Isiscat2011 wrote:

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Jcr:  People have been cutting you a lot of slack when you continue to make derogatory personal comments, but posting a woman's personal information and stating that you could beat her up is going too far, even for cyberspace. 

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 where did i say beat you up? im a god fearing man who would never touch a woman. You made that up in your own head.

Jcr:  People have been cutting you a lot of slack when you continue to make derogatory personal comments, but posting a woman's personal information and stating that you could beat her up is going too far, even for cyberspace. 

I think the main reason there is so much controversy is because there are several very different opinions from the professionals, and also we all react differently to the treatment, so there often is no obvious right answer. The discussion has been heated, and mostly constructive, but I don't think it helps anything to call the group stupid or ask someone to "go outside" to the chat area. If this were easy, we wouldn't need a forum. We could just do it on our own. But sadly, it's not easy, and sharing information with each other has been a big help, particularly when we don't agree. Alan

And does it really matter? I chose to put more than just trust in a doctor, the medical cummunity, and drug manufacturers to mention a few. Its a personal decision to agree to any form of treatment, modification of that treatment, or any other rescue measure. Personally, I refuse to transfuse except to save my life at that moment, and that's been communicated, but that's my deal at this moment in time, like it or not. I am also committed to completing treatment unless my life is again threatened. So, not many options left when your blood labs are tanking with no end in sight. Knowledge is great stuff, I love it, and I think there's some truth, projections, opinions, and false conclusions in just about anything we can find. Its very important that we become our own advocate, but in the end, its the doctor's call based on the available info, his and/or mine. Unless, of course, I want to go rogue and treat myself. Gee, that's worked well for me in the past!

news wrote:

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I think the main reason there is so much controversy is because there are several very different opinions from the professionals, and also we all react differently to the treatment, so there often is no obvious right answer. The discussion has been heated, and mostly constructive, but I don't think it helps anything to call the group stupid or ask someone to "go outside" to the chat area. If this were easy, we wouldn't need a forum. We could just do it on our own. But sadly, it's not easy, and sharing information with each other has been a big help, particularly when we don't agree. Alan

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 nobody said GO outside now did they? i said go to chat so you could fully undertstand what i was saying .Good lord you were the one who said kick cyber butt etc not me, stop reading into things so much.

-- Edited by jrc on Wednesday 4th of April 2012 04:54:32 AM

jrc209 wrote:  

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 meet me in chat stupid, brad post SOC threads god damn people on here are stupid

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'Nuff said. 

 

Sunrise747 wrote:

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Actually we really don't even know if comparing triple-therapy to combo therapy is comparing apples to oranges.  In terms of the impact of a Riba reduction they could be very much the same.  Again the problem is we just don't know.  This study, published in February, finds that combo therapy SVR is impacted by Riba reductions.  Does this apply to triple-therapy?    Nobody can say. 

http://www.natap.org/2012/HCV/020612_03.htm

 

 The blind leading the blind eh? Instead of looking at SOC studies look up triple tx or ask your dr the info is everywhere

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Actually we really don't even know if comparing triple-therapy to combo therapy is comparing apples to oranges.  In terms of the impact of a Riba reduction they could be very much the same.  Again the problem is we just don't know.  This study, published in February, finds that combo therapy SVR is impacted by Riba reductions.  Does this apply to triple-therapy?    Nobody can say. 

http://www.natap.org/2012/HCV/020612_03.htm

 

 

Isiscat2011 wrote:

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Not experts, jcr,  just patients like you.  I wouldn't wish this tx on my worst enemy, let alone my fellow Heppers, which is why I want everyone who goes through it to achieve SVR. 

I know that riba dosage reductions is a sensitive issue, but if people understand that reductions can effect their SVR chances they will be better equipped to discuss the management of their blood problems with their docs.

I wish you the best of luck too.

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 Where did u find this study? Link me please to a proven fact that says it reduces svr?Or are you just going off SOC which is apples and oranges?

krowdog wrote:

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Here's one link, with the conclusion quoted:

http://www.ncbi.nlm.nih.gov/pubmed/17196435                                        

This is from an article in:

Clinical  Gastroenterology Hepatol. 2007 Jan;5(1):124-9. Epub 2006 Dec 28.

Impact of ribavirin dose reductions in hepatitis C virus genotype 1 patients completing peginterferon alfa-2a/ribavirin treatment.

RESULTS:

Of patients who completed treatment, more had reductions (< or =97% cumulative dose) of ribavirin than of peginterferon alfa-2a (43% vs 27%). Neither early virologic response nor SVR was affected adversely by ribavirin reductions when the cumulative ribavirin exposure was greater than 60%. The SVR was reduced significantly (P = .0006) in patients with less than the 60% cumulative ribavirin dose and was associated with prolonged periods of dose reduction, temporary interruptions, or premature cessation of ribavirin. Ribavirin dose reductions had minimal impact on SVR in patients who achieved rapid virologic response, defined as undetectable HCV RNA levels after 4 weeks, even when they received less than the 60% cumulative ribavirin dose. In contrast, SVR was reduced markedly in patients who had ribavirin dose reductions and did not achieve rapid virologic response.

