Re: Digest Number 3087

[Guest guest]

Debby and others, regarding sun: I remember the package insert that came with Imuran said to avoid sun. I believe Palmer's book mentions it, too. If you go to Google and enter Imuran and sun, you should be able to find out.

I am far more sensitive to sunlight and heat than I was before I was diagnosed. That could just be due to my very considerable weight gain from 80 mg Prednisone days.

Harper

[Guest guest]

Harper, I remember the insert with Imuran, but nothing has come through with the 6MP But, I am also on plaquenil and I know that has a sun warning. Somewhere else, there was something that specified that autoimmune problems can cause extreme sensitive to the sun and heat. I know that I just cannot tolerate the heat anymore. I understand the weight gain with the prednisone, but that weight gain has not affected me. It just seems that since being on the 6MP that I am not at all tolerant of the heat.

Case in point. Thursday, our First graders went out for a program practice. It was nearly 100. So, I stood under a tree, with my umbrella. Well, I think the heat caused me to have a migraine, then 10 minutes before the kids left, I was literally on the floor of the classroom retching into the trash can. The poor kids didn't know WHAT to think of their teacher!

I was having extreme pain in my right side and lower abdomen. My GP had dx me with a kidney and bladder infection. So, hubby took me to ER and they thought it was kidney stones. But it was nothing. They pumped me full of pain meds because I was presenting with severe pain in the abdomen. It appears that I had some quick virus and a migraine. I am much better today, but could not go to work because I was too groggy. But boy! Those pain meds certainly put you into another world!

Debby

Re: [ ] Digest Number 3087

Debby and others, regarding sun: I remember the package insert that came with Imuran said to avoid sun. I believe Palmer's book mentions it, too. If you go to Google and enter Imuran and sun, you should be able to find out.I am far more sensitive to sunlight and heat than I was before I was diagnosed. That could just be due to my very considerable weight gain from 80 mg Prednisone days.Harper

[Guest guest]

It never ceases to amaze, and impress me, what parents can think up to help

their children...

Annette

on 8/11/04 12:37 PM, at

wrote:

> I use a straw and suck a small

> piece out of the center of a small piece of banana. I sprinkle the

> supp. into the hole and then blow the piece of banana out of the straw

> and insert it back into the banana. A little smoothing over with my

> finger and you can't tell anything is different.

[Guest guest]

Found the keys, no problem. Couldn't throw very far, 26 weeks of treatment doesn,t leave much excess strength for temper tantrums.

Male chimpanzee, infected with genotype 1a for 20 yrs. Resistance did not appear until after viral loads had declined.Resistant mutants observed in vivo were also observed during in vitro expts.Pharmacokinetics/Pharmacodynamics (PK/PD)Estimating an "in vivo" EC50Neumann, et al., Science282, 103-107, 1998Viral load declines over 14 days in response to antiviral therapy can be described as the sum of two exponential functions.Math is complex, but the only term that is important for drug therapy is "_" ._ = antiviral efficacy = % inhibition 1. Obtain "C" (the drug concentrations in the liver over time)2. Using computer simulation:-- input test EC50 values which generates _ values-- _ values become part of the Neumann et al., two- exponential equation that predicts viral load declines over time-- repeat the process until an EC50 is found that is consistent withthe dose-dependent viral load declines View Older Articles Back to Top www.natap.org

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10.

analysis show that therapy à la carte with peginterferon and rib

Posted by: "elizabethnv1" elizabethnv1@... elizabethnv1

Sat Oct 6, 2007 6:28 pm (PST)

