So enough results are in, and out of embargo so now I can say what I was dying to say at the time, well actually…..

Generic Sofosbuvir + Ledipasvir delivers damn good SVR rates and we repeated a trial Professor Gane did (26/26) with Sof+Led+Riba in GT3 and got 13/13 = 100% SVR – please don’t get excited this was in treatment naive low fibrosis GT3 only and the +Riba was essential.

Here is the data: http://fixhepc.com/forum/media-news/914-easl-slides-94-4-svr4-overall.html

Thank you Dr. J, but I was wondering if you think it’s OK to not have the Ribas with the Sof/Dac meds for my War Vet friend, G.T. 3a 2nd liver transplant. Had failed Ifn/Riba tx in past.

He’s on the PBS orals, under the care of his specialist, but I don’t think they are really “caring” enough.
He has been on it for 2 weeks now ( Sof/Dac no Ribas)& he is SO tired and kind of “out of it” most of the time.
He going to be on it 24 wks.

He’s not meant to have another blood test ’till week 4.
Does anyone think he should be getting checked more often?

Surely they’d want to check his rejection drugs are working ok with the tx??!!

I do feel sorry for him, why is everything such a hassle, why wouldn’t they just check him more often, why do we have to hassle them.
Surely they should just monitor him more closely?

WHY aren’t more doctors like DR. Freeman??

Can anyone tell me if it’s normal to feel VERY TIRED from the drugs?

x

Can anyone tell me if it’s normal to feel VERY TIRED from the drugs?

My observations are:

1) The closer people are to the edge the longer it takes to drag them back
2) The usual 1 week “a bit under the weather” on treatment initiation is more like 2-4 weeks in cirrhotics
3) Cirrhotic viral loads, enzymes and bilirubin take longer to come good, and platelets take even longer

The reality for some people is that treatment arrives too late to drag things back, and transplantation will still be required.

I have one patient like that. He was in ICU when we started treating him 6 months ago, and has no viral load, but his liver was/is so shot he’s now on the transplant list. Without generics he would have been on the casualty list.

There’s a bit of evidence that Ribavirin produces a scant few % points improvement in SVR in 12 week treatment for both GT1 and GT3, but there is also evidence that extending the duration adds more % points.

There is nothing to guide taking it at the end of treatment. What often happens is that it gets taken until the sides get to bad then stopped. The big problem is we don’t exactly know how it works.

You don’t say if you’re GT1 or GT3 in your signature. In your favour is low starting viral load, F0 and womanliness.

If you’re paranoid and losing sleep over things a few extra weeks of Sof+Dac 4-6 or even 12 does deliver slight improvements in SVR.

The duration is a case of diminishing returns. Each extra week adds less and less extra SVR and you have to draw the line at some point.

If you were GT1 I would say don’t worry. With GT3 a few extra weeks are not a bad idea for many people, but you are really at what should be the “very easy” end of the spectrum.

I’d expect you to SVR with 12 weeks but if you’re tortured with worry and can arrange it adding 4 weeks would not hurt and adds a little insurance.

Dr James,
Thanks for clarifying the above..

If an additional 4 weeks adds a little insurance for success…I’m there!!!

Gane needs to clarify his remarks. He made a very vague attack against generics from Bangladesh. But research shows generics from Bangladesh are made from API’s from China.

Interestingly, Gilead admits some of it’s ingredients are API’s from China. So I challenge Gane to come forward with the origin of the Gilead “superior” API’s. Because I say that “perhaps” Twinvir and Harvoni are made from the same API’s.