Is cure rate affected by reducing Ribavirin dose?

[KimInTheForest]

Quite a few people here whose treatment included Ribavirin, ended up having their dosage reduced midway through because of the Riba problems (anemia, etc.). Just wondering… are the treatment outcomes (success rates) the same? Any of you have results to report yet?

When I research this question online, I can only find information about the old therapies of Interferon+Ribavirin, and outcomes of dose-reducing in that situation.

It doesn't really affect me at this point since I just have 7 days left of my Harvoni+Riba (and have been at 1,000 mg the whole time). But I have been wondering if there is any anecdoatal or research data on this question yet of outcomes when dose-reducing ribavirin in new all-oral treatments.

Wishing the best outcomes for all of us,
Kim

[dragonslayer]

Kim,

I believe if you read the Gilead trial data, generally, the data shows that ribavirin was a non factor.. The only time Ive seen it used is if the doctor or insurance wants to shorten the treatment for Cirrhotics who are treatment experienced from 24 wks to 12..   I dont think Ive seen data on that, but aside from that, I dont think there is much if any data showing  a benefit to combining Riba with Harvoni.

[KimInTheForest]

Actually, ribavirin is essential with Harvoni for us Geno 3 folks. But you are right about the addition of ribavirin for Geno 1 people being irrelevant in most situations (or at least in clinical trials comparing with and without riba).

The ELECTRON2 study in New Zealand involving 12 weeks of Harvoni for Geno 3 tx-naive people had a 100% cure rate with ribavirin and a 64 % cure rate without ribavirin.

So I know I do need the ribavirin with it. But with my question, really I was wondering if any of the people on these forums who have completed any of the all-oral treatments where ribavirin was included (solvadi, v-pak, harvoni) - whether those who were dose-reduced on the riba (i.e., stepped down from 1200 to 800 mg/day partway through because of side effects) did indeed go onto achieve SVR12 .

kim

[dragonslayer]

Kim, of course you are right about the GT 3 folks...  Didnt mean to leave them out.. The vast majority here, as in the country as a whole are GT 1 so when a question is asked,  I usually automatically answer in that regard.  I guess I never realized before that you were GT3.   Looking forward to see responses to your question from the GT3 folks..

[KimInTheForest]

It's not just the Geno 3 people, Paul. There are many people on these forums, including many Geno 1 people, who have Ribavirin as part of their all-oral treatment, e.g., all the Geno 1s on Viekira+Riba, or all the Geno 1s with cirrhosis and past tx on Harvoni+riba, or all the Geno 2/3/4s on Sovaldi+Riba.

Good chart of who gets riba added:
http://www.axiumhealthcare.com/hepatitis-c-treatment-comparison-by-genotype/

There are quite a lot of folks here who do have riba included in their treatment. And from what I am reading, quite a few of them have been dosed-reduced by their doctors along the way because of low hemoglobin, etc. from riba. Now perhaps none of them has reached 12 weeks post-tx yet. But some folks must be getting close.

It will be interesting to see if those who have been dose-reduced on their riba midway through have same success rate. I think they will. But that is just a guess.

cheers,
kim

[dragonslayer]

Right Kim.. I was only speaking about GT1 and about Harvoni.

[KimInTheForest]

I hear ya Paul. But even there, GT1s with cirrhosis and past treatment get ribavirin with their harvoni (or else 2x harvoni).

also what would be the point of just looking at harvoni if the question is about treatment outcomes with ribavirin dose reduction?

best,
kim

[Philadelphia]

I'm a riba-reductionist - Viekira Pak Geno 1a, cirrhotic, 24 weeks treatment.

I reduced early due to bilirubin and haemoglobin issues. These have continued to see-saw all the way through treatment. While that mademe anxious, I have to specialist my doctor on this one

He is the "head of Viral Hepatitis Clinical Research Program at the Kirby Institute, has published 180 peer-reviewed publications and has current research funding from Australia’s National Health and Medical Research Council (NHMRC) and the US National Institutes of Health, including a NHMRC Program Grant, Partnership Grant, CRE and CCRE."

I figure he knows his bananas enough to make a measured risk assessment of my situation and do what's best for me.

I don't finish treatment till September, so won't really have any idea till then - or even months afterwards.

[Philadelphia]

HOWEVER (I just remembered this) I do know two Viekirians over here in Aust who were both dose reduced. One has achieved SVR12, the other has hit 4 weeks post and is still clear.

[KimInTheForest]

Thanks Philadelphia! Good to hear about the 2 Aussie Viekirians who were dose-reduced and achieved SVR12 or headed that way. May the same good outcome await you.

kim

[Tess1971]

It looks like everyone here took a higher dose of ribavirin than I did.  I took 800mg with the sovaldi.  I  read the studies and info provided to me by specialty pharm and ghilead and they stated that dose was only to be lowered long enough for sides  to improve and then go back to full dose.  I believe dose is determined by weight. I did not see where it affected the outcome if done so for short period of time.

[KAL]

im geno type 2 and the only treatment (at this time) for geno 2 is sovaldi / ribavirin , 12 weeks non cirrhosis and 16 weeks with cirrhosis .  ,.... harvoni  is sovaldi without the 40mg of ledipasvir .........my doctor goofed when he got approval for med's and had me on 1200mg riba. , i only weight 145/150 and should have been on 1000mg !.......i realized this at week 6 after doin some reading, called him and he said, ooop's , go down to 1000mg...........
i was undetected @ week 4 , im @ week 12 now of 16 and doin pretty darn good !

so i'll have about 90 riba. pill's eft over if anyone needs them lol !

K

[KAL]

im geno type 2 and the only treatment (at this time) for geno 2 is sovaldi / ribavirin , 12 weeks non cirrhosis and 16 weeks with cirrhosis .  ,.... harvoni  is sovaldi without the 40mg of ledipasvir .........my doctor goofed when he got approval for med's and had me on 1200mg riba. , i only weight 145/150 and should have been on 1000mg !.......i realized this at week 6 after doin some reading, called him and he said, ooop's , go down to 1000mg...........
i was undetected @ week 4 , im @ week 12 now of 16 and doin pretty darn good !

so i'll have about 90 riba. pill's eft over if anyone needs them lol !

K

[KimInTheForest]

Thanks for the on-topic replies Tess & Kal & Philadelphia. Good luck to you! May we all achieve SVR12.

kim