Treatment options for patients who have failed

This topic has 14 replies, 10 voices, and was last updated 7 years, 11 months ago by thirdtimelucky.

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3 March 2016 at 10:56 am #13153
Dr James
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- Guardian Angel
@fixhepc
Gaj directed my attention to this. It is a nice overview.

http://onlinelibrary.wiley.com/doi/10.1002/cld.532/full

YMMV
4 March 2016 at 2:38 pm #13283
darbara
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- Guardian Angel
@darbara
http://www.hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed

Treatment naive
F 3/4
Genotype 1 a & b
V/L 17 MILLION
Started Harvoni 11th Dec 2015 for 12 weeks
4 weeks VL UND
6 WEEKS ALT 32, AST 34
EOT 03/03 2016 ! UND
ALT 34, AST 26
04.04.2016 SVR 4
26.05.2016 SVR 12
16.08.2016 SVR 24
19 April 2016 at 7:48 am #15788
Paul-Jarman-facebook
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- Guardian Angel
@paul-jarman-facebook
More data on retreatment after failing with DAA’s, theres hope yet.

https://www.hepmag.com/article/fail-hepatitis-c-treatment-excellent-subsequent-shot

Two time relapser.

SVR 4 achieved 12/16 at last
SVR 12 achieved 22/02/2017 The Bastard has been defeated

GT 3 – about 28 yrs with HCV
19 April 2016 at 12:44 pm #15812
Hazel
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- Guardian Angel
@hazel
Looking good for us G3’s there, for a change! so far at least. Not many far enough through to really say yet but still, does look good.

Genotype 3 30 years, 2x treatment interferon/ribavirin non responder. Cirrhosis 17 years. Fibroscan, decompensating, 40 down to 22 by 29/3/16- now down to 6.5, normal, no cirrhosis. Started Buyers Club Sof/Dac 14 Nov 15. SVR 12 29/0716
19 April 2016 at 12:48 pm #15813
Ariel
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@ariel
All great
Have emailed to self all links just in case
So much good oil in this forum so reassuring xxx
4 June 2016 at 8:03 pm #18394
nobreferreira
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- Novice
@nobreferreira
Hi
1a F4 compensated cirrhosis.
24 weeks treatment Harvoni/Ribavirine
Relapse.

What to do next?

Thanks

Jon
5 June 2016 at 4:01 am #18411
Dr James
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@fixhepc
Sorry to hear that.

https://fixhepc.com/forum/relapse-corner/858-expert-opinions-on-retreatment.html

Would be a good place to start.

The exact re-treatment options will depend on where you are and what’s available.

Sofosbuvir + Davlatasvir for 24 weeks plus an NS3/4 inhibitor like Simeprevir or Asunaprevir would be a good option.

YMMV
6 June 2016 at 7:43 pm #18525
tweakmax
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@tweakmax
nobreferreira wrote:

Hi
1a F4 compensated cirrhosis.
24 weeks treatment Harvoni/Ribavirine
Relapse.

What to do next?

Thanks

Jon

You have < 25 for vl. Retest your vl soon?
10 June 2016 at 11:11 am #18802
Ariel
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- Guardian Angel
@ariel
In Australia another PBAC is approaching
This is the citation from the HepOrg (a govt funded org) re new meds for recommendation:

“Dear ****

The Pharmaceautical Benefits Advisory Committee (PBAC) will consider a new drug combination for hepatitis C treatment at its meeting in July.
The new combination medicine being considered is grazoprevir + elbasvir (Zepatier®), a once-daily, single tablet regimen for the treatment of HCV genotypes 1,3,4 and 6. Used with or without ribavirin, the treatment is highly effective in people with compensated cirrhosis.”

I’m writing a letter to recommend this be approved by the PBAC. In Australia the PBAC can move slowly so lobbying is important
Thankyou for your interest and remember there’s an election at the same time as this scheduled meet.

