Hepatitis Researcher or anyone one more Infergen question

What is the maximum daily Infergen dosage my doctor can prescribe?  Also, what is the standard daily dosage patients usually receive?

[Lonestar823]

I recall reading an old post from Magnum in 2005.  He was about to start treating with Infergen at 25 mcg daily.  There was exchange with DoubleDose who I think did 30 mcg daily induction then dropped to the standard 15 mcg daily which is what I did.  Funny 'cause I remember reading the literature that came with my meds.  It looked like the standard was  9 or 15 mcg three times a week.  Now I think most people are doing the 15 mcg daily.  Hope this helps.  

My best,
R

[Hepatitis Researcher]

15mcg is the daily dose and it is hard enough to take. Everything else is experimental.

[St. George]

What do you think about me trying to push the envelope further and try to have my physician not only prescribe infergen/riba, alinia but also add fluvastatin to the mix?   In studies it increased svr's in 1a's quite substantially.

[Hepatitis Researcher]

The more you walk away from known ground, the higher the chances and the risks. These types of decisions have to be made by an individual who has aquired enough understanding of the issue to make a decision that he can live with in case it does not work out. There are other things that could be added, like thymosin alpha1,PPC, but the same reservations apply.
Starting while the VL is still low might be the most important part, monitoring the VL curve tightly will give insight and hope and help your hepatologist to decide treatment duration.

[DoubleDose]

I did use Infergen at 30 mcg. /day for the first two weeks of the INFERGEN  phase of tx number one.  I had been on escalating dosos of Intron/Riba for eight months initially, and could not get fully undetected.  I was using daily Intron for almost five months,(first three months at three X/week) and was still in the 20,000 viral copies range.  I was desperate to get undetected, and followed the protocol for a German Infergen study that I found.

  The initial two weeks, at 30 Mcg., got me undetected by day 14, and I would NEVER recommend doing this dosage to anyone!  It was pretty frightening, and I thought I was going to actually die from day to day.  I had to hold onto the walls at times to walk, and was mostly a vegetable for two weeks.  Moving down to the 15 mcg. daily dose felt like heaven, and I was able to go for another five months on 15 mcg/day, remaining undetected for the whole five months. (I worked and traveled for business full time during this phase) I had to discontinue tx because my Hemoglobin was plummeting, and I had even cut the Riba dose in half, to 600 mg./day for the last few months.  I knew that I would relapse when I stopped, and I did.

Later using double doses of Peg-Intron and Ribavirin (and Procrit) for 72 weeks, I got the SVR.  Nothing ever felt as horrible as the 30 mcg. of Infergen daily for those two weeks.  I would compare the daily Infergen at 15 mcg. to the high dose of Peg-Intron that I did in my second tx.  And actually, the 15 mcg. of Infergen became pretty tolerable.  I think that had I started out on Infergen, instead of wasting eight months on varying doses of Intron, that I could have SVR'ed on my first go round.  I would possibly have needed Procrit though, to sustain the Riba dose at 1,200 mg. , and Procrit was not being used for HCV tx in 1998.  So maybe I would have had the same result, if I was unable to keep the Riba at full dose.  

I am a believer in Infergen for difficult responders.  I think it has some unique properties, and for SOME people it really knocks the virus down better than any other interferon.  I also think that Peg-Intron, in tailored dosages, can also be highly effective in tough cases.  Too many people who use Pegasys often turn immediately to Infergen.  I think that in some cases Peg-Intron, especially in higher dosages, can be especially effective for GT-1's.  My treating doctor also felt strongly about Peg-Intron, and had many successes on retreatment. The sides can be nasty though.


I hope I answered some of your questions.  Don't be afraid of Infergen, and use it in a customized, and closely monitored regime, watching the viral load reduction curve, and pushing the Ribavirin to maximum weight dosed levels, and you have a very powerful combo for SVR potential.

Best of Luck.

DoubleDose

[mremeet]

If you're thinking about going at it gung ho, then don't forget about the possibility of ribavirin pre-dosing (for maybe 2-4 weeks prior to starting IFN + alinia + whatever else), "pre-emptive procrit" within reason of course and with careful doctor supervision/lab work, and elevated riba dosing (i.e. higher than standard weight based) for the first few weeks/months. Not that you should necessarily try to take all of the extra drugs and do all of these other "over the top" riba regimens simultaneously. You'd have to pick and choose a bit, I'd suspect. But increasing standard riba dose and perhaps predosing riba really could pay big dividends, especially if you were ready for the anemia and had taken action to control it before it even gets out of hand in the first place. On the other hand, not so sure the derm issues could be similary prepared for and minimized...therein lies the risk of getting too aggressive with both riba and infergen simultaneously.

Whichever path you take, good luck.

[jmjm530]

Also, you might want to take a look at the recently posted articles on Phlebotomy (sp?) and SVR.