Copegus 800 mg enough?

Hello everyone, I am not new to his forum just mostly read all the posts, this time I have a question.  Some good info!
Just started tx on the 16th of Sept. So far sides are not as bad as I thought they might be. But in doing a little reading I found that I should be taking 1000 mg of riba, not the 800 mg I was prescribed. Being that I am type 1, stage 2-3 56 yrs young, 160lbs and treatment is scheduled for 48 weeks and not for 24. I have a call in to my Dr to ask if this is correct. Any input out there will be greatly appreciated.

Thanks
Chuck

[jmjm530]

800 mg is too little unless you have other medical issues.

At 160 lbs you should be on 1000 mg/day and are close enough to the cut-off point of 165 lbs (I think that's the cut off) to take 1200 mg/day. I started tx at 176 pounds at 1200 mg/day. I know weigh 150 lbs and still take 1200 mg/day although my NP suggested I could cut back to 1000 if I wanted.

Ask your doctor why you're on such a low dose. If the answer is persuasive, I'd press the issue or change doctors.

BTW have you had a PCR test done yet? Try and get a week 4 if you can with a sensitivity of at least 50 IU/ml.

-- Jim

[jmjm530]

These numbers are off the top of my head so hopefully someone will double-check but I'm almost positive your dose is too low for geno 1's at your weight.

[wonderingwhen]

I am starting out with low platelets and wbc. I know that dr is wathcing these close. I am having blood work done at two weeks and then at four, with the results discussed at the four week dr visit. What does PCR stand for? Sorry but I am not up on all the acronyms yet.

[jmjm530]

Let me modify my last post a bit. I do believe (and so does my doctor) that Pegasys may be a better choice if you're not overweight. But my doctor still recommended Pegasys to me when I started at tx at 176. I think it's probably for folks over 200 lbs where they might get concerned that there's not enough Pegasys in the standard dose.

[bobbyullc]

THANKS FOR THE INFO ON WBC. I JUST GOT MY FIRST REPORT AND MINE SHOWED 3.0 ON A SCALE OF 4.0-10.7 AND I WAS WORRIED. I DO NOT SEE ANC ON THE SHEET BUT THERE IS A "NUET %'. WHICH IS 42.3 ON A SCALE OF 43-75? IS THAT THE SAME. THANKS.

PS I AM 140LBS AND TAKE 1000 MG RIBA.

[susan400]

I'm on high dose Riba, 1400mg a day.  My weight is in the 130's. This is because of my previous and chronic non-responder status. I should find out if this is doing anything in a couple of weeks when I get my PCR.

Susan

[jmjm530]

Your WBC is more than adequate. Look for something that says "neutrophyils, absolute" or something similar. Same as ANC.

Susan,

Good for you on the high dose riba. Here's hoping it gives you the edge this time. For those not familiar, at a certain point moving the riba up too high has certain risks and your doctor should always be in the loop.

[cougareyes]

Your counts look good, my test list out the neutrophils the same way. You get the ANC by multiplying the two. I forget what denomination the numbers are listed as, but if my calculation is correct your ANC would be 1269,which is good. But if you are still concerned check w/ your doc; I'm not an expert.  Good Luck

[Fisheress]

I am female 140 pounds (have not lost or gained any wait as of yet) 46 years young and started treatment on the 12th of this month.  I also take Copegus, 1000mg per day.  400mg in the morning w/my cheerios & milk and 600mg in the evening after dinner.  So far so good with few sides.  Had hip pain during the night a few days ago, got up took 1 tylenol pm and was fine the next morning.  Although I am having occasional muscle pain in my thigh and calf in my right leg since I did injection in that leg on Sat. night, my study cordinator told me to take ibprophen during the day for that.  It has helped.  Think I like the tummy fat for injections better.  Also hope I don't lose any weight or I won't have that lil roll to depend on for injections! (:

I hope you speak w/your doctor about the low dosage you are receiving as it sounds like others here feel you are getting too low a dose also.

Good luck to ya!

Fisheress
P.S. They told me I would have a PCR test on my 4th week. They are so COOL at my clinic, make me feel as if I am their only patient!

[GoofyDad]

Jim's right on the weight cutoff. It's 75 kg or 165 lbs. I'm 163 undressed and I'm on 1,200. I started 10 days ago & Doc told me to cut myself back if I dropped below 75kg. Well, I started below 75kg, so I plan to stay at 1,200 unless I lose more than 10 lbs or so. My plateletes & WBC are also a bit out of range to the low side.

