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INFO: Triple therapy for non-responders

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  • Doc
    First There Was One, Then Two, Now Three? T. M. McCashland, M.D. Brillanti S, Levantesi F, Masi L, et al. Triple antiviral therapy as a new option for patients
    Message 1 of 4 , Mar 1, 2001
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      First There Was One, Then Two, Now Three?
      T. M. McCashland, M.D.



      Brillanti S, Levantesi F, Masi L, et al. Triple
      antiviral therapy as a new option for patients
      with interferon nonresponsive chronic hepatitis C.
      Hepatology 2000;32:630-4.

      Unfortunately, cure of hepatitis C with
      combination therapy ranges from 20%-65%. Thus, a
      large number of nonresponders still pose a
      therapeutic dilemma for the clinician. Brillanti
      et al. studied the combination of interferon,
      ribavirin, and amantidine for 12 months in 60
      patients nonresponsive to interferon. Forty
      patients treated with triple therapy were compared
      to 20 patients with combination treatment. No
      patients withdrew due to side effects. Six months
      posttreatment, 48% had a sustained response in
      triple therapy; 5% had a sustained response in the
      combination group.
      Three abstracts (Hepatology 2000;32:768A, 770A,
      1140A) also describe a higher response rate
      (15-43%) with triple therapy than combination
      therapy in initial nonresponders. Sustained
      responders in Brillanti et al.'s study normalized
      the ALT quickly within 3 months. Surprisingly,
      genotype 1 showed a 32% sustained response and
      non-1 showed a 73% response. The mechanism for
      amantadine synergy with combination therapy is
      unknown. What is concerning is the lower than
      reported sustained response rate in the
      combination group. However, in this difficult
      subpopulation of hepatitis C patients triple
      therapy may provide some early hope. As always,
      large multicenter studies are needed.

      Dr Sharat C Misra MD, DM
      Consultant Gastroenterologist & Hepatologist
    • Edie Rodriguez
      I am going on this triple therapy in a few weeks when the Rib is approved as a single agent for HCV. I am a 1a, naive, with 3.7 m copies per liter. Wish me
      Message 2 of 4 , Mar 1, 2001
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        I am going on this triple therapy in a few weeks when the Rib is approved as
        a single agent for HCV.

        I am a 1a, naive, with 3.7 m copies per liter.

        Wish me luck.

        Edie

        ----- Original Message -----
        From: "Doc" <gidoctor@...>
        To: "GIHepatitis" <GIWorld-Hepatitis@yahoogroups.com>
        Sent: Thursday, March 01, 2001 8:53 AM
        Subject: [GIWorld-Hepatitis] INFO: Triple therapy for non-responders


        > First There Was One, Then Two, Now Three?
        > T. M. McCashland, M.D.
        >
        >
        >
        > Brillanti S, Levantesi F, Masi L, et al. Triple
        > antiviral therapy as a new option for patients
        > with interferon nonresponsive chronic hepatitis C.
        > Hepatology 2000;32:630-4.
        >
        > Unfortunately, cure of hepatitis C with
        > combination therapy ranges from 20%-65%. Thus, a
        > large number of nonresponders still pose a
        > therapeutic dilemma for the clinician. Brillanti
        > et al. studied the combination of interferon,
        > ribavirin, and amantidine for 12 months in 60
        > patients nonresponsive to interferon. Forty
        > patients treated with triple therapy were compared
        > to 20 patients with combination treatment. No
        > patients withdrew due to side effects. Six months
        > posttreatment, 48% had a sustained response in
        > triple therapy; 5% had a sustained response in the
        > combination group.
        > Three abstracts (Hepatology 2000;32:768A, 770A,
        > 1140A) also describe a higher response rate
        > (15-43%) with triple therapy than combination
        > therapy in initial nonresponders. Sustained
        > responders in Brillanti et al.'s study normalized
        > the ALT quickly within 3 months. Surprisingly,
        > genotype 1 showed a 32% sustained response and
        > non-1 showed a 73% response. The mechanism for
        > amantadine synergy with combination therapy is
        > unknown. What is concerning is the lower than
        > reported sustained response rate in the
        > combination group. However, in this difficult
        > subpopulation of hepatitis C patients triple
        > therapy may provide some early hope. As always,
        > large multicenter studies are needed.
        >
        > Dr Sharat C Misra MD, DM
        > Consultant Gastroenterologist & Hepatologist
        >
        >
        >
        >
        >
        >
        > Welcome to GIHepWorld
        >
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        >
        >
      • claudine intexas
        Hi Doc, If I m reading, and adding right, this study mentions a total of 4 studies (or abstracts) on triple therapy in non-responders. I have one of these,
        Message 3 of 4 , Mar 1, 2001
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          Hi Doc,
          If I'm reading, and adding right, this study
          mentions a total of 4 studies (or abstracts) on triple
          therapy in non-responders. I have one of these, and
          in that one the dosing of interferon was 5mu every
          other day. Would you happen to know the dosing of
          interferon in the other studies? I don't suppose it's
          that important, I am just curious. My doctor is
          currently participating in a study of triple therapy
          but with daily dosing of interferon, but he wants me
          to wait and do triple therapy with a pegylated
          interferon.
          Claudine

          --- Doc <gidoctor@...> wrote:
          > First There Was One, Then Two, Now Three?
          > T. M. McCashland, M.D.

          > Brillanti S, Levantesi F, Masi L, et al. Triple
          > antiviral therapy as a new option for patients
          > with interferon nonresponsive chronic hepatitis C.
          > Hepatology 2000;32:630-4.

          > Three abstracts (Hepatology 2000;32:768A, 770A,
          > 1140A) also describe a higher response rate
          > (15-43%) with triple therapy than combination
          > therapy in initial nonresponders.


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        • Doc
          Claudine, I havent checked that out, it maybe daily or alternate day or with peg..all the same. No definite guidelines yet as the studies are too few. Each
          Message 4 of 4 , Mar 1, 2001
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            Claudine,
            I havent checked that out, it maybe daily or alternate day or with peg..all the same. No definite
            guidelines yet as the studies are too few. Each trial wants to be different so it can get published
            , its the world of publish or perish!

            Dr Sharat C Misra MD, DM
            ----- Original Message -----
            From: claudine intexas
            To: GIWorld-Hepatitis@yahoogroups.com
            Sent: Thursday, March 01, 2001 11:47 PM
            Subject: [GIWorld-Hepatitis] Re: to Doc: INFO: Triple therapy for non-responders


            Hi Doc,
            If I'm reading, and adding right, this study
            mentions a total of 4 studies (or abstracts) on triple
            therapy in non-responders. I have one of these, and
            in that one the dosing of interferon was 5mu every
            other day. Would you happen to know the dosing of
            interferon in the other studies? I don't suppose it's
            that important, I am just curious. My doctor is
            currently participating in a study of triple therapy
            but with daily dosing of interferon, but he wants me
            to wait and do triple therapy with a pegylated
            interferon.
            Claudine

            --- Doc <gidoctor@...> wrote:
            > First There Was One, Then Two, Now Three?
            > T. M. McCashland, M.D.

            > Brillanti S, Levantesi F, Masi L, et al. Triple
            > antiviral therapy as a new option for patients
            > with interferon nonresponsive chronic hepatitis C.
            > Hepatology 2000;32:630-4.

            > Three abstracts (Hepatology 2000;32:768A, 770A,
            > 1140A) also describe a higher response rate
            > (15-43%) with triple therapy than combination
            > therapy in initial nonresponders.


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