Treatment details Re: Marty's post

[Guest guest]

Hi Marty,

Good questions, follow the * below

> Dear Doc:

> Just for clarification for all, are you talking a year as in 48

> weeks?, or a calender year of 12 months, or 52 weeks?

*48 wks to be exact but sometimes due to various missed shots , I

prefer a calender year/ 12 months. It is frequent to miss shots thus a

year makes sense, if you havent then let it be 48 wks precisely.

Also, while people

> with genotype 1a and 1b should be on for 48 weeks, if their viral load

> is undetectable during treatment, and their liver functions are

normal,

*It is best that they go on for one year if the above has not happenned

( meaning both parameters which is actually the ETR) otherwise stop at 6

months and keep watching every 3-6 months.

> do you ever recommend going beyond the 48 weeks?, or just waiting for

> the lab results at post therapy and 6 months?

* I will judge the response at 6 months, for usual combo therapy in

non 1 genotypes, if none I would call them non-responders and change to

high dose induction for 2-4 wks followed by combo with high dose IFN and

try and go on with it for a year if no problems occur and even beyond if

viral load shows a diminishing trend. If reponse is favorable at 6

months but not complete then therapy should go on for one year

irrespective of genotype. In 1 genotypes I would begin with high dose

combo and continue for a year unless complete response occurs at 6

months and keep checking at 3 monthly intervals there after .Beyond one

year Ribaviin would get discontinued and IFN can continue for another 4

wks if favorable response is occuring. All these are dynamic decisions

and to be considered separately in each clinical situation. In clinical

trials these considerations are not taken and outside trials, therapy is

a different ball game alltogether. You will be surprised to know that

many physicians in this field are sceptical to treat patients outside of

trials as they do not want the responsibility of adjusting doses and

duration.

Further it is important to remember that changing the type of IFN does

not influence response rates , it may change the adverse effects and

tolerability, so as well with Peg-IFN, only that will allow a larger

dose with lesser side effects, so we hope!

[Guest guest]

Hi Marty,

Good questions, follow the * below

> Dear Doc:

> Just for clarification for all, are you talking a year as in 48

> weeks?, or a calender year of 12 months, or 52 weeks?

*48 wks to be exact but sometimes due to various missed shots , I

prefer a calender year/ 12 months. It is frequent to miss shots thus a

year makes sense, if you havent then let it be 48 wks precisely.

Also, while people

> with genotype 1a and 1b should be on for 48 weeks, if their viral load

> is undetectable during treatment, and their liver functions are

normal,

*It is best that they go on for one year if the above has not happenned

( meaning both parameters which is actually the ETR) otherwise stop at 6

months and keep watching every 3-6 months.

> do you ever recommend going beyond the 48 weeks?, or just waiting for

> the lab results at post therapy and 6 months?

* I will judge the response at 6 months, for usual combo therapy in

non 1 genotypes, if none I would call them non-responders and change to

high dose induction for 2-4 wks followed by combo with high dose IFN and

try and go on with it for a year if no problems occur and even beyond if

viral load shows a diminishing trend. If reponse is favorable at 6

months but not complete then therapy should go on for one year

irrespective of genotype. In 1 genotypes I would begin with high dose

combo and continue for a year unless complete response occurs at 6

months and keep checking at 3 monthly intervals there after .Beyond one

year Ribaviin would get discontinued and IFN can continue for another 4

wks if favorable response is occuring. All these are dynamic decisions

and to be considered separately in each clinical situation. In clinical

trials these considerations are not taken and outside trials, therapy is

a different ball game alltogether. You will be surprised to know that

many physicians in this field are sceptical to treat patients outside of

trials as they do not want the responsibility of adjusting doses and

duration.

Further it is important to remember that changing the type of IFN does

not influence response rates , it may change the adverse effects and

tolerability, so as well with Peg-IFN, only that will allow a larger

dose with lesser side effects, so we hope!

