Aa
Tapering off the Interferon and Ribavirin at the EOT?
There seems to be a renewed interest in the Tapering off the Interferon and Ribavirin as some are getting closer to the EOT or are in the planing stages as to what to do. Most are aware that being on these meds for so long that the body had become adapted to the higher than normal levels of the interferon in the body and are concerned about when treatment is stopped what will be the lasting effects if any, after stopping abruptly. Also what will be the effects of the reversal or abrupt stoppage of the Ribavirin.
This has been discussed many times before with a lot of pro's and con's as to it's validity, of this unspoken controversial option. I think it is worth revisiting the subject again as more people are aware of the personal options to them in how to deal with the aftermath of treatment. "To me understanding this process one needs to understand the process of the meds in the body at the beginning of treatment to see the possible benefits at the end of treatment." This thread should be a good base builder for those looking for the best course of action knowing what they have been through personally while on treatment and a furture base for those looking for such information.
jasper
1. What would be the best way to stop the Interferon?
2. What would be the best way to stop the Ribavirin?
3. Taper both together?
4. taper just the INterferon?
This has been discussed many times before with a lot of pro's and con's as to it's validity, of this unspoken controversial option. I think it is worth revisiting the subject again as more people are aware of the personal options to them in how to deal with the aftermath of treatment. "To me understanding this process one needs to understand the process of the meds in the body at the beginning of treatment to see the possible benefits at the end of treatment." This thread should be a good base builder for those looking for the best course of action knowing what they have been through personally while on treatment and a furture base for those looking for such information.
jasper
1. What would be the best way to stop the Interferon?
2. What would be the best way to stop the Ribavirin?
3. Taper both together?
4. taper just the INterferon?
I'm wondering if you could provide a date for HR's post (above), as well as contact him to ask him for input on this thread.
I'd especially like to know in which scientific journals he's published and whether we can have access to those publications.
Thank you.
I'd especially like to know in which scientific journals he's published and whether we can have access to those publications.
Thank you.
I know that HR was playing with this idea a LONG time ago now and do think that Kalio did taper down perhaps..........but I don't know anyone else who did and before I kept those poisons going on into my system I'd see if perhaps HR will come on and explain if he did ever find ANY benefit.
For someone who's gone through the plethora of autoimmune problems caused by the IFN (and they came LATER in tx as it did build up in my body) i would really REALLY caution against taking these drugs any longer than you need to - these stupid AIs will be with me the rest of my life now and if I could have avoided them I would have (but being a late responder.........didnt have a choice).
If it hasn't helped anybody for SURE is it really worth the risk?
For someone who's gone through the plethora of autoimmune problems caused by the IFN (and they came LATER in tx as it did build up in my body) i would really REALLY caution against taking these drugs any longer than you need to - these stupid AIs will be with me the rest of my life now and if I could have avoided them I would have (but being a late responder.........didnt have a choice).
If it hasn't helped anybody for SURE is it really worth the risk?
Thanks for posting this... That's what I had understood and i couldn't remember where I had read it. Probably in your journal or on a previous post.
I like the idea of tapering and will do it. After the abrupt stop at EOT 2nd tox, my bloodwork never did stabilize. I had low WBC and Platelets that never improved much. Had to follow up with a hemotologist who ran lot's of tests. Why?, never did get an answer. I will taper and hope my bloodwork will stabilize after this tox. here is an excerpt from an older HR post...
by HR
"It needs to be understood that when stopping IFN, a new form of antiviral defense against possible HCV remnants needs to take hold and establish itself - the adaptive Tcell response, that up to this point was greatly aided by the direct effect of IFN on the hepatocytes and the local intrahepatic immune cells. With this IFN aid gone all the burden is on the Tcell response, that will typically get stronger if more remnant viruses are seen ( if they can be seen now, because new epitopes are now present) - with incredible sensitivity, but it takes time to come to full swing and it can furthermore, at this very critical moment, be paralyzed by the prominent absence of innate signals needed to get adaptive Tcell responses going after IFN is abruptly missing from the equation. Here is one more specific EXAMPLE how the Tcell effect depends on the presence of some Interferon: The presentation of the viral epitopes is performed - as described in detail in an earlier post- by the cellular proteasome and the class I MHC molecules that bind the peptide and bring it to the surface for recognition by the "cognate" Tcell receptors of the "cognate" Tcell patrolling the liver.
IFN has a strong influence on the intensity of expression - the number of proteins produced per cell - of the MHC class I proteins. Less IFN - less MHC, less presentations- less recognition - less killing of remnant virus infected cells, less general intrahepatic antiviral milieu by the gammaIFN secretion of these Tcells....
