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Avatar universal

increased ribba and expectations

13 weeks into treatment and no sides u until now.
doc thinks I should increase ribba(copegus) from 1200 to 1400 and  weigh 82 kilo
appreciate any experiences of increases and whether this has been positive or led to a later decrease?
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Avatar universal
"I wouldn't sweat one extra pill at all..."
From an ex-New Yorker to a current New Yorker, I just had to let you know that I think you're the greatest, lol.
Helpful - 0
179856 tn?1333547362
I wouldn't sweat one extra pill at all.  While dose reductions should be the last thing we ever do during treatment once you are over week 12 and UND you could go back to the 1200 if it was necessary.

I have never ever heard of a 592million viral load - however even with a high viral load that should be a moot point.  You need to be UND at week 12 (13) or else look at 72 weeks as the option to give your immune system enough of a chance to be able to successfully be trainned to fight any virus that might be lurking about.  Believe it or not sometimes it is people with extremely low viral loads that have a harder time getting to UND.  It seems it either swings one way or the other. Regardless if you are pos at week 12 (13) - this is something you really need to consider seriously.

Especially if you aren't having any sides at all.  While a 5 point reduction is absolutely nothing to sneeze at - it's kind of like you want to know you are getting every single bit of riba saturation that you can....and unfortunately that is what results in the anemia.

Helpful - 0
Avatar universal
Ribavirin Mode of Action in Chronic Hepatitis C: From Clinical Use Back to Molecular Mechanisms
Wolf Peter Hofmann; Eva Herrmann; Christoph Sarrazin; Stefan Zeuzem
Authors and Disclosures
Published: 12/08/2008


".....Despite the presence of conflicting results, accumulating data from several in vivo studies support the concept of ribavirin-induced HCV mutagenesis as a possible mechanism of action in patients with chronic hepatitis C. However, several precautions should be taken. Firstly, the fact that ribavirin leads to a significant decline of ALT levels when administered as monotherapy is not sufficiently explained by the lethal mutagenesis hypothesis. Moreover, an increase of the mutational frequency has been observed predominantly during the first weeks of ribavirin monotherapy, and may revert later during the treatment period. However, in the case of standard combination therapy, dose reduction and/or discontinuation of ribavirin during the entire treatment period is associated with loss of SVR rates when combined with interferon-α......"

"...Ribavirin considerably enhances the efficacy of interferon-α in the treatment of chronic HCV infection and may be useful in combination with evolving treatment strategies such as STAT-C. Many clinical trials have shown that high exposure to ribavirin and maintenance of ribavirin dosing during interferon-α treatment courses is strongly associated with SVR rates, demonstrating that ribavirin is a key player of treatment success in chronic hepatitis C. Accumulating data are available today that aim to explain the distinct molecular mechanisms of the ribavirin mode of action. Generally, none of the proposed mechanism seems to account solely for the clinical benefit of ribavirin. So far, it is conceivable that different mechanisms contribute simultaneously to treatment optimization in chronic hepatitis C, which may in part be attributed to a direct antiviral effect of ribavirin itself and to a modulating role directed towards the efficacy of interferon-α."

See: http://www.medscape.com/viewarticle/584208
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Avatar universal
hi pam,

thanks for the feedback. and been now for 5 days on the higher dosage of copegus and no feeling fatigued yet. To be honest up until now have not really had any sides and hope it continues this way.
thanks,
david
Helpful - 0
427265 tn?1444076436
I started tx on 1400 mg Riba (weight based for me was 1000 mg) Had no sx or drop in hgb until about week 8-9, then things got rough for a couple of weeks with Hgb dropping to 9.6 I think was its lowest. They decreased it to 1000 mg for 2-3 weeks, now I'm back up to 1200 and doing ok witgh last hgb at 11.0. Have not needed rescue drugs yet.

