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?

[GoofyDad]

"Even though there is a much better chance at SVR with the PIs not everybody will clear on them first try.  

It would be just my luck that I would be in that group. "

I was listening to a talk by a psychogists dude  from Harvard yesterday - and they did a study where they asked people "Are you lucky?" It turns out that the ones that think of themselves as lucky are the ones that act a little outside the box. It's a bit of a chicken egg thing, but the conclusion was that those who play their cards less close to the vest end up giving luck a chance to happen... and often enough it does. Those that say "nothing lucky ever happens to me" ain't out there shakin' and bakin' it as much as they could.


I don't direct these comments to anyone in particular - I just saw a chance for me to loosen it up a bit, and thought it might resonate with someone reading this thread too.

In the immortal words of Dirty Harry, "So what about you, do you feel lucky?"

[Trish77]

"Yes i would say your mopping up but for how long? Either way i don't see where it would matter except if you was already und at the time one would not know if the PI was working, guess though at that point it really wouldn't much matter."

I hear you.  By the same token though, you don't know if the SOC is working either once you're UND until after EOT.  I figure, by the same token you want to maintain total adherence for the best chance at SVR, adding a PI later on if that's the best you can get is simply another way to cement that SVR as much as you can.

[Trish77]

"If you are already SVR then this is just an intellectual exercise, but for people like us who have to go another round or more this is serious."

I think it's rather insulting to suggest that those of us who are SVR are here only for the intellectual exercise and that we're unconcerned with what others are facing when it's not ourselves in the hotseat.  

[can-do-man]

"If you're already UND when you introduce a PI later in the game, you're essentially mopping up, no? "

In my case i was in the boceprevir lead in, like in my first tx after 4 weeks of just SOC there was not much of a log drop. But two weeks after the bocep was added i was und. So i knew the PI was working........ But i have to wonder by treating several weeks after that if that was the reason i become SVR.

Yes i would say your mopping up but for how long? Either way i don't see where it would matter except if you was already und at the time one would not know if the PI was working, guess though at that point it really wouldn't much matter.

[lovebird99]

I guess I should have directed my question to willing.  Obviously nobody else can tell me how you find it within you to do it, since nobody else has done it.

Willing, have you and your doctor discussed the resistance thing?  Trish dismisses it as a minimal risk but then again she doesn't have to face any risk, however remote.   Have you considered what you would do?  

If you are already SVR then this is just an intellectual exercise, but for people like us who have to go another round or more this is serious.

[Trish77]

"Tough call, with the way the trials have been set up it's easy to tell if one is responding to the PI. Not so much when starting later in the game. "

If you're already UND when you introduce a PI later in the game, you're essentially mopping up, no?