The results of this analysis show that therapy à la carte with peginterferon and ribavirin reduces short-term costs and, consequently, the cost per patient with SVR compared with standard therapy. The cost per successfully treated patient (patients who achieved SVR) is 25% lower with therapy à la carte (€17,812 compared to €12,313). As such, the à la carte strategy enables more patients to be treated under a fixed budget. With the same budget used in the standard therapy strategy, i.e. €237,049,713, the à la carte strategy enables 5944 more patients to achieve SVR (compared with standard therapy). Segregating these data with respect to viral genotype, the budget invested for genotype 1 with standard therapy was €191,419,126, i.e. 8085 patients with SVR and, if the same amount was used in the à la carte strategy, the number of patients with SVR would be 12,181; an increase of 4095 patients achieving SVR. Similar results were obtained in patients infected with viral genotypes 2 and 3. With a budget for standard therapy of €45,630,586, this implies that 5223 patients achieved SVR while, with the same budget and therapy à la carte, this figure increases to 6865.Therapy individualization is not only cost-saving in reducing the number of clinical consultation visits and blood tests, but also decreases therapy duration, the number of adverse events, and, as a result, may improve quality of life. A closer analysis shows that the cost-saving is greater in patients with genotype 1 infection than in genotypes 2 and 3 treated à la carte. This is mainly because of the higher percentage response in genotype 1 patients with low viral load who achieve a rapid virologic response and who can, therefore, be successfully treated in a 24-week period. The efficacy of shorter combination therapy has also been shown with peginterferon alpha and ribavirin in an analysis performed by Jenseen[12] of the results of the large study performed by Hadzyannis.[6]Out study shows the importance and impact of a quantitative determination of HCV-RNA at week 4 for genotype 1 patients with low viral load as well as for genotypes 2 and 3 patients. Earlier, the EASL International Consensus Conference on Hepatitis C recommended a 24-week therapy schedule with peginterferon and ribavirin for some patients infected with genotype 1 and low levels of viraemia (<2 million copies/mL) and for all patients infected with genotypes 2 and 3.[1] Recent studies, however, suggest that only genotype 1 patients with low levels of viraemia ( & #8804;600,000 copies/mL) who achieve a rapid clearance of the virus at week 4 can benefit from shorter therapeutic schedules without adversely affecting SVR.[11,12] Patients with high baseline viral load despite a rapid or an ultra-rapid clearance of HCV when treated for 24 weeks, have a similar end-of-treatment response to those with low viraemia but higher relapse rate and, as such, a decreased SVR rate. Shortened therapy duration in patients with genotype 1 infection with low viral load, has an impact on budgetary investment that enables more patients to be treated with a low cost per patient achieving SVR.In addition to the measurement of EVR, it appears that RVR should be monitored and patients with good response should be selected for treatment with the shorter schedule. Similarly, it may become clear in the future that some patients with a slow therapeutic response, i.e. who clear the virus between weeks 12 and 24, could benefit from prolonged therapy, even up to 72 weeks of combination therapy. The results of some published studies support this option. However, the optimal doses of ribavirin in slow responders still need to be determined.[28-30]The highest SVR with therapy à la carte assumed by the review of the literature compared with standard combination therapy is probably related to the selection of the best patients applying the RVR and then shorten therapy. For this reason, the sensitivity analysis, which includes a reduction of 10% in SVR, means an SVR of 45% shows even a low cost per successful patient (a saving of €2.313). Our sensitivity analysis shows a reduction in therapy costs within which are included that of liver biopsy and the use of low-dose ribavirin (800 mg/day) for patients with genotypes 2 and 3 infection and with either treatment strategy. The proportion of patients infected with genotype 1 and low viral load seems to be around 33% for patients infected with genotype 1. However, this proportion can vary depending on the population studied and on the techniques used for HCV-RNA determination. Decreasing the proportion of genotype 1 patients with low viral load to 20%, i.e. those that are 'easy to treat', the à la carte strategy results in a reduction in the number of patients (713 patients) with SVR, which is still a cost-saving strategy compared with standard therapy. Furthermore, although re-treatment for 24 weeks in genotypes 2 and 3 patients who relapse after treatment à la carte is associated with a higher cost, assuming a similar SVR to those obtained in naïve patients treated for 24 weeks, it is still cost-effective with a cost per patient achieving SVR of €12,109. Even when decreasing the SVR rate for à la carte therapy by 8%, the number of patients with SVR with both strategies was the same. Furthermore, therapy à la carte continued to be cost-effective.There are some limitations to the present study. First, the existing published data are insufficient to assess comprehensively the à la carte strategy in the model, particularly for patients with genotype 1 infection and high viral load. Some of the data are available only in abstract form. For genotype 2, shorter therapy only seems possible with peginterferon alpha using adjusting ribavirin dose to body weight (800-1400 mg/daily). Results with peginterferon alpha with a fixed dose of ribavirin do not justify truncation of therapy for genotypes 2 and 3.[31] This is probably related to the fixed low dose of ribavirn (only 800 mg) and the different viral kinetics of both peginterferons. Second, with respect to external validity accorded to the decision-makers, it would be interesting to evaluate whether the results are transferable to other settings. There may be further doubts regarding the benefits encountered in clinical trials (efficacy) using the present model and whether these are applicable to patients treated in routine clinical practice (effectiveness). On the other hand, only short-term outcomes were considered in the model (rates of SVR) showing the cost per SVR of both strategies, which can be useful for short-term decision-making. Also, as the perspective chosen for the estimation of economic consequences of the disease was that of the National Health System, which is only responsible for direct costs, other indirect costs such as work-time loss, leisure-time loss and informal care costs have not been included in the present analysis. Other costs related to the management of adverse effects during treatment with peginterferon plus ribavirin were not considered in the model. The idiosyncrasies of each healthcare system, drug costs, the cost of medical procedures and disease management would be different in different settings and, as such, the model would need to be re-run in different countries to establish its validity.In conclusion, therapy à la carte with an assessment of RVR at week 4 is a cost-saving strategy compared to existing standard therapy. The result is a lower investment for each successfully treated patient with SVR

