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Avatar universal

Hepcvel?

Hello and Happy and healthy New year to all of you!
My husband started therapy 5 months ago with Epclusa. He was treated before, 2 times and relapsed.  now, when he finally bought money for the purchase of the drug("Epclusa"), he heard that there was a lot cheaper therapy  called "Hepcvel".What is the difference between this medicines? I feel like he's blaming me, cause I recommended and find Epclusa in our country didn't knew that there was cheaper cure for hep c ..Now I am interested Is it possible that quality is better in Epclusa..than that choice is right!? Thanks a lot if someone has idea..
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Avatar universal
Hepcvel is the Generic form of Epclusa.
Different countries are now manufacturing generic forms of the Originater medications.
I believe the one you mentioned is Manufactured in India.

There has been studies done on some of the Generics and for the most part it seems they are as efficacious as the Originals , however frankly if it was me and afforadability was not an issue I would feel more confidant in the original manufactured by Gilead.

You say he has been taking Epclusa for 5 months?
Most regimes for that drug are  12 wks.  (Unless possibly he is Genotype 3 with chirrhosis)
Helpful - 0
683231 tn?1467323017
What treatments did he fail previously? Did he fail interferon treatment in the past or did he fail one of the new DAA’s like Harvoni?

Did he treat twice with two of the new DAA’s and fail? All that would have an impact on duration of treatment along with his genotype and if he has cirrhosis.

On the American Association for the Study of Liver Diseases (AASLD) web page

HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

I could not find any information for any genotype, prior treatment status and liver cirrhosis that was longer than 16 weeks most were 12 and only some were Epclusa often Vosevi was mentioned. There is an extensive list of recommendations depending on genotype, prior treatment, if he has any resistance factors like NS3 protease inhibitor or NS5A inhibitor, and cirrhosis status.

On the prescribing information sheet for Epclusa there are only two treatment regimens listed:

Treatment-naïve and treatment- experienced, without cirrhosis and with compensated cirrhosis

12 weeks of Epclusa

And

Treatment-naïve and treatment- experienced, with decompensated cirrhosis

12 weeks of Epclusa with Ribavirin
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Treatment-naïve and treatment- experienced, without cirrhosis and with compensated cirrhosis

12 weeks of Epclusa

And

Treatment-naïve and treatment- experienced, with decompensated cirrhosis

12 weeks of Epclusa with Ribavirin

---------------------------------------

This is correct Lynn by AASLD guidelines as you suggested,however EASL's guidlines (which many Physicians around the world follow) Epclusa is not recommended for anyone w/GT 3 and chirrhosis.

It is recommeneded  Vosevi (12wks.) or Mavyret (16wks)

The reason I asked the OP if he was "possibly GT 3 w/ch   was maybe his doctor prescribed Epclusa for a longer period.

Not ideal ,but thought possibly that is what happened.


He was treated with ribavirin, not DAA meds..and he has cirrhosis. His hepatologist ordered him 6 months therapy, couse he relapsed before. Is it dangerous that therapy last longer? He feels ok, alt and AST are good, only leukocytes and platelets are low..
Abraksas
What genotype is he?
He is Geno 3
So,I thought that might be the case when you mentioned the 6 months.

The AASLD recommended for GT 3 w/ch is Epclusa  12wks.with Riba added and the Easl ( European)  recommended for that situation is either Vosevi 12 wks. Or Mavyret 16wks.

So.... 24 weeks of Epclusa without Riba is an off label regime according to both  Organizations.

Is it enough? Good question

As far as being dangerous. ?

Given you said he is tolerating it well  in the short time , most likely not .

He may want to query the physician why this was the regime he chose.
Just curious as ribavirin is not a stand alone medicine as far as I am aware was it interferon injections with ribavirin? Or what other med did he take along with ribavirin?
Well, am not sure, it was combination of 3 medicines, one was Ribavirin..maybe Pegasys. He felt very bad, now he feels like he doesn't take anything, sometimes just a slight headache..
Ok yeah that was the old interferon treatment one shot a week of interferon along with ribavirin and maybe incevick or victrelis most likely. Got it
Pegasys is pegalayted interferon an improvement from interferon Alpha where you needed three shots a week with Pegasys you only needed one shot a week.

I treated with both interferon Alpha and pegasys with ribavirin but never took incivick.
Yes those old interferon treatments were difficult to endure. I treated a total of three times with interferon based treatments each was 6 months in duration.

In comparison my treatment with Harvoni was very easy. I almost felt like it maybe wasn’t working. I felt somehow I needed to suffer to be cured. But these new meds really do work. They are very effective and the majority of patients are cured even folks like me who failed multiple treatments and have cirrhosis.
Abraksas
Good luck to you and your husband. Epclusa is an excellent drug.
Possibly his physician did not prescribe Riba with it as that may be also one of the drugs he had side effects with. Many have struggled with it in the past.
With extending the Epclusa , he should do fine.
Please drop back in if you have a minute down the road as I for one would be interested in hearing about his success on this regime

Thanks Flyinn and Wilbb, I hope this will beat that beast-HepC! I will let you know when time comes...Good luck and happy new year!!! Love and Peace <3
Two pills left, and the therapy of 24 weeks will be over, but my husband will take 20 more, because he thinks that will be more efficient ..now I am wondering can it be dangerous? His doctor agreed because he sow how determined he is. He feels slight pain in liver and right shoulder almost everyday now, but still He's determined to drink all these pills..


How does he have 20 pills left when you say he has 2 pills left?

