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Author Topic: Half Dose Harvoni ???  (Read 8925 times)

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Offline Mr. Bob

  • Member
  • Posts: 37
Half Dose Harvoni ???
« on: May 31, 2015, 12:55:30 pm »
Hello.  I was thinking
FACTS:
1...Harvoni for some has accumulated  side effects  some temporary, possibly some permanent.
2.  The longer the treatment the higher the SVR rate.  24 weeks 100%
3.  Harvoni has a  half life of Sofosbuvir 27 hrs and  Ledipasvir47 hrs .

 Reduce dose "after 2 consecutive  undetectable tests" to lessen side effects and
Extend treatment if in the 8 or 12 week class.

1 full tablet  then 1/2 tablet  1 full tablet then 1/2 tablet and so on  30 days will be extended to 40 days.


This came to me as an intuition while feeling crappy at 7 weeks  A)-reading the science + B) listening to harvoni patients....and C) common sense....
 

your thoughts please


Offline KimInTheForest

  • Member
  • Posts: 1,972
  • Believe in yourself
Re: Half Dose Harvoni ???
« Reply #1 on: May 31, 2015, 01:49:18 pm »
Hi Bob. I have no opinion on the logic of extending duration of treatment by reducing dose after 2 consecutive UND results. However, I do know it is not a good idea to cut the Harvoni pill in half because the time-release effect (created by intact coating) will be lost and that could affect its effectiveness. Personally, I think if side effects are a problem, I would want to get through Tx faster, not slower.

best to you,
kim :)
Kim Goldberg (Nanaimo, BC)
1970s: Contracted HCV (genotype 3a)
2015: Cured with Harvoni + ribavirin (12 weeks)
MY STORY: https://pigsquash.wordpress.com/2016/01/28/undetectable-my-hep-c-story/

Offline SIXFOOTFOUR

  • Member
  • Posts: 89
Re: Half Dose Harvoni ???
« Reply #2 on: May 31, 2015, 02:09:11 pm »
No-no-no don't split the pills as already posted the coating has a lot to do with the drug absorbson.

Millions of dollars and thousands of hours of research were part of the development of Harvoni if alternating doses or other lengths of therapy were successful or indicated they would have run tests.

We are lucky for these breakthrough drugs follow your prescribed regimen
Sixfootfour
* Contracted Hep C 1971 post transfusion (non A - non
   B Hep dx in 1971)
* Dx as Hep C early 2000
* Geno 1b
* Stage 3-4 Fibrosis by Biopsy and FibroScan
* VL at start of TX > 6 mil
* ALT/AST High normal range at start of Tx 
* Started Harvoni 12 week course 3/6/15 -
   completion 5/29/15
* Undetected at 6 weeks on Tx
* ALT/AST Mid normal range at 6 week blood test
* Completed 12 weeks (84 pills) 6/28/15
* Undetected at 11 weeks & 6 months EOT

Offline dragonslayer

  • Member
  • Posts: 873
Re: Half Dose Harvoni ???
« Reply #3 on: May 31, 2015, 02:29:44 pm »
For the vast majority of patients, Harvoni is not used with a response-guided protocol the way more primitive treatments used to be.  Why is that?  Not sure, only Id have to think that if on-treatment testing were a good predictor of SVR, it would be in the prescription guidance documents.. I do know this.  Folks who have low detect results at EOT go on to a SVR12, and some who are undetected on treatment relapse by that date...   Since low detected at EOT does not spell failure with Harvoni, why prescribe more duration as a result?  SVR12 is the big test with Harvoni; all else is mostly considered noise in the system.  By the same token, you certainly dont want to reduce or split your prescribed dose... Just take as prescribed... For most, side effects are a non-issue anyway.
« Last Edit: May 31, 2015, 02:31:33 pm by dragonslayer »
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Ledoc01

  • Member
  • Posts: 37
Re: Half Dose Harvoni ???
« Reply #4 on: June 01, 2015, 01:32:02 am »
I have to agree with dragonslayer for the most part. I'm not sure if it's "most" that have no side effects but it certainly seems that MOST will ultimately clear.

I took my last pill (12wk tx) on 5/16; yesterday ws the first day I could say I'm feeling mostly normal. YaY!!.. like effin finally lol. Of course only time will tell what the real long term effects are. Hopefully the cure doesn't do any lasting damage.

I had a host of  sides  varying in intensity... some were kinda extremeish but you just have to keep your head down and plow on.

In any event I wouldn't do any pill splitting for the reasons already mentioned. I know the odds are in our favor. Also, fwiw, paying TOO much attention to the interim test's can (in my sometimes humble opinion) just stress you out for no reason. I know I was rather bummed after my 4 week VL numbers came in; I was detected <12. Fortunately my wife had enough energy (we had a baby girl a few days after I started tx) to check into my results and after explaining how the assay tests are done said she wasn't concerned as the odds were WAY in my favor. I tend to give a lot of weight to her assessment since she has a PhD in analytical chemistry and frankly understands the testing procedures better than many of the Dr's prescribing Tx.  That's another thing too...all tests are not equal.
 
After my wife's exhaustive mini lecture on assay's I did a tad more research and found a paper that was kinda helpful as well. While this paper is from 2013, I think it's worth the read.

http://www.viral-hep.org/wp-content/uploads/2013/12/O113.pdf

Long story short...there are only 2 things to really worry about...

Oh hell, now I forgot what they were  ::)

Keep the faith y'all


peace

ps. I hope this made sense lol

Offline BubbaT

  • Member
  • Posts: 267
Re: Half Dose Harvoni ???
« Reply #5 on: June 04, 2015, 12:25:47 am »
Oh hell, now I forgot what they were  ::)

did somebody say brain fog!   LOL! ;)

If you never tried HE, good, don't try it!

Jus saying!
Age 57 male
Infected late 70's
Diagnosed 95
1a, 2 prev biopsy 95, 2004
Ct 2007, 2015
Treatment Naive
F4 A3. Fibrosure/ CT 2-5-15. Ammonia 222
VL 2.2 mil.
Started Harvoni  3-3-15. 12weeks, finished 5-26-15
4 week VL undetected
12 week EOT undetected

 


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