Also, ribavirin reductions late in treatment would seem to have little effect, whereas early reductions might have more pronounced effect on SVR.
Although I would think dose reductions of ribavirin should be avoided where possible, I'm not certain that minor dose reductions due to anemia or other side effects would cause a major disruption in one's outcome. At the same time, I would think that a complete elimination of ribavirin could change a successful outcome into a relapse.
Only one I manage to get so far.
Here is the abstract about REP 9AC from APASLD 2012 Conference in Taiwan:
REP 9AC / REP 9AC’: Potent HBsAg release inhibitors that can rapidly elicit durable immunological control of infection in patients with chronic hepatitis B
Mamun-Al-Mahtab1, Michel Bazinet2 and Andrew Vaillant2
1Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
2REPLICor Inc., Montreal, Canada
BACKGROUND: HBsAg suppresses host immunity and permits chronicity of HBV infection.
We cannot give you specific tapering recommendations, but we can give you some general info.
The key to a successful sub taper is slow and gradual. When a person gets to lower doses (2mg or less), the dosage reductions will become more uncomfortable, with more marked w/d symptoms. The reductions up that point are usually much morretolerable.
The SVR rate for geno 1's using Intron A (pre-peg) with ribavirin was 14%.
Upon treatment with nucleos(t)ide analogues, patients with greater reductions in levels of cccDNA had greater reductions in HBsAg, but these reductions did not reach statistical significant correlations .
CONCLUSIONS:
Although nucleos(t)ide analogues potently reduced serum levels of HBV DNA, the reduction of HBsAg and cccDNA was small. In short-term therapy, the magnitude of HBsAg reduction does not correlate with that of cccDNA reduction.
The data demonstrate that three monthly doses of ARO-HBV led to a maximum reduction in circulating HBV surface antigen (HBsAg) of 4.0 log10, with mean reductions of approximately 2.0 log10 on day 85 in the 100 mg cohort and 1.4 log10 on day 71 in the 200mg cohort (currently the last complete data point available). All eight patients achieved greater than 1.0 log10 reductions in circulating HBsAg.
I mean nobody wants to be in that 6% but are anybody having reductions of any kind in any significant numbers.It should be something that should come up in a conversation with your doc.I say should because if there any more drs. like mine that's not happening. I've got silent bob for my dr.
t say how you responded to the reductions. Since your doctor has decided that they need to more aggressively manage your anemia procrit is being employed which make total sense.
The purpose of reducing the riba is to bring your hemoglobin higher. If you increased the dosage you would defeat the purpose of reductions and procrit. It make no sense. I am not sure why you are worried about treating with reduced ribavirin dosages as it has NO impact on SVR rates.
The first chart shows that use of growth factors improves SVR rates over dosage reductions, particularly in the case of interferon. What is NOT clear here is when the dosage reductions were applied over the course of treatment (first 12 - 20 weeks or later?) and by how much (more or less than 80% adherence?).
setid=0c721ba4-ae19-417f-aae1-221ed1a0866a
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This article is on the Clinical care Options Web Site in a Module titled
Managing Adverse Effects With Boceprevir- or Telaprevir-Based Therapy
(I removed the Boceprevir info)
In telaprevir clinical trials, erythropoietin use was prohibited and anemia was managed through RBV dose reductions.
however the conventional wisdom seems to be that slight reductions (in 200 mg. amounts) as Pooh and frijole have mentioned can most often be effective in stabilizing HGB. without possibly adversly affecting overall results ( and this is when one becomes anemic which as I mentioned.... you are not.
does this kind of decrease usually have much of an effect on hgb, I am a bit uncomfortable about the hgb going lower without procrit to help and only more reductions of riba as a solution. I can't find clear information. Some studies suggest that after und it will not hurt, other seem to suggest not good. I am also at a lower does of INF because of low platelets and anc, but I am und. I hope my next blood work still comes out und.
What stage of liver damage are you? Is this your first time on treatment? Did you have any dosage reductions while on treatment - if yes, what weeks and what was the reduction?
When are you getting tested after treatment? Not until the six month mark?
In telaprevir clinical trials, erythropoietin (Procrit) use was prohibited and anemia was managed through Riba dose reductions. Reduced Riba was not associated with lower rates of SVR.
Here is the link for the Incivek data:
http://www.incivek.
Hi All,
A kind note from Jay0914 asking how my BF was prompted me to post an update.
After an extremely trying 6 weeks where he was anemic, he's now a little better after stopping Riba for a few days and then having massive dose reductions (he restarted at 200mg and now at 400mg). He's now stable, with HGB around 10. He was asked to reduced the Interferon for a couple of weeks as well.
Since he is RVR the doctor wasn't worried about intermittent stoppages and dose reductions.
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