switching PIs in mid-stream?

[willing]

from posts it seems people are starting to make their triple tx plans for the summer. I'm seeing my Dr for a w24 half-way checkup in a bit and will be going over the upcoming  PI rx. Last time he indicated he was happy to write an rx for either tela or boce immediately after approval.

My latest thought is to start with Tela and switch to Boce if the rash is more than I can stand. The main reason is that I know what the anemia will be like but might get lucky with the rash and given that I'm starting late the shorter, 12w, tela duration seems a plus. From reviewing the data, the choice seems to come down to picking your sides. This type of switch was obviously not an option in the trials but should not be a problem now. The two drugs   target the same active site of the same viral protein in exactly the same way so given a couple  of days of overlap the switch should yield no reduction in  the selective pressure on WT virus.

Anyone ask their Drs' about this option or have thoughts on the topic?

[dointime]

Just a word about resistance.  I am sure that you have researched this yourself already.  Boca and tela produce more or less the same resistant variants except that boca has one more exclusive to it.  So by introducing the boca you would be running the risk of getting one extra resistant variant.  That has to be weighed against the increased odds of SVR by switching to the boca.  As you are a previous relapser you have a much increased  chance of SVR this time around by using a PI for the full length of time.

If you were not to succeed this time around then your planB would probably be the same whether you had switched to the boca or not, ie. you would be treating with 2 PI's next time, neither of which targeted the ns3.  So what I am saying is that I don't see that you have anything to lose by switching to the boca, even considering the consequences of resistance to retreatment.

dointime




  

[dointime]

Hi there willing,

The way I see it, you are already committed to the SOC and to a PI.  Your reasons for going this way and for choosing the tela are sound.

So supposing you get into the tela phase and you do develop a showstopper rash then what are you going to do?  If your choices at that point are to stop the PI or switch to boca then that seems like a no brainer to me.  Ofcourse you switch to the boca and you keep after those little b*ggers until you've dug all their graves 3 times over,

Just my 2 cents worth,
dointime    

[child24angel]

Thank you willing.
I have friends that are going to be treating in the
future and I appreciate your imput.

[Bali05]

SVR rates were similar between tx arms of study C210
I doubt it will be pursuit.
Did you ever see any data on TCM435 and GT4 ?
It must exist. I read they did some preliminary studies and GT4 responded strongly
to it. TCM435 is currently in phase 3 with GT1 of course as usual....
Also would like to know if previous Tela exposure could be a problem for TCM435.

[lovebird99]

Thank you.  I hope neither of us will have to switch PIs.

[Bali05]

thanks willing , I am familiar with that study