If you abruptly stop the enormous whipping up of the hepatocyte MHC production it will likely go into lower than normal mode for a while being so used to the whip...thus temporarily HCV remnants become invisible to the Tcell system.
If you taper AFTER the end of the full standardized tx period, then you will never have to ask yourself in case you still relapse, if it was the premature tapering that caused it. Tapering in this fashion can certainly cause no propensity for relapse, rather the opposite. Then at least you have done all you could under the circumstances.
What type of tapering schedule?
Each week one half of the previous dose would get you down in a "geometrical" fashion, as opposed to a linear one. 16mcg 8 4 2 1 1/2 1/4 1/8 Stop.
From patients reporting the "feel" of tapering down, each reduction feels quite good. As a matter of fact, some who stopped abruptly reported negative side effects from the counterswings of the system used to all that IFN. The point is, that tapering is not a useless extension of tx sides, but rather a gentle readjustment of the complex immune regulatory pathways directly or indirectly depending on IFN."
by HR
"It needs to be understood that when stopping IFN, a new form of antiviral defense against possible HCV remnants needs to take hold and establish itself - the adaptive Tcell response, that up to this point was greatly aided by the direct effect of IFN on the hepatocytes and the local intrahepatic immune cells. With this IFN aid gone all the burden is on the Tcell response, that will typically get stronger if more remnant viruses are seen ( if they can be seen now, because new epitopes are now present) - with incredible sensitivity, but it takes time to come to full swing and it can furthermore, at this very critical moment, be paralyzed by the prominent absence of innate signals needed to get adaptive Tcell responses going after IFN is abruptly missing from the equation. Here is one more specific EXAMPLE how the Tcell effect depends on the presence of some Interferon: The presentation of the viral epitopes is performed - as described in detail in an earlier post- by the cellular proteasome and the class I MHC molecules that bind the peptide and bring it to the surface for recognition by the "cognate" Tcell receptors of the "cognate" Tcell patrolling the liver.
IFN has a strong influence on the intensity of expression - the number of proteins produced per cell - of the MHC class I proteins. Less IFN - less MHC, less presentations- less recognition - less killing of remnant virus infected cells, less general intrahepatic antiviral milieu by the gammaIFN secretion of these Tcells....
If you abruptly stop the enormous whipping up of the hepatocyte MHC production it will likely go into lower than normal mode for a while being so used to the whip...thus temporarily HCV remnants become invisible to the Tcell system.
If you taper AFTER the end of the full standardized tx period, then you will never have to ask yourself in case you still relapse, if it was the premature tapering that caused it. Tapering in this fashion can certainly cause no propensity for relapse, rather the opposite. Then at least you have done all you could under the circumstances.
What type of tapering schedule?
Each week one half of the previous dose would get you down in a "geometrical" fashion, as opposed to a linear one. 16mcg 8 4 2 1 1/2 1/4 1/8 Stop.
From patients reporting the "feel" of tapering down, each reduction feels quite good. As a matter of fact, some who stopped abruptly reported negative side effects from the counterswings of the system used to all that IFN. The point is, that tapering is not a useless extension of tx sides, but rather a gentle readjustment of the complex immune regulatory pathways directly or indirectly depending on IFN."
"I was afraid that "Cost" was the answer to my question." Funny you should mention cost, and it does seem doctors are cost conscious.
It will be interesting to see how "cost effective" docs will view the PI's to be..
"In a research note to clients Bernstein's Geoffrey Porges says after doing a detailed pharmacoeconomic (boy, is that a mouthful) analysis he estimates the companies could charge as much as 75-grand per course. "
http://www.cnbc.com/id/28316096/site/14081545?__source=yahoo%7Cheadline%7Cquote%7Ctext%7C&par=yahoo
It will be interesting to see how "cost effective" docs will view the PI's to be..
"In a research note to clients Bernstein's Geoffrey Porges says after doing a detailed pharmacoeconomic (boy, is that a mouthful) analysis he estimates the companies could charge as much as 75-grand per course. "
http://www.cnbc.com/id/28316096/site/14081545?__source=yahoo%7Cheadline%7Cquote%7Ctext%7C&par=yahoo
The extender in the Peg was also my greatest fear; not so much for the damage it would do, but more for any reactions to the IFN and how it would 'build up' over a number of days. I wanted to know if they had an 'antidote' lol!!
Nice thread and good to get some different views.
Nice thread and good to get some different views.
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