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Avatar universal

failed protease inhibitor

63 yrs, dx 1 yr ago 1 month after retiring from 40 yr nursing career. genotype 1a 9.6 million viral count. Decided to wait till new protease inhibitors came out to treat as it would take my clear rate fron 40 to 80%. Began last nov. Viral load down to 1200 first month. Second month, viral load higher so they stopped all drugs a week ago and was told I can never take these  again. I'm the 20% failure rate. Now waiting for more clinical trials - go Gilead. Still have ringing in my ears which started 3 weeks before end of treatment. Doc blaming it on lexapro which I wasn't even taking when it started, and am not taking now. Does anyone else have this problem?
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1972385 tn?1343827076
After 11 weeks on Incevek I had to stop because I came down with anaphylaxis and a red rash from head to toe.I will get my questions answered as to why this happened to me.I think I did too many tx's and didn't get monitored by my PCP.My system must of weakened to have a bad drug reaction.I will be posting a new thread after my appt.with the facts
Helpful - 0
Avatar universal
I am ready for my 3month vl test. My ears are ringing so badly its affecting my quality of life. This didnt start to  be a real problem until about a month post tx. I  too had ringing before tx, but now its to the point I cant hear what people are saying to me. I got a cold with all the extras right after tx and still cant hear!! I have been on 2 different antibiotics, and just finished a round of prednisone. Been to the ENT twice, and am going to some specialist next week. This is very troubling!! I dont know if its from tx or just more bad luck. I did get all meds approved through my hep doc before I took them.
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Avatar universal
Week three my viral load went from 700,000 to 720.  Week six viral load jumped back up to 100,000.  I was on Teleprevir, Riba and Pegasys.  I'm devastated.  This was my second go around with treatment.  First was couple years ago with just Riba and Pegasys.  Just found out today I have to stop all treatment.  I live in VA.  
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Avatar universal
Hi FoxLair,

You posted above that I am mistaken regarding my comment about Lexapro being contraindicated with Incivek.  

Please send me the link to the "medication guide" that you are referring to.  Perhaps my mistake was in using the word "contraindicated".  Lexapro is not specifically contraindicated for use with Incivek, but according to the prescribing information, Incivek can decrease the effectiveness of Lexapro when they are co-administered.

escitalopram = Lexapro
telaprevir = Incivek

I have read the prescribing information for telapravir (Incivek) many times over the past 8 months.  http://pi.vrtx.com/files/uspi_telaprevir.pdf

Information about drugs that are contraindicated or drugs that have a concomitant effect with telaprevir (Incivek) is found Sections 4, 7, and 12.3 as well as in Table 5 (Pg. 6), Table 6 (Pg. 13), and Table 7 (Pg. 14) of the prescribing information available from Vertex.

According to Table 5, “concentrations of escitalopram (Lexapro) were decreased when co-administered with telaprevir (Incivek).  Selective Serotonin Reuptake Inhibitors (SSRIs), such as escitalopram (Lexapro) have a wide therapeutic index, but may need to be adjusted when combined with telaprevir (Incivek).”

In other words, the effectiveness of escitalopram (Lexapro) can be reduced by co-administering it with telaprevir (Incivek).  Since the full dose of escitalopram (Lexapro is 20 mg., it would be difficult for doctors to adjust it up to increase effectiveness when combined with telaprevir (Incivek).

According to Table 6, “escitalopram (Lexapro) has no effect on telaprevir’s (Incivek’s) pharmokinetic parameters (PK), but according to Table 7, “telaprevir decreases the pharmokinetc parameters (PK) of escitalopram”.

Also, with regard to some other medications and herbs that have been mentioned (e.g. alprazolam (Xanax) and St. John’s Wort:

According to Table 5 of the Incivek prescribing information, “telaprevir (Incivek) increases exposure to alprazolam (Xanax)”, which I interpret to mean that the effects of the alprazolam (Xanax) are increased.  

According to Table 3 of the Incivek prescribing information, St. John’s Wort is contraindicated for co-administration with telaprevir (Incivek) as it can cause the concentration of telaprevir to be reduced, which I interpret to mean that St. John’s Wort can decrease the effectiveness of telaprevir.

Advocate1955


Helpful - 0
1972385 tn?1343827076
Sorry you failed treatment.Does this make you a non-responder,relapser,or something else.Ask your dr.The drugs has dulled my senses.My tinnitus has worsened,my vision is worse and my judgement is bad.I'm on week 7 on Incivek,Pegesis+Ribavirin.Side affects are bad for me.I am also 63.I see this as possibly luck running out.I have been on therapy for the last 20 months,off and on between the 2+3 drug tx.
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Avatar universal
Thanks for the compliment frijole.  No apologies needed.  I am trying to help people learn to do the very simple research that I have been doing.  I find that there are many repetitious posts and some from the same individuals at times.  It is almost as if people are not reading what is there to be read or are so anxious that they are forgetting or not understanding what they have just read.  Sometimes a person asks about a trial drug, for example, and just two or three threads down someone else has spoken about their failure on the very same trial drug.  

