Ribavirin resistance
Common Questions and Answers about Ribavirin resistance
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The new STAT-C meds can be used in combination with SOC drugs (peginterferon & ribavirin) for those who previously failed SOC treatment and want to try again to achieve SVR. These patients will have a better chance of SVR with the new meds.
A single mutation associated with resistance has been reported at position 168 in the replicon system. A resistance mutation at this position has not been found during treatment with telaprevir and boceprevir. Therefore, ITMN-191 has the potential to be effective against HCV
variants resistant to telaprevir and boceprevir. However, this hypothesis needs further evaluation in clinical trials.
Therefore, in this small subpopulation, response did not appear to be hampered by the presence of high-level resistance mutations at baseline, provided patients were responsive to lead-in peginterferon/ribavirin. In the 7 patients with high-level resistance mutations at baseline who were nonresponsive to interferon as defined by < 1 log10 reduction in HCV RNA during 4-week peginterferon/ribavirin lead-in therapy, SVR was not observed. By contrast, in the overall population, 27.8% to 37.
A new, large study finds that African-Americans diagnosed with hepatitis C (HCV) respond better to treatment when the antiviral drug, ribavirin, is dosed based on weight rather than standardized.
http://www.hepatitis-central.com/mt/archives/2004/12/weightbased_tre.
The very high sustained virologic rates (SVR) achieved in almost all populations treated with ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir with dasabuvir (plus or minus ribavirin) might suggest that resistance testing is not necessary. However, new data presented at the recent European Association for the Study of the Liver (EASL) meeting in Vienna could suggest otherwise, at least for some patients.
My question is this. What harm can result in not testing for resistance to ns3 ns5 after the holkira Pak failed and automatically assigning HARVONI as next course of treatment?
For example, if a person were to fail to attain SVR with Ribavirin and peginterferon, would that breed a virus that is more resistant to future combination therapies such as protease or polymerase inhibitors given along with Ribavirin and peg-interferon?
600,000 IU/mL)
Specific viral mutations
Genotype 1a has a lower barrier to resistance to protease inhibitors, and therefore emergence of resistance is more frequent with this viral subtype than with genotype 1b.
6 of the 8 breakthrough patients who underwent resistance testing had telaprevir resistance mutations, all of whom also had cross-resistance to boceprevir.
The 6 individuals with resistance all had subtype 1a, while the remaining 2 had 1b.
"Similar to findings in clinical trials, viral breakthrough with DAA for treatment of chronic HCV infection is associated with genotype 1a, advanced liver fibrosis, and prior null treatment response," the researchers concluded.
• 6 of the 8 breakthrough patients who underwent resistance testing had telaprevir resistance mutations, all of whom also had cross-resistance to boceprevir.
• The 6 individuals with resistance all had subtype 1a, while the remaining 2 had 1b.
"Similar to findings in clinical trials, viral breakthrough with DAA for treatment of chronic HCV infection is associated with genotype 1a, advanced liver fibrosis, and prior null treatment response," the researchers concluded.
First time was monotherapy with 3 shots of intervon a week as that was all there was I think about 1995 the first time I treated. Later it was interferon and ribavirin and then one more with interferon ribavirin and a trial drug all with no success. I was a total non responder my viral load never decreased at all.
I was diagnosed with cirrhosis Jan 2008.
Figure 9. Loss of detectable resistance in patients discontinuing telaprevir plus peginterferon/ribavirin.[10]
Taken together, these studies support the role of strict adherence to the futility stopping rules for boceprevir and telaprevir to allow the return of wild-type virus and to limit the further evolution of drug-resistant variants.
was in all the articles I have read in regards to resistance ..especially cross resistance ...there are still many unknowns.
And I agree with you entirely we are going to have to tread very carefully imho through the resistance maze until more is known and studied.
Again ..thx for the input...
There are 235 individuals with hepatitis C virus (HCV) in the study who are receiving treatment with PSI-938 alone or in combination with PSI-7977 or PSI-7977 and ribavirin. During routine safety monitoring, the company detected laboratory abnormalities associated with liver function in subjects receiving PSI-938 300 mg once daily. These laboratory abnormalities have not been observed in patients receiving PSI-7977 and ribavirin in the QUANTUM study or in other trials evaluating PSI-7977.
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