PCR = Polymer Chain Replication or some-such nonsense. Essentially its the quantitative measure of the HVC. There are other tests too, but PCR has a finer graduation.

Jim, at week four, even with a 0 pcr we know we harbor the virus. So is it material whether that's <200 copies, or <50  copies per unit of measure? I mean, I see it as almost the same: You still have HVC either way. You know it's just a tiny bit either way. So is it material whether that tiny bit is a tiny-tiny bit, or a little bit bigger tiny bit?

You can prolly see where I'm going with this. I'm scheduled for wks 4, 8, and 12 quantatative tests, but they are branched chain vs. PC whatever chain.

[wonderingwhen]

I am looking at my lab forms as I write. My 2 week lab ask for ALT(SGPT) and CBC(HEMOGRAM/PLT/DIFF 4 week asks for the same plus liver profile it does NOT have the HCV RNA QT, PCR-NICHOLS checked.

[jmjm530]

So check the box. LOL. Just kidding (sort of). Most docs do not order the week 4 PCR but many do.

Regarding your platelets and low WBC. My knowledge on these values is limited mostly to after treatment starts and not pre-treatment.

That said, many doctors tend to overreact on both these values while they ironically underreact with hemoglobin. Go figure.

In any event, once you start treatment, the important number is ANC (absolute Neutrephils). My doctor doesn't get concdened until they drop below 500. Currently my ANC is bouncing between 600-900 and my WBC is 1.4.

I'd really press him on the riba dose and/or get a second opinion. And definitely get that week 4 PCR if you can to see how things are working out. You're looking for at least a one-log drop in four weeks but ideally you'll have two-logs or better.

-- Jim

[cougareyes]

Can't really spell out what PCR means right now but it is the viral load, amount of HCV in your blood.
By the way, interferon is what effects your platelets and wbc; so that can't be the reason your riba dose is lower. Good Luck

[jmjm530]

Goofy said prev: "I'm 163 undressed and I'm on 1,200. "
--------------------------------------------------------

I was about to sit down to eat dinner and that is more information than I needed. :)

I started 1200 when I weighed 176 and have stayed with it down to 150.  In the beginning the NP was pressing me to reduce the riba as I lost weight. So I'd get on the scale with my heaviest boots and pockets loaded with coins. LOL. Now everyone leaves me alone because they know I don't listen anyway. :) The only way I'd reduce riba now is if my hemoglobin drops to a level I'm uncomfortable with and my weekly Procrit injections can't fix. This could happen as my hemoglobin is down a point the last couple of weeks.

Regarding the test sensitivity...

Ideally, you would match test sensitivity to whatever study you're basing a decision on. 50 IU/ml seems to be the standard a lot of them use but each study publishes their standard somewhere. Hopefully. :)

Would a 200 IU/ml sensitivity make any difference? Maybe not but if it were me, I'd fork out the cost if needbe at least for the week 4 PCR. Especially if I were basing a tx decision on a study that used a more sensitive test.

-- Jim

[jmjm530]

Cougareyes makes a good point about the riba. When you speak to your doctor point out that recent studies show full-dose ribavirin -- especially during the first 12 weeks -- to be very important for SVR. Have you had any bloodwork yet? For example did you get your hemoglobin checked yet?

[mikesimon]

I agree that 800 mg. is not ideal for type 1s. I'd try to take at least 1000mg. I don't recall that ribavirin affects platelet count. I know it can impact RBCs and hemoglobin but I thought interferon is the culprit as far as platelets are concerned. Someone will correct me if I am wrong here but that is my recollection. Mike

[snook_man]

I was started on 1000mg, and I also started tx at 176lbs.. I didn't lose a pound til about week 16, where I dropped to 165lbs.
Then around week 28-32 maybe I dropped to 149lbs. Ended tx at 160lbs. I was also under the impression that 1200mg of Riba is for 180lbs and over, 165lbs is cut off for Pegasys.

[jmjm530]

Pegasys is prescribed all the time for people over 165 lbs and there is no "cut off" in the standard definition of that term. That is what I meant.

I also believe that Pegasys is better for those under 165 lbs and have previously recommended Peg Intron for those overweight. Don't have to call my doc, he's on the same page.

[snook_man]

Pegasys is not weight based, and one dose "fits" all, but any Doc familiar with HCV will tell you that they do not recommend Pegasys for over weight patients. It is thought to be "optimal" for patients under 165lbs. Ask your Dr on your next visit or phone call..Gaurantee he will confirm this.

