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RVR v. EVR
Dec 21, 2007

I've heard conflicting information about how long people with hep C should wait before discontinuing treatment. Some articles I read say that you should stop taking peginterferon if you don't have an early virologic response. But others sources I've encountered tell me that recent research shows people who don't demonstrate a rapid virologic response are very unlike to achieve a SVR and therefore should probably discontinue treatment. What's your opinion on this topic? Its it worth taking a few months before judging whether the treatment is working, or is stopping early sensible?

Response from Dr. McGovern

A Rapid Virologic Response (RVR) is defined as no detectable virus at 4 weeks.

An Early Virologic Response (EVR) is defined as no detectable virus at 12 weeks. This is a complete response.

Some patients attain a 2-log drop in virus at 12 weeks, but still have detectable viremia. This is a partial EVR

A sustained virologic response (SVR) is defined as no virus six months after stopping treatment.

All of these responses were considered "good" responses in the past. However, we are learning that the highest rates of SVR are obtained in patients with RVR, followed by EVR, and then partial EVR (2 log drop only). In many ways, this all makes good sense.

If a patient has not achieved at least a 2-log drop by 12 weeks then the chance of SVR is pretty slim.

I go to 12 weeks of treatment before I would stop therapy in a patient based on lack of a 2 log drop. For all the other patients, SVR is possible, but as you can see, the probability drops off. However, it is still worth pursuing if side effects are manageable because there is still a decent chance. There is also data suggesting that those patients who attain only a partial EVR should be treated longer so their SVR rates will be higher.

Hope this is helpful. I know it is quite complicated but the field is moving to a "tailored treatment" approach, which I think is definitely needed.



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