 

*Now, please note, this is for the *2-drug* peg and riba Tx only.  I can find little on the 3 drug Tx, I think because it is so new. I would expect Ribavirin  dose reductions to have less influence on SVR with the 3 drug tx (just my opinion)

If you can post any newer studies, I would love to see them.

Good luck to all,

Brad

 

-- Edited by krowdog on Sunday 1st of April 2012 04:30:51 PM

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 Also SOC

-- Edited by jrc209 on Tuesday 3rd of April 2012 09:11:40 PM

Isiscat2011 wrote:

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jrc20 wrote:

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 Where did u find this study? Link me please to a proven fact that says it reduces svr?Or are you just going off SOC which is apples and oranges?

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Adding a protease inhibitor to SOC isn't like apples and oranges, i.e, separate and distinct concepts.  It is more like adding an orange to an apple. You still need the apple for the tx to work. If your contention is that adding a protease inhibitor fundamentally alters the treatment to the extent that riba dosages no longer matter then it is time to show us some proof. 

In fact, adding a protease inhibitor increases anemia, and hence, increases the need for riba reductions. 

Brad and Sunrise have already posted the links to the studies that show riba reductions will effect SVR for some people. Incivek admitted the same in the FDA Approval hearings (you can find out more about that in a thread entitled half-way report).  

 

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 meet me in chat stupid, brad post SOC threads god damn people on here are stupid

-- Edited by jrc209 on Tuesday 3rd of April 2012 09:09:22 PM

Not experts, jcr,  just patients like you.  I wouldn't wish this tx on my worst enemy, let alone my fellow Heppers, which is why I want everyone who goes through it to achieve SVR. 

I know that riba dosage reductions is a sensitive issue, but if people understand that reductions can effect their SVR chances they will be better equipped to discuss the management of their blood problems with their docs.

I wish you the best of luck too.

Isiscat2011 wrote:

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jrc209 wrote:

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 And you are a DR? These are proven facts from a DR not some random person new to tx such as yourself!

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 What are proven facts from a DR? 

 

Yours truly,

Random Person

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Ill stay out of this you guys are the experts! Not the people who actually have a degree! Where did you pull your facts from your head?

Ill stay out of this you guys are the experts! Not the people who actually have a degree!

-- Edited by jrc209 on Tuesday 3rd of April 2012 03:36:34 AM

jrc209 wrote:

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 And you are a DR? These are proven facts from a DR not some random person new to tx such as yourself!

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 What are proven facts from a DR? 

 

Yours truly,

Random Person

Ill stay out of this you guys are the experts! Not the people who actually have a degree!

-- Edited by jrc209 on Tuesday 3rd of April 2012 03:36:51 AM

-- Edited by jrc209 on Tuesday 3rd of April 2012 03:38:45 AM

Sunrise747 wrote:

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I am looking for anyone here who has completed a 24-week Telaprevir based treatment who was also placed on a lowered Ribavirin dose at some point.  If this is you can you tell me the following:  What was your Riba dose lowered from/to?  At what week was it lowered?  For how many weeks did it stay lowered?  And have you remained undetectable?  Thanks! 

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Anecdotal information won't help much because each situation is unique.  Clearly riba reductions will impact some people's SVR.  The question has always been how much and when. Every time I read someone advising another person that their riba reduction will not effect SVR it makes me cringe because it certainly could. 

I expect the study that Brad cited will prove accurate in most cases.  Note that the study only included around 500 people, however, and the researchers concluded that more studies needed to be completed before establishing a clear protocol.

"Prospective studies, however, are required to establish the impact of ribavirin dose reduction on SVR."

IMHO, the best option is to insist that your doctor review your specific situation and dosages from beginning to present and chart out a course where the cumulative riba dosage will be as high as possible especially for those who are not rapid responders, and also where the dose reductions start early in tx (as this is likely to be a continuing issue).  Pull out the calendar and calculator and ask your doc/nurse to walk you through it.

It may take some time and planning but it could make the difference. Riba reductions are the easiest, cheapest, and generally the safest solution, but not necessarily the best choice for SVR.  This is still a grey area but one thing I know for sure.  It won't be the medical provider or the person giving the advice that riba reductions don't matter who suffer the consequences when it does matter.

 

I would love to hear more about this.  Anyone else have more details or links to scholarly articles?

I am looking for anyone here who has completed a 24-week Telaprevir based treatment who was also placed on a lowered Ribavirin dose at some point.  If this is you can you tell me the following:  What was your Riba dose lowered from/to?  At what week was it lowered?  For how many weeks did it stay lowered?  And have you remained undetectable?  Thanks!