Why use Peg if S/O works?

[Mendeemoo]

Hi all,
As I am waiting for my doc  to get my scripts in order, I am still researching. :-)
Doc has prescribed Sol, Rib, and Peg. He was reluctant to prescribe Olysio and said insurance probably wouldn't cover it. So here is my question: What (if any) are the benefits of doing the triple combo as opposed to just Sol. and Rib. ? Are there certain instances where that is preferred (viral load, liver condition)? Is it easier to get insurance to pay for the "old established method"? Just trying to figure all this out.  I also read that one of the meds was not recommended if you are on ADHD meds but don't know which one?  I will do what ever I need to do to get cured, but I REALLY don't wan t to do the Peg if I don't have to!

[willie g]

hi, well side effects for solvi and oylisio are less than with and peg and rib. ,plus in October there is another drug coming out, just one pill a day. I am on the sol, and oylisio and clonopin and Zoloft and pain meds, and I could have got on the three meds you were on but my dr. thought the sol and oylisio would best meet my needs because of the meds I was taken and felt my pain level I have now would have been worsened by others, I started my treatment about 5 weeks ago  with a viral load of twenty five million and 7.1 iu  geno 1.  sol. and oylisio have had great results too for most people. there are programs that will pick up the costs of new drugs but as your doing check around somemore, and if your not going to a specialist that's not good either, not your reg.dr.. there will be more comments tomorrow on your questions so stop back. there are people like Lucinda porter who can ask your questions better. she has been in this field since 1997 and other folks who have been thru same treatment as you. don't jump to fast on your treatment program, get more advice and keep doing your homework,, your on a great site,  willie g

[Mike]

Hi Mendeemoo,

The answer is yes: There are reasons why SOL+INTF+RIBV is preferred over SOL+RIBV.

Specifically, SOL+INTF+RIBV has been proven to generate higher cure rates for those infected with genotype 1a compared to SOL+RIBV. In my case, this meant a 10%+ greater chance of a cure vs. SOL+RIBV.

This was due to several factors, including high viral load, previous partial responder, diabetes and hemochromatosis.

The other reason is that, when treating genotype 1a, SOL+INTF+RIBV is a shorter treatment protocol with a 12 week duration compared to 24 weeks for SOL+RIBV.

Simply put, in my case SOL+INTF+RIBV gave me the greatest chance for a cure. Knowing this, my decision to move forward with this protocol was easy. The length of treatment was also a consideration.

I completed treatment in April and achieved a SVR12 in July, which means I'm cured.

When discussing treatment options with your doctor, make sure you look at the protocol that gives you the best chance to put the Hep-C dragon to rest.

Lastly, Gilead is scheduled to receive approval for an  single pill combination (Sovaldi and ledipasvir), which avoids the side effects associated with INTF and RIBV. Since this protocol should be released (and FDA approved) in October, you might want to wait, as it is only a couple of months away.

Talk to your doctor about this.

Best wishes, Mike

[rainbowray]

Hi Mendeemo,
You have good reason to ask these questions, if you need treatment asap then that factors to your decision. What condition is your liver, stage 3 or higher? Then asap is recommended. If stage 2 you can wait for the better options.
I have stage 3 , bridging so I did not want to wait, and optioned for sovaldi/ribavirin
for 24 weeks. I just completed week 7, I am undetected at week 4 which gives me a 94% chance of complete cure. My blood work, and liver panel is all normal range now. This has not been like this for over 30 years.
I am gen 1B.
I wanted Olysio with sovaldi but my doctor is like yours, and does not want to fill out extra forms. I would have gone to another doctor, but I am stage 3 and did not want to fool around anymore. The sovaldi is the key, it kills the virus quick.
I am not an interferon advocate, I refused it 6-7 times in my 43 years of having hepc. The side effects are brutal, and some never leave. It is well documented.
If you do not want interferon, and cannot wait for 4-6 months for better treatments then  sol/riba is another option. There are side effects, but I have not missed a day at work yet, so I can bear them. With interferon I would probably have had to stay home the entire treatment, so go figure.

[Mike]

Hi Rainbowray,

You're not exactly correct about interferon. Some individuals have difficulties tolerating it (just like other drug classes); while others can tolerate it with little or no difficulty.

