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?

[willbb]

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

  I can tell you  from experience..that is indeed a scary group to be in.

[lovebird99]

I can see why willing wants to add PIs at the end, since they were not available to him when he began.  I might try that if I was in the same position because I think PIs at whatever point in treatment should be better than no PIs at all.  The timing just works out that way for willing.

Trish I think you're right about the charted territory/flat earth.  Somebody has to push the envelope.

What I wonder is how do you DO it.  I mean, how do you reach down inside yourself and find the courage to be the one who steps off the edge of the known world?  I know people do it in trials but trials have controls and there's a lot of study and background data that goes into establishing the trial protocol.  The patient doesn't have to do it alone.

I'm not sure if changing PIs will give a big enough benefit to offset the risk that you might need to treat again and if you do run into a resistance problem.  Because some people who do PIs are going to have to treat again.  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.

[willbb]

  It would be very surprising to me if the Hepa"s are just going to say.".....Ok here try this at the end "....      because the patient thinks they might want to try something different.

  For those doing SOC right now . and the timing meshes..who knows maybe it is  viable to try this, however I would imagine the docs are going to be going by fairly strict protocols on this stuff..especially in the beginning  so I would imagine there just wouldn't be avail. for much experimentation  anyway.

[DoraExplora]

For anyone who is new to the forum please note adding a DAA at the end of treatment or changing the DAA mid-stream is not standard protocol.  There are no studies or data to date.  It is the intent of a forum to strive for accuracy and advise those with hepc about established protocols, those which have been studied and proved effective.  No one is saying adding a DAA at the end, rather than the beginning is wrong but advisable to say "do not to try this at home".

Consult with a qualified hepatologist or gastroenterologist before changing any treatment protocol you learn about on an Internet forum.

[GoofyDad]

"If we always waited for charted territory, the world would still be flat.  :) "

And if I hadn't finally made it out of middle school, all my dates would still be flat. Thankfully Columbus got a loan from the Queen, and I convinced Mr Jenkins to pass me for 8th Grade Algebra.

[Trish77]

Uncharted territory but what the heck.  If we always waited for charted territory, the world would still be flat.  :)

I can see adding PI's later under your own circumstances.  Boce has been trialling with a lead-in and this would be like and extra-long SOC lead-in.  I'd rather have the PI's late in the game than not at all.  Treatment has been hard on you and I would want to nail this once and for all.  PI's late in the game would get any that have been resistant to SOC so far that might be under the radar at the moment.  Might be like hitting with a sledgehammer when only a hammer is required but it sure is more likely to obliterate.  

Resistance issues are less of a concern if you really expect the PI's to write the final chapter.  And even at that, the data is emerging that Tela resistance disappears in about two years.   Boce apparently still shows resistance 3 years out and I don't think there is data beyond that.  So from that perspective, perhaps I'd start with Tela in your situation also and only switch if necessary.  Just some extra thoughts in the pot.

Trish