Therapy for HCV
Therapy for HCV
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Posted by thanbey
on February 05, 2000 at 11:08:56:
There has been an huge marketing effort (a successful one) to have us all believe that ribavirin increases the effectiveness of the therapy.
What it has done is increase the effectiveness of IntronA. Study after study has concluded that rebetron ( aka combination) is better than IntronA (aka monotherapy) alone.But head to head studies of other therapies are only being done now.
As you have noted, these are not the only two therapies available. Consensus interferon has demonstrated itself to be as effective as Rebetron, without the risks and side effects of ribavirin.
I have heard hepatologists present this information at the AASLD and at the DDW (the two major liver conferences in the USA). And I have articles on this as well.
I have very serious reservations about people using ribavirin. If you separate the industry hype from the scientific information (some of which is industry hype) it has not been shown to be a better mousetrap. It has been shown to be a better marketed mousetrap. PegIntron is pegylated intronA.
Pegasys (Roche) should be approved this year. It is showing very good results in Europe and in preliminary reports. Because it is not approved, Roche cannot say much about it. But I can. It looks very good. Actually better than very good. Also Roche has Roferon, an FDA approved interferon.
Now in clinical trials are hepatazyme (Eli Lilly) Welferon (Glaxo-Welcome), Interlukins (10 and 12) and natural interferons (Viragen).
There is on-going research ,and more than a little promise on the anti-fibrotics. These may serve to block the scarring process in the liver which is the damage that ultimately becomes cirrhosis. these would likely be oral medications.
The main obstacle to determining which is the best and what causes most risk is the way that that is measured and what we take to be true about the disease.
Right now, the viral load is used to determine the "success" or "failure" of a treatment. This has been a really good measure for HIV, but does not provide the same reliable measure in HCV. In other words, the viral load does not provide us with a measure for severity of disease as it does for HIV.
The problem is, unlike in HIV, we have no FDA approved standard to measure this. Consequently, the research is a mish mash of tests that cannot be compared well with one another. That leaves a void which the industry has kindly filled with marketing information.
In addition to this clinical trials do not reflect a diversity in the patient base. We know, for example, that African Americans have been underrepresented in clinical trials. So, look ar statistics critically when you see them. What is touted as a 38% rate of success, is really only about 15-20% when applied across a general population of patients. But is its you......
Ribavirin has some very serious side effects and can you very sick. I haven't seen or heard of anyone who has not had side effects at some point. Many have to discontinue therapy altogether.
Be prepared financially, in your family life, and in your carreer to put everything on hold for a year (longer idf you want children). Some have been able to work, but not many.
What is the real gain if you are PCR negative and have gained another condition (diabetes, hearing loss, autoimmune hepatitis, psychiatric events, heart conditions, lung conditions, etc etc) that just means you have swapped one condition for another?
You have lots of time to decide what you want to do. You have no symptoms, and you have no significant disease. The disease moves slowly. Even the least effective interferon(if that is what you choose) has been shown to have a positive effect on the liver histology (fibrosis).
The other side of the coin is that treating this early may eradicate the virus. We do not have really long term data about this yet. But it is a possiblity.
We cannot predict whose disease will get worse without treatment. And that is a real concern. Many patients feel that they want to be rid of this virus at all cost. Some doctors agree with this. For those patients who progress, this is a serious disease. So, some would say, treat everyone.
You can protect your liver by not smoking or drinking any alcohol at all, even as an ingredient in other foods (ie desserts). If you do this much, you decrease your risk for serious disease manyfold.
Here is a site where you can find information, pro and con, on the dilemma you face. Arm yourself with knowledge and power.
www.hcop.org .... click on favorite links. You will find info from professionals, from researchers and from patients.
Best of luck to you.
I hope this helps.