In addition, most of the side effects with interferon were associated with the length of treatment. The old protocol was 48-70 weeks, which is much longer then the current 12 week protocol, and, hence, the side effects (if present) had to be tolerated for a much longer period. This is no longer the case.

This isn't to say that INTF is a walk in the park; but is very tolerable with a 12 week protocol and the side effects (not everyone has them) can be very manageable.

Furthermore, as far as the side effects "never leaving." That is not correct, and wasn't my experience or anyone I have spoke to who has taken the 48 week protocol.

I recently completed a 12 week protocol (SOL+INTF+RIBV) and the side-effects were much more tolerable with no difficulty managing.

The point is: Treatment decisions should be made on an individual basis and individual clinical picture. Since the goal is a cure, that should be the main consideration. Next would be tolerance of the treatment, followed by length of treatment.

Knowing that SOL+INTF+RIBV is the most effective FDA approved treatment option for geneotype 1, I would not hesitate to recommend it if it meets the above decision process.

As I previously noted, however, Sovaldi and ledipasvir combo should receive FDA approval in the next few months, which is a single pill and avoids both RIBV and INTF.

Best wishes, Mike



 

[rainbowray]

Hi Mike,
All I know is there has been law suits on the maker of Interferon going, and I have read of awful effects people have got.  for the 48 week treatment of old, the results were poor for cure. Some went thru and got rid of the virus, but it was the exception.
I have no data on permanent side effects on the 12 week "new' treatment, but I won't take the chance. Like I stated, I am not an advocate for it, and my opinion is it is on the way out. I am glad you got cured with it, you can advocate it and that is your privilage. I'm ok with it. I suggest to future users to look up the facts and then decide. I just have my opinion, so I state it.
Glad you are hepc free.

[Mike]

Hi Rainbowray,

Hep-C isn't the only disease treated with interferon.  Hairy cell leukemia, AIDS-related Kaposi's sarcoma, and chronic myelogenous leukemia to mention a few.

In fact, the dosage used for Hep-C treatment (185 uL) is relatively low when compared to the doses used to treat leukemia.

Additionally, Interferon and Ribavirin  was actually very effective in treating genotype 2, with 80% cure rates. It was marginally effective with genotype 1, however, with about 50% cure rates. This percentage was reduced in genotype 1 infections, with factors such as high viral load, length of infection, being a male, high ferritin levels, liver damage and so on.

The lawsuits involving Interferon relate to the psychological side effects in some patients who committed suicide while on treatment (this includes cancer patients). Pleas note, however, this was a very, very, very small number, and relates directly to the patient's premorbid level of  psychological and emotional functioning. This is why Interferon is not recommended for those who are actively depressed or have an active mood disorder.

The good news: Sovaldi changed all this when it was approved December 6th, 2013, and the days of Interferon and Ribavirin are numbered.

When looking at my clinical picture in December 2013, and current research involving Sovaldi, SOL+INTF+RIBV gave me the greatest chance of a cure. This included looking at the research for the off label Sovaldi + Simeprevir (Olysis) protocol.

When I treated in 2001, I had a 25-30% chance for a cure (INFT+RIBV x 48 wks).

In 2014, the chance for a cure was 85% (SOL+INTF+RIBV x 12 wks); 75-80% (SOL+OLY x 24 wks) and 70% (SOL+RIBV x 24 wks).

As can be seen, my best shot for a cure was triple therapy, which is why I moved forward with the protocol.

Cure rate is a critical factor in making an informed treatment decision, which is why I encourage everyone to look at the numbers, the clinical picture and how these relate to the various treatment protocols (including the use of Interferon).


Best wishes, Mike

[Mendeemoo]

Mike, Ray, and Willie,

Thank you all for your input. I was only diagnosed about 7 weeks ago, and until then, I had no idea I had HCV. However, I am sure I have had it for 30 years. At this point, I do not know the extent of liver damage I have (if any). My enzymes had been bad for 4  years, but I just recently had a Sono which did not show that my liver was enlarged. My Doc is not going to do a biopsy since I am going to treat anyway. I am going to ask about the other tests available to check for damage.

