Hep C Discussion Forum

Hi Loopy,

I think Sofosbuvir and Ledipasvir is a great combo. My doc is probably unhappy that Gilead are not doing any significant Trials in Australia, and that they won't give him access to their drugs. Even if Abbott get approval first, Gilead won't be far behind. The final Phase 3 Trial results will decide who sells the most. Hopefully the Geno 3's will get better results. Cheers.

He sounds like my hepa :) pushing always max dose of Riba and Peg to her patients (on tx start i got Riba 25% bigger dose and 20% more interferon), but she said under 110 Hgb she has to reduce a bit dose of Riba. Strangely she was happy to see my Hgb down, mentioning (from her experience) that more toxic Riba is to RBC better antiviral propertie there is.

wow, they pushed you down to 70 Hgb? Will they ever understand Riba mechanism or how it works at all? really mysterious synthetic molecule...i wonder whats the holdup with Taribavirin and other prodrugs being made from Riba?

it's good to have race between Gilead and Abbott, hopefully that will bring price down of new DAAs?

i think i will do 12,24 and 48 EOT VL test after that only if liver shows some signs of inflamation on ultra sound and if ALT goes high again. I don't care what my insurance covers (i did on my own VL 4w and 8w anyways).

you are holding now new age record for his cirrhotic patients with SVR? :) hehe cool!

Saw my doc today, who's just returned from the Amsterdam Conference. He's very conservative but was very excited by my 12w Undet. He calls that SVR 12 and that is the new standard. He claims enough evidence has shown that the relapse rate after EOT +12w is the same as EOT + 24w, and the Trials are no longer doing a 24w Viral Load. " If you want one, you have to pay for it yourself ".  I'm happy to humour him, but still will get a VL done at about 30 weeks. I think he's happy as his previous cirrhotic SVR age record was 54yo.

He claims that I don't need further endoscopies as I don't have varices or portal hypertensive gastropathy. A paper was presented at the Meeting, showing cirrhotics who achieved SVR, drop their portal vein pressure, and the spleen reduces in size.  Evidently inflammatory cells surround the portal vein branches and compress them, as part of the inflammatory response to HCV. This is an effort to reduce the portal vein flow to the liver ( as the portal vein carries toxins from the gut). After SVR, these inflammatory cells disappear, allowing the portal vein branches to dilate, reducing pressure.  I'm happy to cross gastroscopies off my list.

The risk of HCC drops by 60-70%, so liver imaging is still required, together with AFP.  New HCC markers are being developed. There is debate about the timing- many now think yearly tests are enough.

Overall, the Abbott presentations were well received and are thought to be the front-runners. He may be biased, as he's getting access to the Abbott drugs next year. He described Gilead's presentations as disappointing.  This was only his opinion, as he didn't think Gilead had enough Phase 3 Trials going, and the results were not well documented. He thought Gilead were going to still require Ribavirin for the Geno 1a's.

I asked him whether he had changed his mind about Riba. reduction for anaemia. He said that nobody has the slightest idea what the correct therapeutic dose of Riba. is, and probably never will. He will continue to use the maximum dose that patients can tolerate. He commented that my Hb reduction to 7 (70 here) was a great stress test, and showed I did not have coronary artey problems. Great.

He doen't want to see me until the end of September, so I'll miss my little updates.