Ariel
11 August 2016 at 12:41 am #22076
splitdog
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@splitdog
Just thought I’d share– I asked about an HCV RNA NS5a resistance test and it is over $900 USD. They said they could do a cash price of $748. This test is specialized, not many labs can do it, and it is not cheap!

splitdog@roadrunner.com

Genotype 3
VL 4,100,000
ALT 101 AST 71
Treatment Naive
Started Sof/Dac Jan 12, 2016
VL= <15 4 weeks in. AST/ALT normal.
VL=UNDETECTED 8 weeks in.
SVR4= Virus back. 3,300,000

Started generic Epclusa Sep. 23, 2017

4 weeks in <15 *Detected.
12 weeks in <15 *Not Detected.
16 weeks in <15 *Not Detected.
Finished 24 weeks treatment 3-17-18
SVR5 <15 Not Detected.
SVR 20 <15 Not Detected.
SVR 44 <15 Not Detected.

Thank you Jesus.
Thank you Dr. James
11 August 2016 at 1:29 am #22077
fitz
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- Guardian Angel
@fitz
Considering that is roughly the price for an entire 12 week course of Sof/Vel (Sofosvel) that’s a tough choice. 12 weeks of medication or a test which may or may not inform ones choice as to which medication to use.

Perhaps this is a simplistic suggestion, or a course of action you have already taken…. If I were in your shoes, I’d be booking an appointment with Dr James to help sort out the dilemma.

Whatever your decision, you now have options and good ones Splitdog.
11 August 2016 at 1:35 am #22078
splitdog
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- Guardian Angel
@splitdog
Yes, I cannot justify that test price. I’ll have to pass. I’ve decided that I’m getting a $200 Fibroscan test, and if my numbers are good, then I’ll wait for the triple-crown of treatment—Sof/Vel/Vox. If not, then maybe Sof/Vel now.

splitdog@roadrunner.com

Genotype 3
VL 4,100,000
ALT 101 AST 71
Treatment Naive
Started Sof/Dac Jan 12, 2016
VL= <15 4 weeks in. AST/ALT normal.
VL=UNDETECTED 8 weeks in.
SVR4= Virus back. 3,300,000

Started generic Epclusa Sep. 23, 2017

4 weeks in <15 *Detected.
12 weeks in <15 *Not Detected.
16 weeks in <15 *Not Detected.
Finished 24 weeks treatment 3-17-18
SVR5 <15 Not Detected.
SVR 20 <15 Not Detected.
SVR 44 <15 Not Detected.

Thank you Jesus.
Thank you Dr. James
11 August 2016 at 6:39 pm #22097
tweakmax
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- Guardian Angel
@tweakmax
splitdog wrote:

Just thought I’d share– I asked about an HCV RNA NS5a resistance test and it is over $900 USD. They said they could do a cash price of $748. This test is specialized, not many labs can do it, and it is not cheap!

Can buy a 12 weeks supply with this $$$
11 August 2016 at 6:41 pm #22098
tweakmax
- Topics: 18
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- Guardian Angel
@tweakmax
fitz wrote:

Considering that is roughly the price for an entire 12 week course of Sof/Vel (Sofosvel) that’s a tough choice. 12 weeks of medication or a test which may or may not inform ones choice as to which medication to use.

Perhaps this is a simplistic suggestion, or a course of action you have already taken…. If I were in your shoes, I’d be booking an appointment with Dr James to help sort out the dilemma.

Whatever your decision, you now have options and good ones Splitdog.

I think Sof/Velp is good even with presence of RAVs. Probably just need to do the treatment a bit longer.
27 November 2016 at 11:50 pm #24507
thirdtimelucky
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- Novice
@thirdtimelucky
Thats pretty well where i am now. I have been recommended the Sof/Vel/Vox by a Doctor friend in the USA. Just not sure about availability and time frame. Speaking to GP2U tomorrow.
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