My 12th week result and dose reduction Q

I got my 12th week result as "target not detected" PCR by Taqman <10. The details are as below:
Baseline VL - 2350000 IU                    Hg - 14.1
4th Week PCR - 67 IU
8th Week PCR - Dr. didn't permit
12th Week PCR - Target not detected    Hg - 9.9
Started Tx at 155lb with 1200mg(Riba), from 5th week reduced to 1000mg as weight fell to 147lb and when Neupogen came in on weekly dose till date.At 12 week my weight fell to 145lb as well as my Hg under 10 & my Dr. asked me to start Mircera/50microgm (ROCHE) to be taken once in two weeks and reduce my Riba to 800mg(Which I have not yet).At week 13 blood work Hg came at 11.1 and at 14th week blood work stays at 11. I have read many times in these forum about taking minimum 1000mg for GT1 regardless of weight. Could anybody kindly clarify my doubts. Should I reduce my Riba as told by my Dr. as I am Neupogen weekly since 5th week. Thanks in advance!!

[Diane12855]

If your hgb went back up to 11.1, why would they want to reduce the Riba? Have you been taking Neupogen since week 12?

Pardon me if this sounds weird... when I think it, it sounds OK, but when I read it....... Confusion has become my norm.

Diane

[Diane12855]

I meant to say that my hgb has been between 10 and 11 since week 4 and they never dose reduced me or gave me Neupogen.

[spectda]

you are 67 kilos and your dose should be 1000 riba if you taking pegintron. If you are on pegasys I believe the program is different.

Your hgb is not low enough to be concerned, if it goes under 10 then you should be given procrit rather then a dose reduction to keep the level between 10-11 hgb. I believe that the recommended weight based dosage for riba is 12 mg per kilo, at 800 you are at 11.94 per kilo, at 1000 you are at 14.9 per kilo which in my opinion would give you a much better chance of success, your starting dose of 1200 mg and your 1000 MG was a good hard hitting dose actually. Will your doc not give you procrit if necassary rather then dose reduce?

Did the doc lower your interferon dose? What was your absolute neutrophil count when they gave you neupogen?
Good Luck-Dave

[spectda]

I guess I didn't read correctly, you were at 9.9 hgb. If it was me I would want to stay at 1000 mg of ribavirin and get procrit? Perhaps your insurance won't pay for procrit and that is the problem.
- Dave

[hero68]

Hi,
   Hope you are going fine with ur tx. I was on Neupogen since 5th week due to low WBC weekly till date. And by 12th week blood work Hg came down to 9.9 so I started Mircera and by wk 13 & 14 Hg came to 11.1 & 11. May be the Dr. thought to reduce Riba to avoid frequent use of rescue drugs that I am not sure.

[portann]

You're on Mircera. which is similar to helper drugs like Procrit (that Dave mentioned). MIRCERA can stay in your body longer, therefore fewer injections are required for treatment.

[portann]

Sorry, I forgot to say hi and congrats, especially on that 4.5 log drop within four weeks. That is terrific news.


I'll try to get back about your kg/mg dosage adjustments but first, am I correct to assume you're on Pegasys?

[spectda]

"You're on Mircera. which is similar to helper drugs like Procrit (that Dave mentioned). MIRCERA can stay in your body longer, therefore fewer injections are required for treatment."

Thanks for clarifying. I should have checked into what mircera was before speaking

hero68-perhaps your doctor is on top of it then. You certainly got a very good original dose of riba which makes one think the doc understands how important it is.
- Dave

[spectda]

It still seems like staying at 1000 MG would be a good idea and perhaps more mircera if it is safe to take more. I am certainly not a doctor though.
Good luck - Dave

[portann]

You started with 17 mg of riba per kilo and then after four weeks, reduced to 15 mg of riba per kilo.

If you reduce to 800 mg at 145 pounds, you'll be on 12 mg per kilo.

BTW, Neupogen is unrelated to your hemoglobin issue and is strictly related to your white blood cell counts.

Hmm, not sure what I'd do, as I'm a riba gal if possible. Maybe FlGuy will wade in. In the meantime, you're doing great and I'm going to think about things a bit.

[hero68]

I am into VIRAFERONPEG, Peginterferon alpha 2b
Thanks all for your wounderful suggestions.I always wish I could be also like you all sharing informations and helping others.Still I am learning as much as I could so as to help myself and others. Thanks

[portann]

Oh, you're on what I think of as Pegintron.

I'm a Pegintron dummy but there are quite  few people here who took it;  in fact, some took both Pegasys and Pegintron (aka VIRAFERONPEG).


Here's a link to a well-known Ideal study about the two, even though it's not relevant! :)

http://www.hivandhepatitis.com/hep_c/news/2008/011408_ideal.html)

[spectda]

I apologize if I just confused matters since I really didn't carefully read the information you provided and understand it properly, thankfully you had diane and susan to make sense of things.  

If you are currently at 11.1 hgb it seems like everything is good with your riba dose and your mircera dose. at week 12 you were at 9.9 hgb and you started the mircera, at week 14 you were at 11.1 hgb which seems just right and a good response to the mircera.

You seem like you are doing very well with this treatment,
congrats and good luck in continuing to svr.

Dave