Lengh of triple tx

[jpinthekeys]

I am going to start tx soon with incivek for 12 wks and continue with pegesys for an additional 12 wks for a total
of 24 wks. I have noted that some people are doing 48 weeks with triple treatment.
I also thought the clinical trials had a 24 week arm that had about a 82% clearance rate. I had previous tx with
peg-intron a few years ago and had a svr at 4 weeks but after 48 weeks stopped treatment and relapsed.
I know we are not Dr.s here but is there any data that suggests that 48 weeks gives it a better chance if I become
indectable at 4 weeks with the triple tx? PS my geno-type is 1a and viral load is 12 million. I really dont want to do
48 weeks but if there is a better chance with 48 weeks would want to consider that as an option.

                                     Thanks, John

[Idyllic]

1. In other words different sets of rules (Treatment Futility Rules) exist for
Treatment naive & Relapsers

and

Nulls, Prior partial responders & cirrhotics

2. But these rules (Treatment Duration Rules) apply to all of us on Triple:

•Discontinuation of therapy is recommended in all patients with either of the following circumstances:
•HCV-RNA levels >1000 IU/mL at treatment weeks 4 or 12, OR
•HCV-RNA levels detectable at treatment week 24

(Sorry Will couldn't resists cutting & pasting the great job you did in explaining that one!!)

Plus, this is the first time I think I finally understand these principals!!

[jpinthekeys]

Thank you all for the info, I am hoping since I had a good response while
on the double TX last time I will have a better chance of clearing it after 24 weeks. Thanks again, and also I have gained valuable info on here deal with the side effects that I didnt have last time around.

[pooh55811]

John, just to clarify because I know you must be wondering why some of us are doing 48 weeks, it is because we have to do 48 weeks. We would love to do 24 but we don't qualify for 24 so we have to do 48 weeks.

People on Incivek who do not become Undetectable at 4 weeks, have to do 48 weeks. People on Vic also do longer if they are not Undetectable at 8 weeks (8 weeks into Tx but 4 weeks after adding Victrelis). The other people who do 48 weeks are people with cirrhosis, previous null responder,s and previous partial responders.

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%204.aspx

[willbb]

Sorry ..my copy  did not come through properly..The second part of my post was this:

Will


Treatment futility
•Patients with inadequate viral response are unlikely to achieve sustained virologic response, and may develop treatment-emergent resistance substitutions
•Discontinuation of therapy is recommended in all patients with either of the following circumstances:
•HCV-RNA levels >1000 IU/mL at treatment weeks 4 or 12, OR
•HCV-RNA levels detectable at treatment week 24

[Eki1]

Oh, and I think a third option is that Incivek doesn't make your viral load go below 1,000 at 4 weeks, in which case you will not go SVR at all and should consider stopping treatment.

I'm not sure about that either, but I read it somewhere.

[willbb]

As a prev. "relapser" the treatment protocol  is stated below.
If you are UND. @ week 4 and still at week12  you would do a total of 24 weeks and there  is no benefit to extending beyond that. If you still have virus at week 4 or 12 <1000 you would do 48 weeks.

Good luck and welcome...
Will


Duration of treatment depends on HCV-RNA levels

Triple therapy: telaprevir, peginterferon alfa, and ribavirin

Treatment-naïve and prior relapse patients
•HCV-RNA levels undetectable at weeks 4 and 12: Administer triple therapy first 12 weeks, then dual therapy an additional 12 weeks
•HCV-RNA levels detectable at weeks 4 and 12 (ie, 1000 IU/mL at treatment weeks 4 or 12, OR
•HCV-RNA levels detectable at treatment week 24

http://reference.medscape.com/drug/incivek-telaprevir-999658

[Eki1]

I don't think I'm educated enough to answer your question.  Please take the following with a huge grain of salt, as I'm getting data from multiple sources and can't exactly cite my source:

If you are undetectable at 4 weeks and UND at 12 weeks (the same week you stop incived), then you have an 80% chance of SVR, and only need 24 weeks of treatment.

If you are not UND at 4 weeks and 12 weeks then you will be treated for 48 weeks and have a 56% chance of SVR.

I think that's true.  Again, don't quote me.