GI-PA , Any info on lowered Pegasys dose

[AK - Hepper]

Hi Erin and everybody else, too. I've been on 3/4 dose interferon since week 4, week 23 now. Doc was worried cause my absolute granulocytes went down to .7 and wbc's were going down, too; 2.1 at week 4. Since adjusting the dose both have edged back up a little, 1.2 and 2.5.
Is there any info regarding the success rates at this dose? I am 1b, went from 376,000 to 990 at 12 weeks. Still doing the full 1200 riba. Thanks....Tim

[jacksonpotter]

I have had low wbc right from the beginning dropping to 1.9 last month.  Back up to 2.4 this month.  Always somewhere in between.  Never lowered any medication.  My doc said this is a normal side effect.  I get blood test every month.  If you lower your dosage there is a chance you could jeopardize your SVR.  I was undetected at week 12.  I will take my 24 week viral load test next week.  Only reason to be concerned with low wbc is exposing yourself to sickness.  Stay away from people with colds and wash your hands lots!  Drink lots of water.   1200 mg riba, 180mc peg once a week.  geno 1a  
I would ask for normal dosage and see what happens.   Low wbc doesn't hurt.  Low RBC makes you tired as hell.  I've got that  problem too.  Part of the treatment.  

[Wondering417]

Hi! I have HCV, genotype 2b, stage 2 fibrosis...I just started peg-IFN/ribavirin treatment last week and since then felt no side effects at all. Is this normal? I thought I would feel one or more of those dreadful side effects that I read about immediately after my first injection. But so far, none. Even my friend, who works in a pharmateutical company and who was involved in research and development on the      interferon, was very amazed that I felt no side effects at all. Can anyone comment on this? thank you,

Wondering417

[modra]

Hi
MY NAME IS TERRY.I HAVE HCV.I HAVE BEEN ON PEGASYS FOR 5 SHOTS.NOW I HAVE TO GO DOWN TO 1/2 SHOT BECAUSE MY WBC IS TO LOW.WHAT IS NEUPOGEN?PLEASE HELP ME UNDERSTAND.

[willing]

Hi, everything we type into the "Post a comment" window actually gets turned into HTML by the site-management software. HTML is a a way of describing what a web page should look like. Often, it's mostly text, but every once in a while there's something called a "tag" that tells the browser to display something unusual. Tags often have the form "&lt;X&gt; text &lt;/X&gt;" where "X" is some tag name. For example, the "strong" tag is used for emphasis: if you type &lt;strong&gt; emphasize this &lt;/strong&gt; in a post, what people see is <strong> emphasize this </strong>. The tag used to display a link to another web page is named with the letter "a". In the opening part of the tag you insert the URL address. For example if in a post you write &lt;a href="http://www.medhelp.org"&gt; this link&lt;/a&gt what people will see is <a href="http://www.medhelp.org">this link</a>.

A caution : if the fog is piled thick and deep, which it often is for me, it's easy to stumble while typing the tag opening or closing. Unfortunately, the software that manages this site is not very robust about detecting HTML errors in a post. In particular, if you leave out the closing " while typing in the href="web address" no one else will be able to post to that thread, as I discovered a while back.. Hope this helps. If you want to see what the actual HTML for a web page you're looking at try "View|Page Source" in Netscape or "View|Source" in IE.

[AK - Hepper]

Thanks, I'll have to give that a try on a clear day if I get another one :-)

[willing]

Hi, Maj's story sounded familiar - I went through the exact same steps with the Quest site printout  for my 24 week - that's when  I found out you could save a little money and get the same accuracy by ordering the "Quant TMA" instead of the Heptimax. In fact, the insurance should be picking up the cost of the more sensitive test since the recommendation from one of the recent "consensus" conferebces is at least down to  50 iu at 24 weeks.

The main advantage of staying "in the box", that is following exactly the same tx as the big clinical trials, is you know your chances of winning and losing. A 75% dose reduction in the IFN is cutting it kind close - published reports found at least 80% adherence to medication for 80% of the time to be a significant predictor of <a href="http://hepatology2.aasldjournals.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=fullfree&id=ajhep036s114#head5">outcome</a>. Even with full adherence us 1s are facing a 30% chance of relapse at 48 weeks.  I would bet your 24 will be clear but to not increase the relapse odds I'd talk to to the doc about returning to full dose and pushing past 48. Best -wishes.

[AK - Hepper]

While I'm not too crazy about it, I'd already resigned myself to the idea of extending my tx out a while, pending the 24 week results. The doc claims 3/4 is enough to do the job, but I really don't like taking any chances here. Guess I'm gonna have to try and light a fire under his ass Friday. I'm really gonna feel like I got gypped if I spend a year plus going through this **** and relapse, will always be wondering what if.

I sure am glad I stumbled onto this site, you people have really been a wealth of information and inspiration, I want to thank all of you.

Willing, can you explain to a computer know- nothing how you put those direct links in your posts? I've always wanted to learn how to do that!

Thanks again, everybody.... Timbo

[AK - Hepper]

Thanks a bunch, Erin, and foreign girl, revenire and maj neni. Guess I'll be holding my breath with fingers crossed for the next coupla weeks till those results get back. Thanks for the links too, maj     Timbo

[GI.PA]

Some good points are brought up here.

You are probably doing fine at 3/4 dose with only a slight decrease in effectivness.  However, you are at that critical week 24 where if your PCR is not clear, you will most likely not have a sustained response.  

I would suggest seeing what your 24 week PCR holds.  If positive, talk to your doc about stopping treatment.  If negative, consider Neupogen to bring you back to full dose of Peg for the remainder of treatment.  One could also consider just holding the course at your current dose (assuming your week 24 is negative)...the data "suggests" that dosage reduction of the Rib probably has more effect on SVR than dosage reduction of the Peg.  And that the PEG effect is greatest during the first 12 weeks..not as important during week 24-48.  

This is where is just isn't "cookbook" medicine...a little more of an art..

GI.PA

GI.PA

[MajNeni]

Hey, Tim,
Since you're coming up on 24 weeks, you're about due for a PCR, right?  Try to get one of the more sensitive tests
If this were my situation, I'd try to hurry that test.  If I were still showing virus, I'd ask to be put back up to 100% dose; if I were clear, I'd consider counting my blessings and continuing as is... If the white counts/absolute neutrophil still show low, I'd ask for Neupogen and maybe consider a few weeks extra at the end.  
From 4 to 23 weeks is an awful long time for a doc to be so unaggressive with tx!  Has he monitored you fairly often (CBC's)?  Sounds like you may have to diplomatically put info in front of your doc and ask for interventions*.  Maybe your primary doctor can help in this, ordering and looking at CBC's more frequently, or whatever.

I recently got info from Quest off their site, printed it, and presented it to my doc.  He's treated over 400 HCV patients, but I'm the first to get a Heptimax ordered!  Go to:

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TG_HCV_MolecularTesting.htm    
(Molecular Testing in the Management of Hepatitis C Virus Infection/Test Guide/Testing Algorithm)

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TH_HEPTIMAX.htm  
(Heptimax Test Highlights)

LabCorp is another lab company that does PCR's, etc., I just haven't been to their sites.
Best,
Maj Neni

[Revenire]

I went down to 25% on my dose for three weeks. I asked for Neupogen because I wanted to stay at full dose.

I would ask for the Neupogen and try to get back to the full Peg dose.

How much riba do you take? What is your level of liver damage? Genotype?

[Foreign girl]

I had the same problem around week 24 and demanded Neupogen so I could stay on full dose of Pegasys.

Good luck.

Foreign girl.