: 6898
  • Karma: 102
Sorry you're here. Please have a look over in the Experts Corner for the latest expert advice on retreatment.

fixhepc.com/forum/retreatment-corner.html

Don't let the fact your first treatment did not bring the results we hoped for cause you to lose hope. Most people who retreat will clear.
YMMV
The administrator has disabled public write access.
The following user(s) said Thank You: LondonGirl, Kiwi66, nobreferreira, hanknassi

Expert Opinions On Retreatment 1 year 8 months ago #25965

  • sabrecat
  • sabrecat's Avatar
  • Offline
  • Elite Member
  • Posts: 259
  • Thank you received: 739
  • Karma: 10
Hello all,

I needed to be retreated quite a while back and am now virus free to date.

Need LFT's done again in June and as I am still fit fighting fit so I expect my liver is okay virus wise.

Been lucky with liver scans to date as well.

I was looking through the list of sub categories in this topic and all the posts are months and years old.

Just wondering if treatment had got to the stage where treatment failures are now uncommon.

Maybe 'retreaters' like me have gone the way of the Dodo? If so, well and good.


Jeff
GT3a 1990 Failed Inter 1998, comb in 2000. HCC 2012
Started 24/52 Sof/Dac 27th October 2015.
1. Bloods 2 October 2015: AST - 165 (20-40), ALT - 265 (5-40), GGT 189 (5-50)
2, Bloods 20 November 2015: ALT etc normal; VL 19
3. Bloods 8 January 2016: AST - 40, ALT - 59, GGT 48 VL RNA UND
4. EOT 12 April 2016 - blood tests: all is well, CT scan: okay
5. AFP 11 June 2016: 4 ref< 11
6. VL July 2016: DET
7. Oct16 start treat - June17 UND
8. Jun 18, lfts okay, platelets a bit low.
The administrator has disabled public write access.
The following user(s) said Thank You: DrJames, coral, Hazel, hanknassi, Mar

Expert Opinions On Retreatment 1 year 8 months ago #25971

  • Mar
  • Mar's Avatar
  • Offline
  • Administrator
  • Posts: 233
  • Thank you received: 625
  • Karma: 10
Hi Jeff, glad to her of your re-treatment success, that's really great. I believe that treatment failure with the new medications (and their good quality generics) is less than 10%, which is amazing, especially compared to the older medication failure rate of 60%.
The administrator has disabled public write access.
The following user(s) said Thank You: DrJames, sabrecat, Hazel, Mnem, hanknassi

Expert Opinions On Retreatment 1 year 8 months ago #25988

  • coral
  • coral's Avatar
  • Offline
  • Platinum Member
  • Posts: 579
  • Thank you received: 1718
  • Karma: 32
Hi sabrecat,

You were one of my fellow retreaters and I'm so happy that the virus is gone and things are going so well.

As Mar said the treatments have a good success rate although realistically there will still be a small percentage of relapsers. Posts like yours are great to remind us that there are so many options now for the very small percentage like us that don't beat it first time around.

Great news sabrecat.

Coral
G1a probably early 1980's, Biopsy F1(2010), F2-F3(2015). VL 5+mill; 2+mill (2014) Tx naive. Accessed Sof/Led through Dr Freeman at GP2U and Buyers Club (lifesavers!!!)
Commenced tx 12/11/15. 9 wk: VL <15 Detected but LFT = Normal 12 week results: UND (Yay!) Due to slow response commenced Sof/Dac 4 Feb for 12 weeks. EOT @ 24 weeks 27 April 2016. (With thanks to Dr Freeman et al). SVR11 result: VL 1,950,000. It's back!
New tx 030916 (Viekira Pak, Solvadi, Ribavirin UND @ 111116. EOT 170217.
SVR12 and SVR 24...
The administrator has disabled public write access.
The following user(s) said Thank You: sabrecat, Hazel, hanknassi, Mar

Expert Opinions On Retreatment 1 year 8 months ago #25999

  • DrJames
  • DrJames's Avatar
  • Offline
  • Platinum Member
  • Posts: 1864
  • Thank you received: 6898
  • Karma: 102
Maybe 'retreaters' like me have gone the way of the Dodo? If so, well and good.