Certainly the forum is not a research site in itself but when you have people posting that they are taking weeks and months to reach undetectable status on a trial regimen as opposed to others who clear within a week or two, I would think the inquiring mind would want to take note of that as well as the failures and successes.  

I have said it before and I will say it again, if people have difficulty reading and understanding it would be most beneficial to get someone to help them or simply opt for the standard of care or triple option and depend on their doctor for the decision making.  But I digress, this comment is  not directed at this poster.  
Helpful - 0
223152 tn?1346978371
curiouslady - didn't mean to set you up as an authority.  You are much more focused on the new trials than most, that is all.  Sorry
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Avatar universal
I am so sorry that your treatment was not successful
You mentioned you started last November 3xtx
May I ask Vic or Inc
As I am about to start tx in 10 days

Also. I thought tx was 24-48 weeks long? Confused
Sorry to burden you with the question, maybe someone else know answer
Xoxox C
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Avatar universal
I have to correct something that is being said.  I am really not on top of everything in the experimental trial world.  I know about the trial I am on and related issues.  Otherwise, I read the posts that have to do with trials and the drugs that are used.  When I see repetitive posts about people failing at particular drugs or having success with particular drugs I remember that.  It is not difficult to check the archives.  I would suggest that everyone do that.  
Helpful - 0
1491755 tn?1333201362
Very sorry to hear you didn't clear.  My ears rang the entire time I was on treatment, which was Inf,and Riba, as I was G2.
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223152 tn?1346978371
I am so sorry that you failed treatment.  How many weeks did you treat before they stopped you?  Did you have a lead in and victrels or did you do incevik?  What is the degree of your liver damage?

curiouslady seems to be on top of all the future trials without interferon.  Perhaps that is a route to take.  Meanwhile rest and  heal.
bean
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Avatar universal
You are mistaken, in fact Lexapro is the AD recommended for Vic and Inc, read the medication guide.
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Avatar universal
It is a sad fact that the newly approved protease inhibitors will fail in a certain percentage of the population. hcv genotype 1a, IL28b genotype CT or TT, ribavirin resistant viral mutation, what ever...

Now that you have developed a protease resistant that will leave you resistant to most other types of protease inhibitors (not completely all though) it would be wise not to take another protease inhibitor for the next few years until your wild population re-establishes itself and the mutant form declines.
Until then, they will likely be trying other DAA's such as NS5A  and polymerase inhibitors which you may consider, but personally I think the best route is one of the newer protease inhibitors (TMC 435 or such) and a polymerase inhibitor. It is likely that they will eventually have clinical trials to test protease inhibitors on those who failed early protease inhibitors.
Options are coming.
Hang in there.
Helpful - 0
190885 tn?1333025891
i had the ringing...it stopped after tx....if you were taking incivek /riba /interferon when you stopped then that combo may be working its way out still
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1995824 tn?1330379049
So sorry to hear that the protease inhibitor didn't work for you. I am on week two, with telaprevir, 4.2 mil viral load, so I am just hoping and praying that all of this regimen will work for me.
I, too, have tinnitus (ringing) but I had it before I started treatment. It has definitely worsened. I feel like I am outside in a field of crickets all the time.
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Avatar universal
I believe that Lexapro is contraindicated with Incivek.  Why did your doctor blame Lexapro if you were not taking it when you started triple therapy and you are not taking it now?
Advocate1955
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408795 tn?1324935675
Welcome to the forum.  Sorry to hear of your failure to tx, which Protease inhibitor were you on?  I have heard of someone having ringing in the ears but I don't remember the situation, maybe they will chime in later.  Read around and stay in the loop, something has to be approved soon especially with all the new Polymerase Inhibitor's in clinical trials right now.  It really looks like big Pharma is trying hard to create something new and better so that's good and in your favor.  Your Doctor is nuts for trying to blame it on lexapro.  
Helpful - 0
Avatar universal
There is recruitment going on for BMS 790052 and PSI 7977 trial for failures of the triple which is an extension of a trial that is ongoing now.  Please check clinicaltrials.gov and type in NCT01359644 for details on the original trial and the sites.  It is believed that these will be the same sites for the extension.  I don't think there are that many open slots though so I wouldn't wait too long.  While Gilead now owns pharmasset I don't think they have changed the name of the premier drug which caused them to acquire the smaller company.  
Helpful - 0
1815939 tn?1377991799
Bye the way, I am very sorry to hear that the triple med treatment did not work for you. Hopefully there will be some new drugs on the market soon and that they will work for you.
Helpful - 0
1815939 tn?1377991799
I have ringing in the ears. I already had some ringing in my ears when I started treatment (which I am quite sure was from the Wellbutrin I started last May). However, I noticed that after starting treatment (on Sept. 26th)  with Pegasys, Riba, and Incivek, the ringing became quite pronounced. It is very loud, especially at night. I am still on treatment (in my 17th week) and I still have it. I do blame the original ringing on the Wellbutrin as it is a side effect of Wellbutrin. However, I think the triple med treatment is adding to the intensity of the ringing. I just hope it goes away after I am off all of these drug. I know this question was posted a few months back and several people did say they developed ringing in the ears after starting treatment.
Helpful - 0
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