The most important thing with enhanced doses is for the Dr. to stay on top of the labs, weekly for me, so adjustments/rescue meds can be made quickly when needed. My worst sx is the unrelentig fatigue, but I don't know if that's from the Riba or Interferon at this point (23 weeks).

Good luck!   Pam
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Avatar universal
"I believe it pushes the virus into fatal mutation which stops it developing a new strain which can resist interferon."

That is the way my hepatologist explained it to me - or something very close to that anyway - and it appears to be true at this juncture in my case as well.
Either way montanabln, it seems you can handle the increase in dosage. Best of luck.
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Avatar universal
thanks for the information and will give my blood tomorrow and then find out what the results are at week 13  - again due to working in the 12 week abroad and then get back in contact on this forum
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Avatar universal
HCA
Personally I don't think ribavirin reduces the viral level at all.
I believe it pushes the virus into fatal mutation which stops it developing a new strain which can resist the interferon.
I don't think it will harm you to take the extra pill,see how you go-if it makes you too tired tell the doctor.
Everything depends on the RNA ( the viral load)-let us know what the 12 week result is-it is the most important one.
Good luck.
Helpful - 0
717272 tn?1277590780
The riba is a helper drug to interferon, goosing its activity.  I'm no expert but think it might help things go a little faster.
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Avatar universal
yes, according to the copy of his results was 592....
this meant a drop in 5th week of 95% (to 3460 000)

I wish it had been 5.92 million as would have cleared most likely at week 4

so you believe if I am able to handle an extra ribavinn ( copegus) it will do me no harm but good?
Would an increase of ribba help in reducing the virus level or do you believe it is still just new theory and not reality?
Helpful - 0
Avatar universal
HCA
Thanks for your reply.
The viral load numbers are a bit confusing -is the baseline really 592m as you say?
and 3.5 m at week 5?
The viral load was very high (the highest I have ever seen).
I think it was more likely to be 5.92m at start and I'm not sure what the five week figure is.
Your hb drop is o.k which suggests you have plenty of ribavirin in your system-not sure why he wants to increase,but basically the more ribavirin you can tolerate whilst clearing the virus the better.
After you are 'negative' it is not so important.
If your viral load is about 5000 at week 12 you would need to do a total of 72 weeks to have a decent chance of SVR,assuming you were negative at week 24.
Good luck-you cant predict the 12 week test=you might get a nice surprise.
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Avatar universal
my view being only to remain on 1400 if I am able to handle it.and continue to work, as otherwise cannto afford to continue therapy.
I found on 1200 I had no side effects.
Helpful - 0
717272 tn?1277590780
Whether they keep you at the 1400 will depend upon if you can tolerate it.  The major effect that you will notice will be decreased hemoglobin and increased tiredness.  Hemoglobin is the oxygen-carrying red blood cell.  Decreased hgb means decreased O2 throughout the body and exhaustion.  If your hgb starts to drop you may want to go ahead and get your insurance company to approve Procrit.  If HGB goes below 10 you will want to use it to help you feel better.
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Avatar universal
was not able to give my blood in 12 week owing to working in the 12th week abroad
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Avatar universal
my base line                                          592 000 000 ml  
HB was 17 and now approx HB12.3

at week five                                               3 460 000 ml

+expected goal at week 12 set by doc                 5 000

+Was on 1800 interferon and 1200 copegus until last week
Last 5 days 1400 copegus

+will have my blood taken tomorrow for 12 weeks results and expects to be around 5 to 6000

+ Doc believes because of the unusually high viral load that I cannotexpect to be
   negative at week 12


Helpful - 0
Avatar universal
HCA
1400mg is a safe dose if you can tolerate it.
The question is 'why?'
The only valid reason would be if your haemoglobin has not dropped significantly.
If your virological response is disappointing increasing ribavirin will not help.
In order to help you we would need to know,
a) Your baseline viral load
b)Your viral load at 12 weeks
c) Your baseline haemoglobin
d)Your haemoglobin at 12 weeks
If you can provide these numbers we will understand a lot more
Helpful - 0
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