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good, Im glad you found your keys,, lol,,, I once threw the hand held phone into the woods when my ex was threatening me.. lol,, I found it too, haha!g <drdigger@...> wrote: Found the keys, no problem. Couldn't throw very far, 26 weeks of treatment doesn,t leave much excess strength for temper tantrums. Male chimpanzee, infected with genotype 1a for 20 yrs. Resistance did not appear until after viral loads had declined.Resistant mutants observed in vivo were also observed during in vitro expts.Pharmacokinetics/Pharmacodynamics (PK/PD)Estimating an "in vivo" EC50Neumann, et al., Science282, 103-107, 1998Viral load

declines over 14 days in response to antiviral therapy can be described as the sum of two exponential functions.Math is complex, but the only term that is important for drug therapy is "_" ._ = antiviral efficacy = % inhibition 1. Obtain "C" (the drug concentrations in the liver over time)2. Using computer simulation:-- input test EC50 values which generates _ values-- _ values become part of the Neumann et al., two- exponential equation that predicts viral load declines over time-- repeat the process until an EC50 is found that is consistent withthe dose-dependent viral load declines View Older Articles Back to Top www.natap.org Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (1) 10. analysis show that therapy à la carte with peginterferon and rib Posted by: "elizabethnv1" elizabethnv1earthlink (DOT) net elizabethnv1 Sat Oct 6, 2007 6:28 pm (PST)

The results of this analysis show that therapy à la carte with peginterferon and ribavirin reduces short-term costs and, consequently, the cost per patient with SVR compared with standard therapy. The cost per successfully treated patient (patients who achieved SVR) is 25% lower with therapy à la carte (€17,812 compared to €12,313). As such, the à la carte strategy enables more patients to be treated under a fixed budget. With the same budget used in the standard therapy strategy, i.e. €237,049,713, the à la carte strategy enables 5944 more patients to achieve SVR (compared with standard therapy). Segregating these data with respect to viral genotype, the budget invested for genotype 1 with standard therapy was €191,419,126, i.e. 8085 patients with SVR and, if the same amount was used in the à la carte strategy, the number of patients with SVR would be 12,181; an increase of 4095 patients

achieving SVR. Similar results were obtained in patients infected with viral genotypes 2 and 3. With a budget for standard therapy of €45,630,586, this implies that 5223 patients achieved SVR while, with the same budget and therapy à la carte, this figure increases to 6865.Therapy individualization is not only cost-saving in reducing the number of clinical consultation visits and blood tests, but also decreases therapy duration, the number of adverse events, and, as a result, may improve quality of life. A closer analysis shows that the cost-saving is greater in patients with genotype 1 infection than in genotypes 2 and 3 treated à la carte. This is mainly because of the higher percentage response in genotype 1 patients with low viral load who achieve a rapid virologic response and who can, therefore, be successfully treated in a 24-week period. The efficacy of shorter combination therapy has also been shown with

peginterferon alpha and ribavirin in an analysis performed by Jenseen[12] of the results of the large study performed by Hadzyannis.[6]Out study shows the importance and impact of a quantitative determination of HCV-RNA at week 4 for genotype 1 patients with low viral load as well as for genotypes 2 and 3 patients. Earlier, the EASL International Consensus Conference on Hepatitis C recommended a 24-week therapy schedule with peginterferon and ribavirin for some patients infected with genotype 1 and low levels of viraemia (<2 million copies/mL) and for all patients infected with genotypes 2 and 3.[1] Recent studies, however, suggest that only genotype 1 patients with low levels of viraemia ( & #8804;600,000 copies/mL) who achieve a rapid clearance of the virus at week 4 can benefit from shorter therapeutic schedules without adversely affecting SVR.[11,12] Patients with high baseline viral load