[Tonyz]

Riba is weight based. I believe 75Kg's is the point at which 1000 and 1200 Mg is defined.


              Blessings


                  TonyZ

[jmjm530]

Unless you go off label, Pegasys is one dose for all weights. Riba is weight based. They also wanted to start me at 1000 mg which may be one of a couple of weight-based standards floating around. The other cuts 1200 and 1000 at 165 pounds.

[GoofyDad]

Jim: "I was about to sit down to eat dinner and that is more information than I needed." Damn, and we're s'posed to bulking you up. Well tell ya what... I'll spare you the photos :O)

Hey Fish! Good to see you around. How are things?

WW: Jim has cited a study before that indicates increased riba absorbtion when taken with a high fat meal. IIRC, 35gr fat yeilds upto 70% increased absorbtion. You might want to read that & see what you think.

Holly Parmessian Batman! I just found this and it says 58gr/fat! http://www.fda.gov/cder/pediatric/labels/Rebetronl.doc

    

[GoofyDad]

errr, uh, make that absorption. Dooooh!

[jmjm530]

Bobby,

1000mg sounds good. I'll probably also be at that dose by the time my weight falls to 140lbs. At 150lbs I'm already starting to feel the effects a little more than I'd like. My pre-tx hemoglobin was 14.8 and low-point at week 2 was around 11.2. I stablized in the 13's with 40,000 Procrit/wk until recently. Now my hemoglobin is 11.9. Not a low absolute number, but perhaps getting low for an old guy like me. :)

----------------------------------------------------------------
Susan 400 said prev: "I'm on high dose Riba, 1400mg a day. My weight is in the 130's

Curious what your hemoglobin was pre-tx and now. Did they put you on Procrit and if so how much? What is the plan with the riba? Do they plan to keep it at 1400 or will they make adjustments depending on your next PCR?

[susan400]

My hemoglobin is still high, but slightly lower since switching to the 7 a day Riba. The doctor thought it was fine.  My red cells are still normal, hematocrit slightly high.  He's watching me real close.  I get regular blood work and see him once a month.  For now, I think the plan is to keep me at 1400 daily.  If I still to have any problems handling it, he'll have to see about cutting me back down to 6, but I'm hoping I don't have to start cutting down the Riba because I really want to be UNDETECTED!

Susan

[DoubleDose]

ww:  I will chime in with my opinion, since using too little ribavirin on my first treatment is what caused my subsequent relapse.  I started tx in 1998 at 170 lbs, and used 1200 mg/riba for about 8 months, until my hemoglobin forced a reduction down to 600 mg/day.  I finished the final 6 months of tx, on high dose daily infergen, was undetected for the final 5 months, but was at only 600 mg/ Riba for that period.  I relapsed in one month after stopping.  No Procrit available at that time, unfortunately.

My 2nd round of tx was an 18 month ordeal, using high dose Peg-Intron, and 1200 mg/Riba daily.  I needed Procrit by the third month, but was able to keep the Ribavirin at full dose for over 15 months.  My last few months were at 1000 mg/day, due to continuing drops in Hemoglobin (probably caused both by the riba, and the high doses of Peg).  I did not relapse after tx ended, and am 2 years post-tx, and SVR.  I weighed about 172 going into tx, and was down to 165 for much of the period.  I was a type 1-B, by the way.

I highly recommend 1200 mg, even if Procrit is necessary early on, because most recent studies show the HUGE importance of high Ribavirin dosing to obtaining SVR, which is the real goal.
Battle this one out with your doctor, but do it quickly!  Early Riba dosing is the MOST important (first three months!!!).  Best of luck.  


Susan:  I know you are ready for a tx that works for you!  I am a big believer in Infergen, as long as the Riba is high...and it sounds like you are doing a mega-dose!  I am very much hoping to hear of your success.  If you can get undetected, just keep the pedal to the metal, and go for extended duration.  Please keep us posted regarding your progress!  We are with you!!!  Best of luck!!!

DoubleDose

[NYgirl]

I am 123 pounds, 40 years old and on 1,000.  The doctor had me slated for only 800 but I took the advice of Jim and asked that the doctor UP my Riba when I started.  I told him if I had any problems we could always adjust downwards later.

Since I was told the Riba is so important especially the first 12 weeks - I was willing to go in armed with info to the doc.

