Aa
Skipping Pegasys Dose
I am geno 1, a liver TP recipient, and had an partial EVR to SOC. I cleared at 24 weeks and have finished 49 of 72 weeks currently. Due to a stroke (TIA) a couple of days ago, my liver doc wants me to take a "drug holiday" and skip this week's Pegasys dose. I am reluctant to do this but said I would comply. I am very worried about compromising my chances of SVR and I am not aware of anything that could link the interferon to stroke risk factors.
Does anyone have any information or comment either on the effect of a missed Pegasys dose on SVR or on any link between Pegasys and risk of stroke?
Brent
Does anyone have any information or comment either on the effect of a missed Pegasys dose on SVR or on any link between Pegasys and risk of stroke?
Brent
Thanks for the information and advice. I do not seem to have any of the risks associated with TIA or stroke, except that I should get more exercise. Maybe a reduction in Peg dosage could be considered. Last time I had a drink, it was illegal (and no, I wasn't around during prohibition, if that's what your thinking) :)
No blood thinners except aspirin which I am now taking daily. No blood pressure meds.
It's a puzzzlement?
Thanks,
Brent
No blood thinners except aspirin which I am now taking daily. No blood pressure meds.
It's a puzzzlement?
Thanks,
Brent
yes Brent, I think that's why the doctor wants a little cutting back.
lots of substances can weaken cellular strength and lead to more bleeding, INF is just one of them. Giving the brain time to heal and maybe adjusting dose would be better than ending up with permanent big time troubles. Even though the brain reroutes around
many minor damages, you don't want more and more to occur,
I have 13 such areas of damage, so you'll want to keep an eye on this, and also look at whatever other medications you are on that have history of stroke.
If you speak to your pharmacist, they sometimes know more about alternative RX's without bad history. When I did physical therapy, I had a patient who had strokes due to taking 2 doses or a muscle relaxant. (One her pharmacist had warned her not to take).
So you will want to reevaluate everything you are on, and make sure no alcohol is present.
Alcohol actually weakens the brains cellular structure significantly. I have seen MRI's where the brain has shrunk to one half it's original size in late stage alcoholism, but even small amounts act as a solvent in the brain, making strokes, and bleeds much more likely.
I hope you'll get to continue therapy. Are you on any blood thinners or blood pressure meds?
MB
lots of substances can weaken cellular strength and lead to more bleeding, INF is just one of them. Giving the brain time to heal and maybe adjusting dose would be better than ending up with permanent big time troubles. Even though the brain reroutes around
many minor damages, you don't want more and more to occur,
I have 13 such areas of damage, so you'll want to keep an eye on this, and also look at whatever other medications you are on that have history of stroke.
If you speak to your pharmacist, they sometimes know more about alternative RX's without bad history. When I did physical therapy, I had a patient who had strokes due to taking 2 doses or a muscle relaxant. (One her pharmacist had warned her not to take).
So you will want to reevaluate everything you are on, and make sure no alcohol is present.
Alcohol actually weakens the brains cellular structure significantly. I have seen MRI's where the brain has shrunk to one half it's original size in late stage alcoholism, but even small amounts act as a solvent in the brain, making strokes, and bleeds much more likely.
I hope you'll get to continue therapy. Are you on any blood thinners or blood pressure meds?
MB
Brent,
As mentioned, my sister in law had a series of TIA strokes back in February. At the time, this is the link my brother in law sent me to help me understand what had happened to her and why - this is from the Mayo Clinic:
http://www.mayoclinic.com/health/transient-ischemic-attack/DS00220
While of course it doesn't have any connect in this article between HCV and interferon, to understand how and why TIA's happen and then be able to tie it in with what you know of your own health situation might be helpful .. at least I'm hoping so. The risk factors page may be helpful this way.
Then if they can explain why reducing the Peg reduces whatever risk factor or causality they think you might have .. or if they can't explain it .. then might help with sorting that out too.
Not fun to go through especially with everything else. Glad you are feeling better.
Trish
As mentioned, my sister in law had a series of TIA strokes back in February. At the time, this is the link my brother in law sent me to help me understand what had happened to her and why - this is from the Mayo Clinic:
http://www.mayoclinic.com/health/transient-ischemic-attack/DS00220
While of course it doesn't have any connect in this article between HCV and interferon, to understand how and why TIA's happen and then be able to tie it in with what you know of your own health situation might be helpful .. at least I'm hoping so. The risk factors page may be helpful this way.
Then if they can explain why reducing the Peg reduces whatever risk factor or causality they think you might have .. or if they can't explain it .. then might help with sorting that out too.
Not fun to go through especially with everything else. Glad you are feeling better.
Trish
Interesting information. It seems to imply that interferon plays a role Post-Attack leading to cellular damage rather than the cause of the attack. Is that right?
Thanks for your support,
Brent
Thanks for your support,
Brent
sorry to hear of your trouble. Hopefully it will be a one time event. Lots of small strokes happen as we age, and often go unnoticed.
there has been some research linking INF to increased risk of stroke.
your doctor probably wants to give it a rest and make sure you speak to him about encephalitis or too much pressure in your brain..there are ways of testing for these.
Interferon regulatory factor-1 may be linked to cerebral ischemia and stroke
July 28th, 2003
Interferon regulatory factor 1 appears to be involved in the mechanisms following cerebral ischemia that lead to cellular damage, and is present in intravascular neutrophils, neurons, and brain inflammatory cells.
According to published research from the United States, "Interferon regulatory factor-1 (IRF-1), a transcription factor that controls the expression of genes related to inflammation and injury, may be involved in the mechanisms of cerebral ischemia. In this study, we used immunohistochemistry to determine whether IRF-1 protein is upregulated after cerebral ischemia, and to define the identity of the cells that express IRF-1 in the postischemic brain....
mb...
this clip above is old, but INF has been around for 40 years, so it's pretty much a known quantity as drugs go.
there has been some research linking INF to increased risk of stroke.
your doctor probably wants to give it a rest and make sure you speak to him about encephalitis or too much pressure in your brain..there are ways of testing for these.
