Hi Mike,

the message I seem to be getting from Ronald Koretz, MD about SVR is that Peg interferon may have done more harm than good??

Otherwise he seems to raise some good points about how this virus will do its best to survive.

Me being F3 in 2012, now probably F4, I have to rely on a common sense view that largely getting rid of the virus and therefore keeping my LFT’s etc under control gives:

1. a small chance that liver and recurrence of a HCC wise, things might get better
2. an assumption that it may slow down the above getting worse.
3. a better quality of life on the way through.

The talk also seems to re-inforce the idea to get treated early before damage occurs. Another thought for me being an early non coper with Interferon is that I may have been lucky – Ronald Koretz, MD’s early part of the talk did not seem to sing its praises too well and my partner at that time comparing it to giving a dog arsenic to cure heart worms come to mind.

yours with thanks for fishing these threads out for us to read.

Jeff.

Well Tim,
Someone has to mind the store, I suppose, and it couldn’t be left in better hands…
I feel very, very fortunate that interferon was never an option for me. My disease was diagnosed right after Sovaldi and Olysio were first being prescribed “off-label”.
I assume I would have gone for the interferon tx if I had been diagnosed, say, 10 years earlier.
I will never truly know.
My heart and soul go out to those brave, desperate people who went through that hell, only to be unable to tolerate that poison, relapse and/or suffer permanent physical and psychological damage as a result.
It is one reason I am doing what I do now. I am cured. The problem is not. I don’t plan to stop until that situation is resolved.
The senseless restrictions on these new treatments, based on obscene pricing, is simply criminal.
It shames the whole concept of America and what she used to stand for.
M

Politics-
It provides job security for liars, cheats and ego maniacs.
I don’t think they could find work elsewhere.
M

Hi Jeff,

Thanks for highlighting Ronald Koretz’ article. I had previously dismissed it based on the blurb and first few seconds of the video but your comments made me return to it. He is obviously an outlier of the HCV field in many ways but that is not necessarily a bad thing if it encourages others to review their positions and actions.

Personally I disagree with what appears to be his main contention; that because there is not a complete alleviation of all progression of liver disease in all patients after SVR then it is not a cure. I get his argument that Interferon+/-Ribavirin was not always beneficial and has ongoing problems for many patients (hah, I’m a walking argument for that proposition) but I believe that was well known but certainly not universally acknowledged in the Hepatology community for a long time. Interferon was always seen as less than benign in other fields were it was used too but was usually the only option available at the time. However, for him to extraplolate that to the current use of DAAs is a big leap based on the evidence so far. I think that while it is early days for DAA treatment, the benefits we are seeing accrue for the many outweight the possibility that for a few the outcome won’t change. As he would ask of others, where is his evidence to support his current position? Having said that I do agree with his points about evidence based medicine rather than just marketing driven and that does mean long term follow ups. That is how we learn and progress science/medicine.

In the meantime I agree with your three points of benefit, though I suspect you understate the first. The evidence seems to be building that while it doesn’t completely remove the risks there is a significant risk reduction there. The third point is the real winner though!

Edit: beachs, good point about his hymn sheet. As I said, a review of his history shows him to be an outlier though I didn’t find much about his drivers. Hopefully an enquiring mind but???

Some of us take longer Hazel, but I didn’t have to go through Interferon – Thanks to Greg J, Dr F & MonkMed.
So glad to see your UND there on your profile

Still waiting for mine, (delays at lab this week – annoyingly!). UK medics consider my <12 'job done' - We shall see.
My very best wishes to you.
Stay well.
lg

(edit) Dear Tim, I am not surprised you & Dr Debasis are so busy You both take such an interest in your patients and speak at length with every one of us who have concerns. I want to write a BIG public thank-you to you both

pps : Here's the official Redemption Trials link again for anyone Tweeting in support of Dr Freeman today #ILC2016 :
https://www.clinicaltrials.gov/ct2/show/NCT02657694?term=redemption&rank=1

Hi Serg, I see this as the point being made possibly?

what justification is there for the gargantuan prices of these drugs?

What treatment helped your difficult to treat friend reach SVR in the end?

I agree there is much more detailed research to be done, I guess this just the beginning.

btw – Portugal treated everyone with HepC and have reported 96% SVR at ILC2016 I believe. So you could say they did a massive trial!

Hi Serg,

Well yes, apparently Roy M. Poses MD has those beliefs. Again I’m unable to find any evidence provided by him to back them up. Maybe a cautionary canary in the mine? Possibly but there don’t appear to be large numbers of other medical professionals taking a lot of notice of his song.

The best evidence available suggests that most patients with hepatitis C will not go on to have severe complications of the disease (cirrhosis, liver failure, liver cancer), and hence could not benefit much from treatment.

Hmm, so most patients who don’t have the three HCV related complications he mentions will get no benefit from treatment because their complications aren’t severe enough? Maybe he has “evidence based medicine” that shows that F3 patients lead a perfectly normal, active, healthy life with no ill effects? Perhaps he has been provided with enough “evidence based medicine” to prove to his satisfaction that no extrahepatitic manifestations of any kind occur?

For the rest of his arguments all I can do is thank him and tell him I will take his caution under advisement. No doubt I and most of the rest of the world will get on with the great experiment of living. By doing so and taking what appears to be the best option available currently we will gradually build up the “large scale trial evidence” he apparently requires before he makes decisions. Of course this may take a few decades but personally I don’t have time to wait.