[Guest guest]

Hi Marty,

Good questions, follow the * below

> Dear Doc:

> Just for clarification for all, are you talking a year as in 48

> weeks?, or a calender year of 12 months, or 52 weeks?

*48 wks to be exact but sometimes due to various missed shots , I

prefer a calender year/ 12 months. It is frequent to miss shots thus a

year makes sense, if you havent then let it be 48 wks precisely.

Also, while people

> with genotype 1a and 1b should be on for 48 weeks, if their viral load

> is undetectable during treatment, and their liver functions are

normal,

*It is best that they go on for one year if the above has not happenned

( meaning both parameters which is actually the ETR) otherwise stop at 6

months and keep watching every 3-6 months.

> do you ever recommend going beyond the 48 weeks?, or just waiting for

> the lab results at post therapy and 6 months?

* I will judge the response at 6 months, for usual combo therapy in

non 1 genotypes, if none I would call them non-responders and change to

high dose induction for 2-4 wks followed by combo with high dose IFN and

try and go on with it for a year if no problems occur and even beyond if

viral load shows a diminishing trend. If reponse is favorable at 6

months but not complete then therapy should go on for one year

irrespective of genotype. In 1 genotypes I would begin with high dose

combo and continue for a year unless complete response occurs at 6

months and keep checking at 3 monthly intervals there after .Beyond one

year Ribaviin would get discontinued and IFN can continue for another 4

wks if favorable response is occuring. All these are dynamic decisions

and to be considered separately in each clinical situation. In clinical

trials these considerations are not taken and outside trials, therapy is

a different ball game alltogether. You will be surprised to know that

many physicians in this field are sceptical to treat patients outside of

trials as they do not want the responsibility of adjusting doses and

duration.

Further it is important to remember that changing the type of IFN does

not influence response rates , it may change the adverse effects and

tolerability, so as well with Peg-IFN, only that will allow a larger

dose with lesser side effects, so we hope!

[Guest guest]

Hi Marty,

Good questions, follow the * below

> Dear Doc:

> Just for clarification for all, are you talking a year as in 48

> weeks?, or a calender year of 12 months, or 52 weeks?

*48 wks to be exact but sometimes due to various missed shots , I

prefer a calender year/ 12 months. It is frequent to miss shots thus a

year makes sense, if you havent then let it be 48 wks precisely.

Also, while people

> with genotype 1a and 1b should be on for 48 weeks, if their viral load

> is undetectable during treatment, and their liver functions are

normal,

*It is best that they go on for one year if the above has not happenned

( meaning both parameters which is actually the ETR) otherwise stop at 6

months and keep watching every 3-6 months.

> do you ever recommend going beyond the 48 weeks?, or just waiting for

> the lab results at post therapy and 6 months?

* I will judge the response at 6 months, for usual combo therapy in

non 1 genotypes, if none I would call them non-responders and change to

high dose induction for 2-4 wks followed by combo with high dose IFN and

try and go on with it for a year if no problems occur and even beyond if

viral load shows a diminishing trend. If reponse is favorable at 6

months but not complete then therapy should go on for one year

irrespective of genotype. In 1 genotypes I would begin with high dose

combo and continue for a year unless complete response occurs at 6

months and keep checking at 3 monthly intervals there after .Beyond one

year Ribaviin would get discontinued and IFN can continue for another 4

wks if favorable response is occuring. All these are dynamic decisions

and to be considered separately in each clinical situation. In clinical

trials these considerations are not taken and outside trials, therapy is

a different ball game alltogether. You will be surprised to know that

many physicians in this field are sceptical to treat patients outside of

trials as they do not want the responsibility of adjusting doses and

duration.

Further it is important to remember that changing the type of IFN does

not influence response rates , it may change the adverse effects and

tolerability, so as well with Peg-IFN, only that will allow a larger

dose with lesser side effects, so we hope!