In reading Mike's first reply, I can understand his point. Best success rate and shorter duration. I didn't realize that S/O was 24 weeks. I don't really think I have much liver damage, and want to get rid of this stuff ASAP before I DO get any damage. I also think if I wait for the new stuff, it could turn in to a longer wait trying to get insurance on board. I hate unfinished business 

Given the facts, I think I may just go ahead with my doctors recommendation. I am a pretty strong person, and I think I can handle it. I would rather have 12 weeks of bad side effects than 24 weeks of mediocre side effects.  However, while I am waiting for everything to process, I will continue to research and can change my mind if other facts come to light!

Thanks again for everyone's input.  I really appreciate it!

On a side note, my cousin was diagnosed within a week of my diagnosis. But she has cirrhosis. I have been gathering info for her too!

[Mike]

Hi Mendeemoo,

Make sure to talk to your doctor about all options. Ask your doctor what protocol will give you the best outcome and why. Ask about the other protocols and why not?

I'm like you. I did the research, weighed my options and moved forward with the best option.

12 weeks goes by really fast and you'll know if the treatment is working by week 5, at which point, you should be virus free (that's a big pump!).

 But it gets better: you'll be 1/2 way through the treatment and headed down the home stretch.

Next thing you know, the dragon is slayed!

Whatever protocol for geneotype 1a you choose, know that you have an excellent+ chance for a cure!

 I waited 14 years for the day a drug like Sovaldi would arrive. And guess what: That drug is here and 10's of 1000's now have hope and are being cured this very day!

Sovaldi is a game changer - a miracle drug!

Best wishes, Mike

[rainbowray]

Mendemoo,
Just want to clarify,  Sovaldi/Olysio is 12 weeks,  Sovaldi/Ribavirin is 24 weeks for Gen 1 .   Also a great non-invasive test for the liver is the fibroscan, or even a blood test called fibrosure. It is nice to know the damage, but if you made your decision on treatment now then I guess the tests can wait.  sono test do not show fibrosis detail to well.

[Mendeemoo]

Mendemoo,
Just want to clarify,  Sovaldi/Olysio is 12 weeks,  Sovaldi/Ribavirin is 24 weeks for Gen 1 .   Also a great non-invasive test for the liver is the fibroscan, or even a blood test called fibrosure. It is nice to know the damage, but if you made your decision on treatment now then I guess the tests can wait.  sono test do not show fibrosis detail to well.

Ray,
Thanks for the clarification. Sovaldi/Ribavirin is 24 weeks? But if you add interferon it goes back to 12 weeks right?  I could be confused but I am pretty sure my doc said 12 weeks.  Also, thanks for letting me know the names of the liver tests - fibroscan and fibrosure - I knew I read them somewhere but couldn't remember the name! Hopefully the brain will clear up a little after I'm cured!! :-)

[Mike]

Yes. That's because the Interferon works in tandem with the RIBV. RIBV will not kill the virus. Intferon will; but not in great numbers. Together they can do the job. Add Sovaldi and you have a super combination. That is why SOL+INTF+RIBV is currently the recommended protocol for genotype 1 for those who can tolerate INTF.

This will change in the near future, however, as INTF and RIBV free treatments are showing great results and high cure rates for genotype 1.

In fact, it looks like a 12 week S/O protocol will be approved in January 2015.

Gilead should receive approval for a daily pill (combination of Sovaldi and ledipasvir) in October 2014. This will be a 12 week protocol as well.

Best wishes, Mike

[willie g]

hey MENDEEMOO , how you doing today, I was told to check up on you and tell you to have a great week,,,, willie g

[Mendeemoo]

Hey Willie! Thanks for checking on me!
Not doing too bad today. Got some Ambien from the doc so maybe I can sleep. This 4 hours a night is for the birds!! I'm a little scared it will make me groggy, but I don't think it can be worse than the groggy from lack of sleep :-)

How are you doing???

Mendeemoo

[riavishingru]

My sentiments. I wouldn't use the other drugs. 1a's who are stage 3 or 4 aren't supposed to take riba or interferon that just lowers the Viral count as undetectable opposed to killing the virus by stopping the replication with S/O. Unless your genotype is 2 I wouldn't take the stuff your doc recommends. Yes there are lawsuits being put together now for lifetime sides of those drugs. If you are Genotype 1a why not ask for S/O. It's not so hard to get if you have low platelets or other damage. S/O is da bomb.