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Hep C Discussion Forum -> Post Treatment -> EOT Ribavirin Con Predicts HCV relapse
Post Info TOPIC: EOT Ribavirin Con Predicts HCV relapse
Tig


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RE: EOT Ribavirin Con Predicts HCV relapse
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Kellie, you're onto something that has been supported by more than one article I've read recently. Sorry I don't have that data handy but will find it if anyone is in need of the source. Anyway, the information said the bioavailability of RBV was likely increased after taking it with a fatty meal or snack, just as the PI's instruct you to do now. I have to add though that Victrelis states with a snack or meal of some kind, the requirement to make it a high fat meal isn't stated. I spoke with my specialist at the pharmacy and I asked her specifically about what to eat when taking RBV and mentioned the articles supporting the high fat snack and the increased bioavailability. She said that while the information she is aware of doesn't support the probability of a better bioavailability when RBV is taken with a fatty snack but she believed that it's going to be better tolerated when taken with something. But she also said it could be taken alone. So it's another one of those personal choices. I'm not one that is concerned about always taking these meds with a fatty meal, but I do eat something just prior to taking any of it. If there is something fatty, like cheese, etc. available, it's probably a good idea to consider it. It's all about reading and succeeding!! Good post Kellie xo smile



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Kellie


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I asked my NP about this at my last appt. She said the Riba saturation test has not been approved for use and if it was, it would have been necessary to take the test at the beginning of treatment as well as end, to compare. hmm I am currently on 1000mg daily and have started a few weeks ago to take the riba with a bit of fat. I don't know if this does anything really, but in my mind it does.smile  8 days to go - Have a great day everyone!



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HCV 1A 1980. Dual tx 2003 -UND at wk 11-discontinued due to severe depression

Started Triple 4/16/13 for 24 weeks

UND wk 4,6,8,12,17 & 24

E.O.T. 9/29/13

EOT + 12 weeks=SVR, and EOT +26 weeks=Cured!
Tig


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Garfield, I appreciate your desire to believe that and you're welcome to follow that train of thought but I fail to see what this plasma RBV assay during and after treatment will accomplish or benefit, outside of another number. We'll have to agree to disagree on this one.  If you are prescribed the highest dose possible throughout treatment, what will you gain by having this expensive assay performed? You acknowledge that having this level tested in Germany (eg) may determine reduction or elevations of the RBV dose, again this is fine if you want to reduce your dose. But I thought the objective was to provide the best possible chance of SVR following EOT, by maintaining the highest plasma level throughout treatment,right? My position is that here in the US, you are started on the highest dose your body mass will allow. So it seems fairly likely to me that if you're taking the highest dose allowed, you're going to have the highest plasma level already. You won't need another test to determine that. If they want to tweak the dosing options due to anemia, etc., there is aleady an established method to accomplish it. But should that be a number you believe will determine your success or failure in treatment, by all means determine it. Thanks!



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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garfield


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Hi Tig,

         you have not to believe it. When you search for Ribavarin level, Hb-reduction, SVR you will find many other studies, which show the same.

In different studies the cut-off-concentration associated with relaps was between 1600 and 2000 ng/ml, a level of 2300 ng/ml was associated with greater than 4 g/dl Hb-reduction.

In germany, in modern doctors office, the Hb-level reduction will additionally used as an indication of the Ribavarin level and then the dose will be increased or reduced. 



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garfield


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Hi Tig,

           a missunderstanding.

of course only reduction in case of severe anemia, but increase in case of too small Hb-Reduction.

I think, in USA it is the same, Ribavarin dose 1000 - 1200 mg depending on personal weight.



-- Edited by garfield on Sunday 18th of August 2013 02:36:38 PM



-- Edited by garfield on Sunday 18th of August 2013 02:37:09 PM

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Tig


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This was a microscopic example, only 34 patients. I must be missing something or don't understand the significance of this report. First it's only reporting on the SVR rates of people on combo therapy. It doesn't mention genotype, so the relevance to GT 1a and 1b is missing entirely. Aren't people undergoing this therapy currently dosed based on body weight? I know that's how they have determined my dose, which is currently 1200mg/day. I don't believe they routinely prescribe anyone higher doses of Ribavirin, do they? Also, I believe everyone's SOC that includes Ribavirin at any dose, takes it from day 01 until EOT. So if you're being prescribed the highest dose recommended from day 01, what would be the benefit of this high priced assay? You should already be at the highest possible Ribivirin plasma concentration allowed according to current dosing guidelines. So again, unless I'm missing something, what would be the benefit of knowing what your RBV plasma levels are if you're taking the highest allowed dose throughout your entire course of treatment? Many doctors and pharmacists would hesitate to dose above current guidelines, because of dose limits and liability.  I guess if you're concerned that you aren't being dosed high enough, then this assay would be informative. But I have to wonder if this test would be enough to rewrite the book on Ribivirin dosing. I would like to see a far larger study group including all genotypes, treatment regimens and weeks of treatment overall before I would be placing much importance on it. I would prefer to see Peg Int and Ribivirin removed from the HCV drug cabinet altogether, they are both difficult to tolerate for most and are far from the answer for the worst genotypes. I think the future lies in the newest medications on the horizon, not resurrecting the importance of RBV. If I'm missing the importance of this assay, please explain. Thank you!



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Tig

67yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Cinnamon Girl


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Here you go...  smile

http://hepcfriends.activeboard.com/t54688167/the-end-of-treatment-ribavirin-concentration-predicts-hepati/

By the way, there`s a search box at the top of the page if you`re looking for something in particular. 



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
rotting to the core


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Sorry I just read this but I can't find it again, got so excited I lost my spot...cry. Stupid drugs are making me stupid...I want this blood test, and adjust my riba intake if necessary. Such good news!!!!

Timothy



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Timothy

GT3a Baseline VL 514,000, Week 4 VL 130, Week 12 UND and have been UND ever since.  

Completed 48 week of Pegasys & Copegus. EOT VL UND.   Achieved SVR after 48 weeks of treatment.                                                   

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