despite a rapid or an ultra-rapid clearance of HCV when treated for 24 weeks, have a similar end-of-treatment response to those with low viraemia but higher relapse rate and, as such, a decreased SVR rate. Shortened therapy duration in patients with genotype 1 infection with low viral load, has an impact on budgetary investment that enables more patients to be treated with a low cost per patient achieving SVR.In addition to the measurement of EVR, it appears that RVR should be monitored and patients with good response should be selected for treatment with the shorter schedule. Similarly, it may become clear in the future that some patients with a slow therapeutic response, i.e. who clear the virus between weeks 12 and 24, could benefit from prolonged therapy, even up to 72 weeks of combination therapy. The results of some published studies support this option. However, the optimal doses of ribavirin in slow

responders still need to be determined.[28-30]The highest SVR with therapy à la carte assumed by the review of the literature compared with standard combination therapy is probably related to the selection of the best patients applying the RVR and then shorten therapy. For this reason, the sensitivity analysis, which includes a reduction of 10% in SVR, means an SVR of 45% shows even a low cost per successful patient (a saving of €2.313). Our sensitivity analysis shows a reduction in therapy costs within which are included that of liver biopsy and the use of low-dose ribavirin (800 mg/day) for patients with genotypes 2 and 3 infection and with either treatment strategy. The proportion of patients infected with genotype 1 and low viral load seems to be around 33% for patients infected with genotype 1. However, this proportion can vary depending on the population studied and on the techniques used for HCV-RNA

determination. Decreasing the proportion of genotype 1 patients with low viral load to 20%, i.e. those that are 'easy to treat', the à la carte strategy results in a reduction in the number of patients (713 patients) with SVR, which is still a cost-saving strategy compared with standard therapy. Furthermore, although re-treatment for 24 weeks in genotypes 2 and 3 patients who relapse after treatment à la carte is associated with a higher cost, assuming a similar SVR to those obtained in naïve patients treated for 24 weeks, it is still cost-effective with a cost per patient achieving SVR of €12,109. Even when decreasing the SVR rate for à la carte therapy by 8%, the number of patients with SVR with both strategies was the same. Furthermore, therapy à la carte continued to be cost-effective.There are some limitations to the present study. First, the existing published data are insufficient to assess comprehensively

the à la carte strategy in the model, particularly for patients with genotype 1 infection and high viral load. Some of the data are available only in abstract form. For genotype 2, shorter therapy only seems possible with peginterferon alpha using adjusting ribavirin dose to body weight (800-1400 mg/daily). Results with peginterferon alpha with a fixed dose of ribavirin do not justify truncation of therapy for genotypes 2 and 3.[31] This is probably related to the fixed low dose of ribavirn (only 800 mg) and the different viral kinetics of both peginterferons. Second, with respect to external validity accorded to the decision-makers, it would be interesting to evaluate whether the results are transferable to other settings. There may be further doubts regarding the benefits encountered in clinical trials (efficacy) using the present model and whether these are applicable to patients treated in routine clinical

practice (effectiveness). On the other hand, only short-term outcomes were considered in the model (rates of SVR) showing the cost per SVR of both strategies, which can be useful for short-term decision-making. Also, as the perspective chosen for the estimation of economic consequences of the disease was that of the National Health System, which is only responsible for direct costs, other indirect costs such as work-time loss, leisure-time loss and informal care costs have not been included in the present analysis. Other costs related to the management of adverse effects during treatment with peginterferon plus ribavirin were not considered in the model. The idiosyncrasies of each healthcare system, drug costs, the cost of medical procedures and disease management would be different in different settings and, as such, the model would need to be re-run in different countries to establish its validity.In

conclusion, therapy à la carte with an assessment of RVR at week 4 is a cost-saving strategy compared to existing standard therapy. The result is a lower investment for each successfully treated patient with SVR Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (1) Recent Activity 2 New MembersVisit Your Group Cancer Support Groups on Find answers, connect with others. FruitaBü Parents on teaching families how to eat healthy. Search Ads Get new customers. List your web site in Search. Need to Reply? Click one of the "Reply" links to respond to a specific message in the Daily Digest. Create New Topic | Visit Your Group on the Web Messages | Links | Calendar It's a pleasure having you join in our conversations. We hope you have found the support you need with us. If you are using email for your posts, for easy access to our group, just click the link-- Hepatitis C/Happy Posting Change settings via the Web ( ID required) Change settings via email: Switch delivery to Individual | Switch format to Traditional Visit Your Group | Terms of Use | Unsubscribe Jackie