Hi Jeff,

Nothing has really changed in terms of success rates although going a little longer in GT3 definitely helps.

The peak of originator DAA use was around 2015Q2 - 2016Q1 when there were around 160,000 patients being treated each quarter. In 2017Q4 that number was 80,000 so over the last 2 years, the number of people treating with originator medication has fallen to 1/2 what it was. The situation for generics appears similar and we only help about 1/2 as many people as would have been the case a year ago.

So the major reason is there are less people treating so fewer people relapsing.

Another reason you don't see much here is that most of the hard cases (cirrhotic past treatment failure) have either been successfully treated or died. This leaves a relatively easier population to treat where the SVR rates are over 95%.

The other significant change is that 3 years ago I was one of the only doctors prescribing generics. Over time other doctors have seen the results themselves and started prescribing and of course, have had relapses. The conversations have tended to be in the background involving me the patient, their doctor and sometimes others. Mostly we've settled on adding Sofosbuvir to Viekira or Zepatier or adding Asunaprevir or Simeprevir to Harvoni or Sovaldi/Daklinza to produce the Vosevii you have when Vosevii does not exist. Anyone who has worked with HIV understands that 3 drugs (targets) are much better than 2, however, the guidelines (both AASLD and EASL) and the various government/insurance funding requirements, and to a degree ethical and medicolegal considerations, dictate this is better done on the QT with informed consent from those that need to know.

Almost all the patients who relapsed the first time have been successfully retreated the second time. There are a couple of exceptions - one who failed 12 weeks Sof/Dac and then 24 weeks Harvoni who cleared on 24 weeks Viekira/Sof/Riba. Another GT3 who is still on maintenance Sof/Dac while we wait for something better (they were bucket list unwell prior to treatment and travelling well on HIV style maintenance).
YMMV
The administrator has disabled public write access.
The following user(s) said Thank You: coral, sabrecat, hanknassi, Mar

Expert Opinions On Retreatment 1 year 8 months ago #26015

  • sabrecat
  • sabrecat's Avatar
  • Offline
  • Elite Member
  • Posts: 259
  • Thank you received: 739
  • Karma: 10
Thanks for this information. In the course of reading it, I stumbled with the term "originator DAA’s" so I googled the term and come across the following article relating to South Africa:

medicine-access.pointofcarejournals.com/...9a-a40b-95d9d7f566df


All the words and terms are there: affordable, generic, Gilead, patents, and an already burdened health care, system.

From the abstract:

In time, access to lower prices for some originator DAA therapies has materialized; however, to many, this still may be out of reach. Generic medicines for hepatitis C do work and are effective and affordable. If we are going to achieve the objective of the elimination of viral hepatitis, generic medicines will need to form part of the solution.

It took me back to thinking about the many issues that had been discussed on this forum over the years.

Yours all,

Jeff
GT3a 1990 Failed Inter 1998, comb in 2000. HCC 2012
Started 24/52 Sof/Dac 27th October 2015.
1. Bloods 2 October 2015: AST - 165 (20-40), ALT - 265 (5-40), GGT 189 (5-50)
2, Bloods 20 November 2015: ALT etc normal; VL 19
3. Bloods 8 January 2016: AST - 40, ALT - 59, GGT 48 VL RNA UND
4. EOT 12 April 2016 - blood tests: all is well, CT scan: okay
5. AFP 11 June 2016: 4 ref< 11
6. VL July 2016: DET
7. Oct16 start treat - June17 UND
8. Jun 18, lfts okay, platelets a bit low.
The administrator has disabled public write access.
The following user(s) said Thank You: coral, hanknassi, Mar
Time to create page: 0.131 seconds

Copyright © 2015-2019 FixHepC

Back to Top