Is this standard tx?

[tobywankenobi]

Mailed my scrip to Roche thursday... My doc has me on 180mcg of Pegasus injection once a week and 800mg of Copeg ribavirin daily. I weigh 245lbs. Is this standard dosing? And why do I have to go to my doctor for my first shot? I have recent blood work and have watched the video for giving myself injections and how to take care of my medications! Thanks

[sfbaygirl]

I totally agree with desrt and Jim.  Perhaps I am more aggressive and say YOU NEED TO DO THIS RIGHT the first time. Many Doc's think that Geno 2's are easy to treat, this isn't always the case, as we see here.  At your weight you need to take more Ribavarin. As a Stage 3, you also need to be aggressive with your tx, you have time before cirrhous, but not much.  Not trying to scare you, but having read numerous studies and just relapsed myself being on SOC with a Dr. that wasn't cutting edge at the time,  I feel strongly about giving my opinion about treating above the SOC 800 Riba recommended for 2's.  I have seen too many people not get the correct amount of Riba during tx. It should be weight based.  YOU need a  cutting edge tx and a great hepatologist to manage your care.  Sorry if I sound scared for you and am concerned, not trying to scare you...maybe I am!  Get a another opinion before you start.  That couldn't hurt, huh?

Linda.  

[desrt]

You're correct, it's the IFN that comes with the heavy psych warnings. I've never heard of a dosage being changed for this reason - your doctor will either allow you to do treatment or he won't.

[tobywankenobi]

Yes you are so right, I can't believe I have made it this far, as I have had so many days when I just said " F#@K IT ! " . The bi-polar meds are the reason for the weight gain. I have had to go through all kinds of different tests and waiting for approval  from many different doctors before they would alow me to start tx.. All I want is this virus out of my system. I feel dirty and I know people look at me funny when they know that I have Hep C!! Even people in my own family?
  I will print this out to show to my Drs. ( I have several because I am in a teaching liver clinic for Emory School of Medicine) , I just don't see them putting me on an outdated med schedule. Maybe it is because of the bi-polar BUT I thought it was the Interferon that was the psychiatric altering drug? I am always a little paronoid to bring things up to my Dr. but I will mention this to her, because I do think that a mistake may have been made. I maybe bi-polar but I am not stupid!!!  Thanck you all for such good feed back on this subject as I had been getting prepared for the nausia that accompanies the Riba. .........Peace Love and Happiness!!!!!!!!

[ladywhy]

As you mentioned in your other posts regarding Bi-Polar disorder...that may be why doc has you on this dosage. You mentioned dollars regarding Roche. That would have No effect on them giving you higher dosage meds. It''s a wonderful program and a great write-off for them. Call your Dr. and ask him why the low dosage, for your peace of mind..and print out these  links. Just don't get yourself overwhelmed, my friend. You'll be ok!
Good night and keep us posted!
Yvonne

[CockSparrow]

I was going to stay out of this as both zazza and Jim pretty much covered what I was going to say. But your last post is of some concern for me anyway.
You have a couple negative predicts with the SOC protocol. These are you are F3 and your weight.
Below are the G2 Stats from the Accelerate Trial.
This was the largest trial ever undertaken for G2s &3s. While I have some issues with it, It nevertheless gives a reasonable guide as to SOC SVR rates.

Per Protocol SVR G2 82%
ITT SVR G2 75%

EVR      G2, 94% (333/356)
EOT VR G2, 84% (299/356)

SVR G2, 75% (268/356)

ITT SVR Rates by sub group
Pretreatment VL
Genotype 2
400K–800K IU/ml 79% (27/34)
>800,000 IU/ml 73% (196/267)

Cirrhosis or bridging fibrosis
No 79% (210/266)
Yes 64% (58/90)

Liver steatosis at baseline
No 79% (151/192)
Yes 77% (27/35)

Rapid Virologic Response
Yes 85% (210/247)
No 53% (53/100)

Accelerates mean body weight was 84kgs (185lbs) for G2s.
If you don’t RVR then extending Tx would increase your chance of SVR. Using WBR would increase your chance of SVR with 24 weeks. As there are studies that used WBR that had SVR rates of around 70%+ for G2 non RVR.

I would take the Accelerate study with you to your Doc highlighting the F3 Response rate and use Mangia or one of the other short course studies to show the response rate with WBR. Bear in mind though that the European studies had a lighter mean body weight. The Mangia short course study had a mean body weight of 69kgs (152lbs). It had SVR rates of 50%-72% in the 24 week arms for non RVR. The 50% figure comes from only 10 patients in the control arm. Interestingly these figures were higher 80-90% in the 12 week arm.
The point I am trying to make is that lower body weight and/or WBR increase your chance of SVR.
So does extending but that’s already been ruled out.

