Procrit

I went to my doctor today ( 1.5 hour drive) and I went in loaded with all my questions I printed off this site, the ones you ask before starting tx. (I have been seeing him for 2 years now) When we got the questions of "what will you do my RBC goes low?" he said, "lower your dose, I don't use Procrit, its not approved." I said, "will that lower my chances of clearing the virus? He said, Yes. Darn, I like this doctor. The only other one i have access to is a real A------. I know I need to be able to access my doctor while on tx so Seattle, 2.5 hours away is out of question.  What do you suggest I do? He also said he suggest another bx, its been almost 5 years since last one, stage 1, grade 1, genotype 1a no fribrosis. He feels if my bx is the same that I should hold off on tx.

Thanks

[Bill1954]

I think he’s technically correct; epo (Procrit) has never officially been labeled for HCV therapy, to my knowledge anyway. However, there’s been plenty of research supporting this use. I’d ask him to elaborate, and see if you can pinpoint exactly why he objects. Also, perhaps you could request referral to a hematologist for blood management; chances are the blood doctor will be amenable to this use.

A new biopsy might be a good idea now, but only if you’re going to consider postponing treatment. If you’ll treat regardless, you could go ahead and Tx without the biopsy.

Let us know if you need supporting documents for the use of epo, by the way.

Good luck—

Bill

[GreatBird]

I was allowed (even given) Procrit on a clinical trial that was for Shering Plough which leads me to believe that even if it isn't officially labeled, its use is widely accepted.

[FlGuy]

The biopsy may be a good idea to understsnd the current state of things.  But if at any point that you deceide to treat  it would be most advisable to know that rescue drugs (procrit-like and Neupogenl-ike) are as avaiabily when the time comes.one option is to enlist an oncologyst-hematologist and then have the liver doc responsible for liver matters and the hemo responsiblle for blood values.  I had that arrangement for two treaments and the team concept worked well.  But a one point the 3 main players need to stake out their areas of responsibility with you the patient being the brains of the operation and its driving force. Treatments that are doomed to fail can be rescued with the correct approaches.  There is space for creativity and stylizin.

[newleaf09]

I agree with both Bill and Greatbird; I was given Procrit in a trial sponsored by Schering Plough, also.  They were the original developers of interferon.  Schering Plough provided Procrit because they wanted people to STAY on treatment, not drop out because of exhaustion and misery.  They definitely did not want their experimental drug trial to fail because patients were forced onto sub-optimal levels of ribivirin, either.  I think adding a hematologist to your team and allowing the hematologist to manage all of the hematological side effects (low hemoglobin, low neutrophills) is a great idea and may make the use of Procrit more palatable to your GI and his label ethics issues.  Many people have managed TX with the team approach.

There have been a few well-respected studies that have illustrated that it is much more critical to keep ribivirin at full dose to achieve SVR.  

[WriteItDown]

I would try to treat with triple therapy (SOC + protease or polymerase inhibitor) instead of SOC, regardless of the Procrit situation.  The new drugs will give you a much better chance of clearing and if you're still at a low stage you can afford to wait.

Also it seems that with triple therapy lowering the riba dose (especially later in the treatment) is not as disastrous as with SOC.  It's standard on a number of the trials, and higher SVR rates than with SOC are achieved anyway.

If it were me I'd opt for the second biopsy to see how my liver was doing; and then either wait for Telaprevir and Boceprevir to be approved if the stage is still low; or try for a good clinical trial if there's been progression.

(All that being said I don't have an opinion regarding your actual question about Procrit -- sorry!)