Pegasys reduction affecting SVR

[Healed24]

Hello I have question to anyone who has gainged SVR on reduced pegasys dose. I had my Quantative test done at 11weeks and I had cleared the virus. I had been on reduced pegasys dose (135ml) from week 2 (the first 2 weeks my ANC count dropped to 200) so the doctor lowered my dose to 135ml. It looks like I'll be on a reduced dose throughout treatment and I was just wondering my chances at SVR.

More Information: I am currently on week 17/48, genotype 1A, started tx with viral load of 208,000.

Thanks in advance

[jmjm530]

First, I'd get another PCR ASAP to make sure you're still non-detectible. Ideally the test should have a sensitivity of 50 or under.

Assuming you're still non-detectible, ask your doctor why you're not on Neupogen. Neupogen should bring your ANC  back up quickly without requiring a Pegasys dose reduction.

If your doctor won't prescribe Neupogen, I'd find another liver specialist  right away, unless of course Neupogen is for some reason contraindicated in your case. Is your current doctor a liver specialist who is experienced in treating hep c patients?

To answer your question more directly, a reduced dose of Pegasys will negatively effect your chance of SVR although no one can say how much. My gut though tells me you're still un-detectible and probably will stay that way if you get back on your regular dose.

BTW are you above, below or at normal weight for your height and what level of liver damage do you have. That's usually expressed as a "stage" in your biopsy report.

-- Jim

[jmjm530]

Just to clarify the above, I wouldn't wait for the result of the PCR to ask your doctor about the Neupogen. I'd do that right away as well.

[friole]

I agree with Jim.  Why did your doc not put you on Neupogen?  My doc is a gastro doc and he has a hemotologist do the blood monitoring.  She wanted me on Neupogen at 800, but we waited until the next bloodwork, and it came up to 1200.

How much has your ANC gone up since the lowered the Peg?  Besides the worry of not attaining SVR, I would think you are at risk for serious infections.  Especially with fall and winter approaching.  

There are no hepatologists in my town.  Perhaps it is the same with you. However, you could ask for a referral to a hemotologist.  I would consider that.  

I am only on #8/48 so cannot address the chance of SVR with reduced dose, but I do think you need to be put on Neupogen.

[nyhepc]

he must be in practice with my doc!!!!!  oops....my old doc, that is.  :)

[Healed24]

Thanks to all who responded to my previous post. Unfortunately I neglected to say that I just started neupogen last week (my ANC went from 100 to 600) but my doc still said that was low and I should continue on the 135ml. My last PCR (which was 5 weeks ago) had a sensitivity level of 10, and according to that test I was undectable. My doc didn't want to use the neupogen because of the sideffects, but when my ANC dropped to 100 he went ahead and gave it to me. I'm also on procrit shots once a week, and a full dose of ribavarin (1000mg) for my weight (120 pounds). My doc said I had a pretty good chance of SVR because my viral load was so low when I started tx (208,000), but I just wanted to check with some of you guys. Thanks for your advice I am going to check with my doc about upping my pegasys dose to 180ml, if he blows me off I am going to check with another specialist.

Thanks to all

[jmjm530]

That clarify things a bit.

Usually Neupogen is indicated when the ANC drops below 500. So your doctor was a little slow with the Neupogen. That said, it appears he made the right decision to reduce the Pegasys dose when the ANC dropped to 100. And in his defense, depending on how often you tested, the ANC may have dropped too fast for him to react on a timely basis.

The good news is that Pegasys is "one dose fits all" and therefore favors people like yourself with lower body weights. In other words, if you were 220 lbs, I'd worry more about your reduced Pegasys dose. But at 120 lbs, you should do fine with 135ml at least on a temporary basis.

Right now, your ANC at 600 is OK. But like your doctor says, you may have to wait for it to come up some more. His concern no doubt is that going back to  full-dose now would drive your ANC too low again.

Depending on how much confidence you have in your doctor's experience treating hep c patients, you might want to have a consult with a heptologist or hemotologist. In the meanwhile, I assume he will monitor your ANC on a weekly basis.

All said, given your stats -- and how sensitive you seem to be to the drugs -- I agree that you have a really excellent chance of SVR.

My knowledge is limited with ANC and Neupogen, but the key it seems is to first stablize your ANC and hemoglobin to avoid further dose reductions; and second to get you back on a full-dose of Pegasys if possible.

-- Jim

[Healed24]

Thanks for all your help you guys. You have really lifted my spirits and given me some questions to ask my doc.

[cuteus]

it sounds like a good idea to consult with a new dr and go from there. It is a good thing the riba was not lowered as well. SOme folks have been on reduced Pegasys for over a year and no riba after 52 wks full dose and relapsed, others have been on reduced doses for both since month 3 and achieved SVR. It is so much guesswork and gut searching with HCV.
I had three GIs after my dx, started tx with the 2nd and finished tx with the 3rd. You do what you have to, in order to get HCV out for good.
GL

[Healed24]

Thanks I'm definately going to consult another dr.

[FlGuy]

I'm on week 12/24. My hematologist uses 1000 as the line for giving neupogen.  Several weeks back she gave me neupogen for two days.  A couple of weeks later, 3 days of neupogen.  Both times level went to 2000+.   A couple of weeks ago the dipstick went under 1000 again.  This time she gave Neulasta which shot the ANCs up to 9000+.  No sides from the neupogen.  But the Neulasta was nasty - felt like an extra dose of the peg.  In any case, watch the ANCs espicially with the cold/flu season coming up.  Need to make sure you don't interrupt the pleasure of the peg/riba.