toughest geno

[larf]

which is it ?
with new drugs i think its 3A or 4
what are your thoughts
i am 3A BTW

[Bali05]

"as a fellow G4 I was told by my GI that the new PI's were working with our type and when it is released he will add that to my treatment. That's what I've been waiting for"

I asked my hepatologist about it who had just returned from Boston and the AASLD 2010.
Nothing new for geno 4 !

Again the only study for geno4 and Tela is C210 which showed some response
but very little compared to geno1 or 2 with Tela.
To get Tela for a Geno4 to tx when it comes out would mean "off label" use
not sure who would be paying for it and if it would be worth it.

If you have any specifics on which PI your GI is talking about , I would be much
obliged :-)

I did read in a German Liver trade pub that the TCM-435 shows good response
for geno4 but I did not see any data yet.

b

[spectda]

Also just to be fair to Merck and Boceprevir, and especially because I am very thankful that I am treating with it. I would expect that the success rates would be similar to telaprevir by genotype since they act on the virus in a similar manner at a similar place.

I don't know if that is a correct assumption as I can't find the data from Merck and boceprevir on the other geno's but that doesn't mean it isn't out there. More options for drugs means more people get cured. That can only be a good thing.

[larf]

i dont think anyone mentioned
wanting the worse geno

is was a querry of sorts

[spectda]

"I've never seen anyone want their genotype to be the worst so badly before. Usually people are wishing for the glass half full effect when dealing with this disease. I'd much rather be a 3 than a 1 or a 4 regardless."

Wise words Deb. What's really important is being diagnosed correctly and knowing what's effective against it.

- Dave

[spectda]

Vertex seems to believe that telaprevir shows strong viral activity against geno 4 with half the length of standard treatment. Also it seems the triple combo that includes telaprevir svr rate is at best on par with the SOC svr rate for geno 3 and a little less then geno 2. Although I would guess that a difference of 5% svr rate is well within the margin of error when making comparisons in svr rates.

I guess the big question for geno 4 would be how the relapsers and non-responders respond to telaprevir. Personally I would want to try it if I was geno 4 and failed with soc.

http://www.drugs.com/clinical_trials/vertex-pharmaceuticals-present-data-easl-suggesting-telaprevir-s-potential-broad-range-hcv-patients-7052.html

“Telaprevir is the only agent that has shown the possibility of achieving SVR rates in combination therapy approaching 70% in the treatment-naïve setting with a significantly shortened treatment duration when compared with current therapy, while our recently acquired polymerase compounds are showing strong early antiviral data, which may put us in a good position to shape new STAT-C combinations with telaprevir,” said Kurt Graves, Executive Vice President, Chief Commercial Officer and Head, Strategic Development of Vertex.

Telaprevir Presentations

Interim data from two Phase 2 studies (C209 and C210) in treatment-naïve HCV patients show substantial antiviral activity against HCV genotypes 2 and 4 when telaprevir is combined with the standard of care compared with standard of care alone. Across both studies, HCV genotype 2, 3 and 4 patients were randomized into one of three arms to receive 15 days of telaprevir alone, telaprevir in combination with pegylated interferon (peg-IFN) and ribavirin (RBV), or peg-IFN and RBV alone. A 5.3, 4.7 and 3.4 log10 IU/mL mean plasma HCV RNA reduction was achieved after 15 days of telaprevir, peg-IFN and RBV treatment as compared to a 4.0, 4.5 and 2.0 log10 IU/mL mean plasma HCV RNA reduction in the control peg-IFN plus RBV arms in HCV genotype 2, 3 and 4 patients, respectively.

[nygirl7]

I've never seen anyone want their genotype to be the worst so badly before. Usually people are wishing for the glass half full effect when dealing with this disease. I'd much rather be a 3 than a 1 or a 4 regardless.

[Marcia2202]

The treatment was 8 weeks with  RO5024048 +180mcg Peg + 1200 mg Riba per day and then continuing with SOC until 48 weeks, from what I can see on her profile

[Boobert]

Hey Bali as a fellow G4 I was told by my GI that the new PI's were working with our type and when it is released he will add that to my treatment. That's what I've been waiting for.

[Bali05]

there is only one small study with Tela and geno4 C210 and it showed a little
response but not as much as geno 1 or 2 , so it is very questionable
if that will get any further attention.
i think we will have to wait for the second round of PIs to hit before we see
something for geno 3,4.