But anyway personally as a non medical person so my thoughts as a patient I really doubt it will make any difference to his health or his treatment results whether he takes additional Epclusa for another 20 days or he doesn’t. As long as his doctor says it’s ok since we here are not doctors so cannot offer medical opinion.

The only thing that will prove him cured is the test at least 12 weeks after taking his last dose.

Best of luck
It Is complicated to explain. He was told he has to take pills 6 months, but there was 28 pills in every box. Then  he calculated how much he still needs up to 6 months, and that's it. He bought 20 more. Then he will take that test. I hope it will be no harm from taking more..but if he relapsed, then I am afraid he will give up.. it will be third time. I pray God to succeed...
It’s not really 6 months. Normally treatment duration is defined by weeks not months. My treatment was 24 weeks. The meds are supplied in 4 weeks dosages so 28 days. He didn’t really need to get any additional meds.

I failed 3 treatments with interferon based meds, I relapsed after treating with  Sovaldi and Olysio (they were the first of the new DAA’s released) for 12 weeks. I was finally cured on my fifth treatment.

Wishing him good luck
Thank you Flyinn! Don't know why nobody has explained him that it is week regime, not months...I will let you know, when he finally finish therapy, the results.
Abraksas
Adding 3 more weeks to a 24 wk regime most likely won’t make a difference either way, however as lynn mentions if his doctor oks it then it then it sounds like he is going to  to go ahead.
If his side effects are minimal logic says 3 wks. Should not bring any on, however everyone reacts differently.

I am curious, has he had any viral loads done along the way.
Reason I ask this if one fails treatment it is usually tell tale at 12 eeeks post last pill, however sometimes it is by breakthru( showing significant increase in viral load at some point during treatment)
If that was the case the regime stops .
That type of failure is rare but can happen
Also, if he hasnot yet purchased his meds he may want to chat with his doctor about  putting the money towards another treatment of Vosevi/ with Riba that has been very successful in GT 3./chirrosis even in those that have failed a DAA
Obviously this would be in the event he fails the Epclusa
He has not done any viral load tests. His Alt and AST is ok now. Platelets and leukocytes low. He fells tired but ok, with slight pain in liver area..
I hope this medicine will work. If won't, then I think he will give up. Treatments with Riba was terrible for him..and there is no money left for new journey..I can  just pray ..


Not doing a VL test is not that crucial until 12 post , however most knowledgeable doctors will run them at periodic intervals just to make sure on some patients there is proper adherence  to meds ( and to watch for possible breakthru,as I mentioned which is rare)
But in this case before he goes out and spends funds on extending tx. I would suggest a VL test.
If he has had a breakthru he would be not only wasting money but also he could be doing himself more harm than good because of building resistance to the meds
Let’s hope he is successful, but if not there still is therapies (that I mentioned above that may work)
Keep in touch and best of luck to you both
Thanks willbb! I didn't know about breakthrough.. I will tell him..
It is very rare but if he is going to spend  more money it would be worth doing prior to extending
Best...
About the weeks bs months thing I think it is just how people talk about things.

It’s simpler and most people understand when you say something is 6 months duration. If I say it’s 24 weeks we think how long is that then do the math dividing by 4 ( four weeks in a month) and come up with 6 so we say oh ok 6 months duration.

The prescribing information sheet that may come with his prescription would say weeks of treatment.

Saying 6 months is speaking less accurately but something we understand more readily than saying 24 weeks.  

I hope this treatment works for him but as willbb has said there is another treatment that is more effective than his curent one.

Liver enzymes return to normal during treatment for everyone as far as I know because the virus is either totally gone or al very low levels in the blood so it is not present in the body in high enough amount to injure the liver which is what causes the release of liver enzymes.

Breakthrough is very seldom seen. His extra meds won’t make a difference.

His platelets are low is because of his cirrhosis. My platelets were about 85 before I treated. After I finished treatment they rose to about 110 and stayed there for a couple of years. Now at 4 years post they have risen a little further to 125 still below normal but small improvements over time.
Breakthrough is very seldom seen. His extra meds won’t make a difference.
——-
It will if he has one.  

Abraksas
Again my suggestion is to get a VL test done if he can before doing another 3,weeks
Hey willbb are you saying his taking an extra 20 days of treatment could prevent a breakthrough or relapse?

Or do you mean taking the additional meds could complicate any later treatment he might do if he does relapse or has had a break through?

I guess I’m just not tracking your comment “it will if he has one”.

Seems to me if 24 weeks hasn’t done the job I doubt taking another 20 days would change his outcome on this treatment that he is currently on and soon to complete.

I’m just a layperson but I’m interested to hear your thoughts in this situation.

Best regards
Hi lynne
My thoughts are this and I said this to  the OP
The additional 3 weeks as I mentioned will probably not make any difference in efficacy , however it sounded like he  was going to go ahead and do that with his doctors ok
I suggested  and do think if he We goes ahead with that it would be prudent to get a VL done for a couple of reasons.
1) As he may have had a breakthru(rare but possible, as it did happen in the Astral trials for Epclusa) there would be harmful to keep strenghing resistance mutations if indeed that rare event has already happened
2) It would be a total waste of money if that has happened.
I also suggested that if it was me I would probably think about talking with my doctor about another Treatment(Voseviif he happens to fail) rather than spend the money on another 3 weeks that very well make no difference.
But all this would be moot at this point if indeed BT has happened .
So getting A VL would be prudent
All great points thanks
Thanks Wilbb and Flyinn!
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