Telaprevir SVR Rates Unaffected by Ribavirin Dose Reduction

[flcyclist]

For those struggling with anemia, following is some recent information regarding Riba dose reduction with Telaprevir.  Sorry if it was already posted.  

The data shows that similar sustained virologic response (SVR) rates were achieved regardless of ribavirin dose reduction, including dose reduction to ≤ 600mg/day in a telaprevir-based treatment regimen for both treatment naïve and previously treated genotype-1 chronic HCV patients.[1]

http://www.prnewswire.com/news-releases/incivo-telaprevir-svr-rates-unaffected-by-ribavirin-dose-reduction-in-treatment-naive-and-previously-treated-patients-with-genotype-1-chronic-hcv-147925655.html

[hrsepwrguy]

Well I can chalk the 8.9 hgb up to a lab error, this morning my HGB is 11.9 and HCT is 35, the same as it has been since wk 20

Thanks for all the input

Keith

[Willy50]

look at this study w/ boceprevir.  

http://www.natap.org/2012/EASL/EASL_42.htm

A RANDOMIZED TRIAL COMPARING RIBAVIRIN DOSE REDUCTION VERSUS ERYTHROPOIETIN FOR ANEMIA MANAGEMENT IN PREVIOUSLY UNTREATED PATIENTS WITH CHRONIC HEPATITIS C RECEIVING BOCEPREVIR PLUS PEGINTERFERON/RIBAVIRIN

very interesting,
willy

[willbb]

that the timing matters;
----------------------------
Yes ..it would seem so according to all the data released that once one is well into tx. with  a P.I  ,especially if UND. it is the preferred and most successful option (as hersp is  at 35 weeks)
Will

[Willy50]

The first RBV dose reduction trial in effect took place in Prove 2 in the no- riba arm.  They had a 30% SVR rate.

One has to be careful in quantifying what one means when one says dose reduction; how early, how deep of a dose reduction, on what staging of damage, on what type of past responder, whether one is a 1a or 1b, or CC or TT, or viral kinetics of personal response.  
It all will affect this. (or so i think)

I did a quick read, but all I saw was the general admonition that it wouldn't matter, but I would agree more with Cando or Trish that the timing matters; if it didn't why were the no-riba arms failures in the Telaprevir trial.

It is clear that the timing and the depth of reduction does matter.  I haven't studied the latest so I'm not sure how they worded the "Telaprevir SVR Rates Unaffected by Ribavirin Dose Reduction" document, but I wonder if it is a bad title that needs some conditions placed into the sub-heading.

Keep in mind that failure with a PI is to be avoided.  For me, the interesting issue is that a simple dose reduction may work as well as being placed on rescue drugs/ transfusion.

willy

[Trish77]

You may have more say in this decision than you think.  Trials have certain parameters to follow, yes.  But the trial doc has a certain leeway within which he/she can operate.  Rescue drugs like procrit and neupogen were allowed on my trial as well as mandated dosage reductions below a certain point, i.e. hgb dropped below 10.0, automatic ribavirin reduction.  The use of rescue drugs was left to the doctor's discretion.  I was able to successfully lobby my doc to start procrit when my hgb tanked to avoid any more ribavirin reductions after the first one at 13 weeks. If I hadn't asked, I might not have gotten it. My trial nurse didn't think it necessary and I asked to speak to the doc.  However, when my white count dropped at Week 25, it took me 7 weeks of constant pleading to get him to agree to give me the neupogen.  For whatever reason, he wasn't a big neupogen fan and he reduced my interferon instead.  Finally, when that dosage reduction clearly wasn't working, he agreed to the neupogen.  

So...I guess what I'm saying with my lengthy example is that your doc may have some say of his own to bear here.  If it's up to him when he brings in the procrit, you can voice your own preference for using procrit sooner than later as a means of avoiding dosage reduction and that procrit as a means to avoid dosage reduction is your preference.

I find 400mg drastic also.  Is this the trial's dosage mandate or your doctor's decision?  It's like the trial's but I'd ask.

At 35 weeks, a dosage reduction is not as critical as earlier in treatment but it's good to avoid dosage reductions where they can be avoided.

Good luck with all this.

Trish

[Trish77]

Thanks bean, I'm glad to see you're hanging in there and holding that UND.

I think the report is good hope for those who can't do that 100% also - which is why flcyclist is posting it, I think - but is just a little too imprecise, as these reports often are when they lump all results together and come up with a median and report that, but not who the lower end of that median applies to. Always good to dig a little deeper into the details.  

Hope the rest of your treatment goes well and fervently hoping for that SVR for you.

Trish