Interferon regulatory factor-1 may be linked to cerebral ischemia and stroke
July 28th, 2003
Interferon regulatory factor 1 appears to be involved in the mechanisms following cerebral ischemia that lead to cellular damage, and is present in intravascular neutrophils, neurons, and brain inflammatory cells.
According to published research from the United States, "Interferon regulatory factor-1 (IRF-1), a transcription factor that controls the expression of genes related to inflammation and injury, may be involved in the mechanisms of cerebral ischemia. In this study, we used immunohistochemistry to determine whether IRF-1 protein is upregulated after cerebral ischemia, and to define the identity of the cells that express IRF-1 in the postischemic brain....
mb...
this clip above is old, but INF has been around for 40 years, so it's pretty much a known quantity as drugs go.
So glad to hear that you are OK! I'm sure that your doctors are being rightfully cautious -- my husband's doctors pretty much echoed what Mikesimon posted above -- his hep doc said there is some evidence that SOC can induce ischemia, but not in a way that's quantifiable statistically. (But enough that some GIs won't treat stroke/cardiac patients.)
I know you have a tough decision in front of you -- I certainly wish you the best outcome!
~eureka
I know you have a tough decision in front of you -- I certainly wish you the best outcome!
~eureka
Thanks for the prayers and hugs! I am really praying for Nick. I know he'll get the call soon!
Brent
Brent
First, thanks to all of you for your comments, concern and thoughts. And just to be clear, I AM JUST FINE! No damage shows up on MRI of brain and I have no after affects. The loss of feeling and speech only lasted a few minutes with a couple of aftershocks lasting only a few seconds. It was a little scary, but I am fine now.
jmjm - thanks. I should have thought about Dr. D. Good idea.
comeagain - I really appreciate your support. I hope all is well with you. :)
Marcia, Charm - thank you so much for your support.
Texas - Not sure I am up to getting out the giant magnifying glass and going through the fine print that comes with the Pegasys again! It'll be a challenge to my eyesight.
Fretboard - Thanks for the advice. I think I am resigned to this adjustment to SOC at least for now
mikesimon - The Fellow filling for my vacationing hepatologist said much the same, that there were reports linking interferon with ischemic attacks, but it was not clear if there was a coincidental or causal relationship. It looks like my hepatologists are on the right track.
Zazza - I have the exact same concern: I have a lot invested in this treatment and do not want to do anything to jeopardize the chances of SVR. Thanks.
Thanks again for the support! You're all terrific!
Brent
jmjm - thanks. I should have thought about Dr. D. Good idea.
comeagain - I really appreciate your support. I hope all is well with you. :)
Marcia, Charm - thank you so much for your support.
Texas - Not sure I am up to getting out the giant magnifying glass and going through the fine print that comes with the Pegasys again! It'll be a challenge to my eyesight.
Fretboard - Thanks for the advice. I think I am resigned to this adjustment to SOC at least for now
mikesimon - The Fellow filling for my vacationing hepatologist said much the same, that there were reports linking interferon with ischemic attacks, but it was not clear if there was a coincidental or causal relationship. It looks like my hepatologists are on the right track.
Zazza - I have the exact same concern: I have a lot invested in this treatment and do not want to do anything to jeopardize the chances of SVR. Thanks.
Thanks again for the support! You're all terrific!
Brent
I am definitely not an expert on this, but I thought that the serum half-life of pegasys is 10 or 12 days. Couldn't it be an idea instead of skipping a shot to move it ahead those extra days and then continue taking the shot on this new day.... Just a thought, which only has to do with logic, but not experience....
Marcia
Marcia
Could you talk to your doctor about temporarily reducing your dose instead of skipping it? Being a slow responder myself, I think we need our 72 weeks if possible. So sorry to hear about your stroke.
I'm very sorry to hear about your difficult time you went thru, going to the hospital and all. If I was in your same position, I would go with what your doctor said. Besides, the information mikesimon put up validates your missed dose in my mind, and I certainly think that SOC has to be adjusted and deviated at some point for some ppl, as we are not all the same.
Good Luck
Good Luck
I'd look at the info packed with the meds...you know there is always a long list of this could happen or that could happen...Sorry to hear of your troubles...I'd probably listen to my dr.
From: http://www.pegasys.com/hcp/default.aspx
"......During treatment, patients’ clinical status and hepatic function should be closely monitored, and PEGASYS treatment should be immediately discontinued if decompensation (Child-Pugh score ≥6) is observed. Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alpha-based therapies, including PEGASYS. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alpha-based therapies and these events is difficult to establish...."
Mike
"......During treatment, patients’ clinical status and hepatic function should be closely monitored, and PEGASYS treatment should be immediately discontinued if decompensation (Child-Pugh score ≥6) is observed. Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alpha-based therapies, including PEGASYS. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alpha-based therapies and these events is difficult to establish...."
Mike
I'm so sorry to hear that you had a stroke. I wish you a speedy recovery! I agree with Jim, post the question directly to Dr. Dieterich. Here is the link www.medhelp.org/forums/show/272
Marcia
Marcia
Sorry to here about your trouble , just want you to know your in my thoughts and in my prayers.
ca
ca
You might want to address this question to Dr. Dieterich in the Expert Forum,
here: http://www.medhelp.org/forums/show/272
All the best with your stroke recovery and treatment.
-- Jim
here: http://www.medhelp.org/forums/show/272
All the best with your stroke recovery and treatment.
-- Jim
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