Anybody had pegays dose reduction?

[nency]

Has anyone ever had dose reduction of Pegasus and still being SVR or EVR?
My doc suggesting to reduce dose on fifth week of Tx from 180 to135 for ANC 704 and no neupogen, because neupogen causes sides also---that is his argument!????????
Honestly, I am afraid! What do you think guys? OR may be I am overdosed, my weight only 100 lbs and Height 5.4, then it is a good thing- I need child dosing? OR…………… I can not think of anything else, but I am afraid not to respond on lower doses! Please help!

[nency]

Thank you very much for your support! Unfortunately, all great people have this horrible disease. This forum helped me to understand how many good friends around me, care for me during this difficult time. I am praying for you. Honestly, my life would be much more complicated if you guys were not around!  Kisses.. Nency

[roostermom]

I am type 1b, female and started pet/ribo treatment weighing in around 125 lbs and 5'4''. within the first month, my wbc dropped, and rather that reduce the meds, i added neupogen. my weight dropped to 88 lbs on tx, but still didn't drop the dose. i was virus free at the half way point and free after 48 weeks, but within in 3 months it was back. I haven't done anything since. I had a Fibrospec blood test last year, and it showed no further liver damage. Letting it rider until they figure out something i will be able to tolerate better.

[Moniker!]

I should have said peg reduction, not riba. I've been off treatment a year and a half now, and have forgotten the names of the meds. It was a Pegasys reduction I had, not a riba reduction. HappyThanksgiving and enjoy. Best to all.

[Moniker!]

I was genotype 1a. I'd had hep c for over thirty years. I was 57-years-old when I started treatment. My riba dose was reduced by a quarter, then reduced by half, and then they had me skip a week altogether (the seventh week). At week twelve my PCR indicated undetectable. After week twelve, I did go on Neupogen, and then took full dose riba until week forty-eight. My forty-eight week PCR indicated undetectable, and also my six month, and my one year post tx PCRs. I am SVR.

The dose reduction didn't stop me getting a cure. I still do wish I had taken Neupogen right away to avoid the reduction because I worried a lot that I'd had the reduction. It made me feel less secure about my chances.

I'm very well now, feel good. I go to the gym three times a week, and I have never been in better health. I am very thankful to be SVR. Best of luck to all of us. Happy Thanksgiving.

Bob

[jmjm530]

Glad you got in to see Dr. D.

Hopefully, you will be able to contact him in the future -- appointments, phone, email, etc -- re important treatment decisions.

-- Jim

[nency]

Thank you  for your help. I had second opinion yesterday. Once Jim recommended me Dr. Dieterich in NYC, so he said do not change anything, but he did not disagree with my doc that even lower doses might work for me, because it is individual approach, BUT! He said he does not want to take any chances to reduce my response to Tx. It would be helpful if more people shear their experience in regards to dose reduction and SVR with Type 1b. Feel free to give any advice.
Thank you once again, Happy Thanksgiving.
Nency

[HassanHelmy]

Yes, I know one colleague who had to reduce the dose from 180 mg to 135 mg in the middle of the treatment due to blood data, after one month of 135 mg dose, he get to the 180 mg back, he was UNDE at week 8 and stay there even after dose reduction. He finished tx three months ago, he still UNDE! by the way, he "was" genotype 4!

[FlGuy]

I used Neupogen and felt very minimal sides.  In my opinion (even if neupogen is warratened) the risk of reducing doses and the impact it may have on final tx results is greater than the impact of getting Neuped.

[jmjm530]

Some reading from 3 studies, for you and/or your doc. Present or maybe future.

Of note is conclusion 3 which suggests that growth factors like Neupogen may not be as necessary as previously thought and do not correlate with increased infection rate on combo therapy. This may be in part why my liver specialist, and some others, rarely use Neupogen in their practice (that's from my NP) and if so, only intervene when it gets very low -- like in the 200-300's. The other thing is that ANC can bounce around a lot. One week my dropped to around 300 and two weeks later it was over 1000. All without Neupogen or Peg reduction. But again, don't dose yourself, it should be under medical supervision. If you don't have confidence in your doctor, seek another opinion.

http://www.hivandhepatitis.com/2006icr/ddw/docs/060606_a.html

Conclusion 1: The researchers concluded that use of G-CSF is safe and enables adherence to full-dose peginterferon in patients with chronic hepatitis C who develop neutropenia during therapy. Use of G-CSF was also associated with higher early and sustained virological response rates.


Conclusion 2: The authors concluded that the use of growth factors prevents dose reductions of pegylated interferon and ribavirin and “maintains more physiologic hemoglobin levels” in patients receiving treatment for hepatitis C. The study will continue in order to determine whether use of growth factors allows for higher SVR rates.

Conclusion 3: The authors concluded that, “Neutrophil count is not correlated with infection rate in recipients of interferon-based therapy for hepatitis C,” and suggested that, “Reduction in interferon dose and/or dosing with granulocyte colony-stimulating factor in those with neutropenia is not supported by this analysis.”

[nency]

Thank you for your feedback, I was waiting for all day to hear from you, then I decided to post another question just to know how you feel about my issue. So I am sorry for the same questions. Apparently, I can't deal with all this on my own, therefore your opinion is a great help for me. Thank you very much!
Nency

[jmjm530]

Answered in other thread.