He laughed like crazy at me but he did change the dosage.  Since you weight much more than I do...I would definitely ask to change.

[DoubleDose]

An additional thought:  If you do become undetected, then I think keeping the Riba at the current dosage level might provide an advantage to eventual SVR.  I do not remember whether you have used Procrit in the past, but now would be a good time to discuss it with your doctor, in the event your Hemo values continue to decline.  You need every possible tool to insure success, especially in light of some past tx disappointments.

Remember that the Infergen dosage is also very important to getting the appropriate viral load reduction curve, so early reductions in Inf. dosing might be very risky.  My feeling is that once you find the daily Inferegen dose that gets you dropping by more than 2-Logs per 12 week period, then that is the dose you should stay with.  When I did Infergen in 1998/1999, I started at 15 mcg. twice a DAY for the first two weeks (got undetected by the end of two weeks!), and then switched to 15 mcg. /day for the duration, remaining undetected for over five additional months. The 15 mcg./day dose became pretty tolerable as time went on.  The Riba induced anemia is what did me in.

How many weeks have you completed so far?  Have they done any early viral load tests?  Are they planning on watching the load reduction curve closely??  If it is working, will they allow you to remain at 15 mcg. daily dosing, for the duration?  Discussions of any long term extension of tx, if you get undetected?

DoubleDose

[ASmile4U]

Thank you...will do some additional searching before I make my next appointment.   And also do my best to persuade him...he is often a little more lenient with me because I work in the medical field...but not always!  :)

[jmjm530]

I thought I sent you some studies a few weeks ago?

[ASmile4U]

You did...was just looking to see if doubledose had anything additional.  :)

[jmjm530]

Can't hurt to have more ammunition.  My only suggestion is that you  extract relevant quotes from each study and put them all on a single page in large type. You can keep the rest in a folder. As you probably know, most MD's have the attention span of a knat. :)
In fact, someone did a study which showed the average MD interrupted the patient after about 18 seconds or something. In other words it's like pulling teeth to get them to listen. And people wonder why so many people don't get proper diagnosis. :)

[ASmile4U]

Thanks for the suggestion.  From your description, sounds like you've met my doc!  LOL  :)

[DoubleDose]

Sorry, I don't have any current studies on Infergen, I stopped reading the Infergen related research after my first tx.  I do remember seeing studies that showed better % SVR rates for higher and daily Infergen dosages, and you can probably find some by using Google or Yahoo.  You can also look at the archives on:  www.hivandhepatitis.com   to identify relevant studies.  The important thing is how quickly you can get to undetected, and staying at the dosage that gets you there.  Ideally you want to be undetected before the 12 week point, and the earlier the better!  Many studies found little difference in side effects using the daily 15 mcg. vs. the daily 9 mcg. dosage
The daily might also be as tolerable as the 3X/ week regimen.  I do not get too excited about 3x/week protocols, since they seemed to not do so well in the 1990's.....and I think using Infergen 3x/week is not much different.  Maybe your doctor could be persuaded to let you try daily, and see how the viral load reduction curve looks over a month or two.

And another site with HCV research, and I believe several studies on Infergen  (Consensus Interferon) for non responders, etc.  See link:   http://www.natap.org/hcv.htm

When you google for studies you might try:  high dose infergen for HCV, High dose Consensus Interferon for HCV (Smae thing of course), Daily Infergen, Daily High dose Infergen,  and other combinations....

Best of Luck!

DoubleDose

[ASmile4U]

I will start Infergen tx soon...I hope...still waiting for platelets to recooperate from first round of tx.  Doc will only do 3/week rather than daily.  He believes that because of my age, being female and recent infection that will work for me. I started with VL of 1.9 down to 44,000 at 12 weeks...although I didn't want to stop until 24 weeks, he stopped at 16.  And unless I can show him significant differences in SVR with daily vs 3/week, he will not consider daily.  Since you've been through tx, what is your opinion and do you know of any studies that I can read through to help plea my case?  Thanks.  :)

[BUDDYA]

I too, started on Copegus..600mg in the morning and 600mg in the evening..I am 6'2" and 215 lbs..taking it with the injection. I have been on this for 8 weeks and 40 weeks to go..I have Geno type 1A and stage 3 fibrosis..this is my third time starting the treatment..last time was about 8 months ago and got all messed up on depression drugs that were being given me but they werent keeping an eye on me..I am 56 years old..So far the tests have been favorable..hope this is the last start..If not will do it again...Never give up hope