[larf]

does the new drugs not work on G4 then ?

thanks

[LauraV2000]

Marcia,

You said one of your friends was a type 3 non-responder who was successful in a trial in New Zealand.. can you tell me if the trial was for PSI 7977?  I am a type 3 nonresponder and have been told I can possibly join the trial. There is one going on in NZ too.

[Kristina538]

If you put '3A' in the 'search this community' box, you'll be able to check those who've treated and how they've co-strategised the treatment.   We've had a lot of successful 3A's through here, albeit some have had to treat more than once, and more aggressively the second time.

At time of tx in 2008 I was told 80% chance with no liver damage.   With bridging fibrosis I was given a 'lower' statistical chance, but when I managed a RVR (rapid response to Undetected at 4 weeks into tx), by chance went back up to 80%plus.  i.e. you don't always fit perfectly into the general statistics.  

[Marcia2202]

omg.... my brain running away with me... sorry guys

[Marcia2202]

As far as I know there are genotypes 3a and 3b. There is no such thing as a genotype 'only 3'. Sometimes one might get a result of 'only 3', but that is because either the test can't figure out the correct result or they didn't test for the subtype.

As far as I remember the cure rate for g3's was around 70% with 24 weeks, anyway, that's what they said 2 years ago, when I was treating.

Then again, it seems from what we know today, that the most important factor is RVR. That seems to bump up all genotypes to 90% with their respective lengths of SOC tx.

I personally believe that all the info we have now will start changing with the PI's (Tela and BOC) and the other PI's coming into play.

And there are PI's on the way which work with geno 3. One of our friends from NZ was in one of those trials as a non-responder and made it to SVR. But one has not heard much about them lately.

I believe that g3 was said to be tricky, as it used to be lumped in with g2. Since it is not lumped in with g2 anymore, it has just taken a different place on the list. Obviously a lower success rate than g2, but better than g4 or g1.

As telaprevir and boceprevir don't bite on g3, it looks like g1 will have a higher success rate than g3 once these two get on the market.

Instead of it being g2, g3, g4, g1  

it will become g2, g1, g3, g4

It's kind of like the galaxies are alining themselves in a different way...

[Bill1954]

Cando, our genotype was so tough it must have come from the South Bronx :o).

[can-do-man]

I would guess the person who is a relapser or non responder has the toughest geno. At least i'm sure thats how they feel....:)

[Bali05]

I `d love to see data where geno 4 responds with 80% SVR doing straight SOC.
Please share .

[larf]

what i am really saying is i guess, that because g3a is often tricky  and with new drugs the once so called easy geno is now the toughest most likely,  its hard to say about geno 4 as there is not much data and the data is on low numbers
i have read svr rates in the high 70% one even as 80 %
g1 50 %
g3 65 - 70 %
the g3 % was often skewed due to it being lumped with g2
interesting how the hcv has changed
it will be about 4 years i predict before geno 3 will make its advance in svr rates

[Trinity4]

I'm just tryin' to keep everything in balance, Poindexter. You do more thinkin than you got to, so it's my obligation to do less.

Trinity

[Bali05]

"but 3a is often more tricky than say just 3"

as far as I am concerned they all can be tricky.....
just think of IL28b  CC vs TT alone

[Bali05]

geno 1 :  approx 50%  with 48wks
geno 4 :  approx 60%  with 48wks
geno 3 :  approx 72%  with 24wks
geno 2 :  approx 82%  with 24wks

[nygirl7]

I guess this is a glass half empty or half full situation but everything I have read has said up to 80% can clear compared to geno1 and 4 who at best have a 45-50% chance. Those are huge odds differences.

Hepatitis C Genotype: Test of Hepatitis C (U.S. Department of ...Approximately 6% of Americans with hepatitis C have genotype 3; Chance of clearing hepatitis C virus is 65-80%; Treatment usually lasts for 6 months ...
www.hepatitis.va.gov › ... › Understanding lab tests - Cached - Similar

[nygirl7]

I thought geno3 was about the same as 2 and that 4 is about the same as 1.  Image all these years I got it wrong in here?  Without PIs that would make 4 the toughest geno - if and when the PIs are released. We've been waiting for that for years and hopefully it will be soon.

I've never read 65% before though that is the truth.

[Trinity4]

There is no just genotype 3 to my knoweldge.  Each genotype has a subtype.