Hope this helps
CS

[tobywankenobi]

Thanks, I am going to heed the advice. I hope I can talk to my doc. at the time of my first shot. What you say makes perfect sense to me. I will recieve my meds 3 months at a time, so I hope that I CAN increase the Riba. BUT I am pretty sure that she will not tx me for more than 24 weeks. When I asked one of my drs. how long I would be txing she told me for 24 weeks unless I did not drop 1 Algo. by week 4 then we would discontinue. Like I said without insurance...............It is about the dollar. I will try however as much as I can. I want to know, again, what it feels like to be free of this dragon that follows me always.

[jmjm530]

That's not what Zazza is saying. Zazza is saying you should be on weight-base dosing from the beginning. I agree.

[jmjm530]

As a genotype 2, stage 3, I strong urge you to ask your doc to put you on weight-base ribavirin. For you that would be around 1400 mg/day of ribavirin. Weight base ribvirin now seems to be the cutting edge protocol for geno 2's and perhaps your doc is following older and more standard protocols. This is especially important because you are stage 3 and have more at stake.

Of course, your doctor may have another reason -- other than genotype -- to put you on only 800 mg, but if not, do consider weight base as it should give you a better shot at SVR.

Also, ask for a viral load test -- not just blood counts -- at week 4. That should be a very sensitive test (at least down to 50 IU/ml) and should be taken the day before your fifth injection.

All the best with treatment.

-- Jim

[zazza]

You do know that if you are not UND by week 4, you should consider doing 48 weeks of tx. Not trying to scare you, just hoping you will do all in your power to get well. Zazza

[zazza]

A slow responder cannot wait with upping his dosage of riba to weight based until he finds out that he is a slow responder at week 4. What if you had achieved UND by week 4 by having weight based dosing from the start of tx? Then you would have missed that chance.

This fixed dosing for geno 2 and 3 is hopefully going to be outdated soon. If some of them need weight based riba and the doctors don't know which ones, then by using logic all should get it.

[tobywankenobi]

Went to the site you mentioned. I guess what it is saying is that I should'nt sweat the dosage until I see what my response rate is, especially @ week 4, right? However I do feel that this dosage is low and I will run it by my doctor at the time I take my first shot. I am recieving meds through a patients assistance program and I do believe that dollars have alot to do with treatment. especially here in the U.S.. Peace to you!

[ladywhy]

"If I knew now what I know @ start of txing".Shoulda read, If I knew then what i know now...you guys know what i mean lol
a bit foggy...

Zazza: Thanks for locating the excellent site!

[zazza]

http://www.hivandhepatitis.com/2007icr/easl/docs/050107_b.html

Read the second section "What about Slow Responders?"

Even 1200 mg ribavirin seems little to me considering your weight.

[ladywhy]

Hear, Hear!

Toby: I would definately heed desrts' advice! If I knew now what I know @ start of txing...I would definately upped riba the 1rst wks of tx.

[zazza]

Genotype 2 is considered the easiest to treat, but if you don't become UND by week 4 you are not among those easy to treat. The best to do is to use weight based ribavirin from the start even if you are a geno 2, and then get a viral load test at week 4 to check if you are UND by then.

800 mg ribavirin for your weight is not weight based dosing.

[desrt]

There have been studies that seem to show 800 mg works just as well as weight based for geno 2 and 3. Given your weight and possible stage, I would ask your doc if you could at least do the first half of tx at 1200, assuming you have no anemia or other health issues. There is some evidence that riba does its most important work during the first weeks of tx.
It's very rare for anyone nowadays to have true allergic reaction to their first shot, but it has happened. This is the only reason I can think of to have the first shot done under supervision, unless they don't think your competent to do a SubQ shot.

[tobywankenobi]

VL 8,500,000 ,Geno 2b, Est. stage 3 (no biopsy) , been treated since 2006----- could'nt tx until other factors were taken care of. I have been waiting so long for this time to come, I want this whole ordeal to be over, ya know. Love to all!

[ladywhy]

That seems like a pretty low dosage of riba....
You don't have to go for your 1rst shot if you're comfortable doing it yourself...i didn't go. Saved myself a $25.00 co-pay!
I am 170 lbs and my weight dosage was 1000 mg. but it does depend on geno-type. I'm sure other's will chime in and give you more info.
All the Best!
Y

[debnevada]

this is not weight based ribavirin, but are there other factors that your doctor may be taking into consideration?

Docs like you to take the first shot under supervision.  This is a plus rather than a minus.  At least they are offering it....sometimes once you get the needle in your hand you draw a blank.....