Riba drop

[Diana66]

Hemoglobin dropped to 88, I am actually on 1000mg per day, what is the standard drop in Riba?
Going down to 800 or straight to 600?

Funny enough, I feel better than I did last week, today after long time I eaced up the stairs.
Quite reluctant dropping it to 600, especially that I do not feel so bad !!!!!!

Platelets dropped to 39 and neutrophils to 0.56 so interferon still at 135 for now.
They let it go down to 20 on platelets before dose reduction

ALT went to 18 after last weeks spike to 23, so all good I guess

[Diana66]

One week of reduced Riba dose from 1000 to 800 and hemoglobin went from 8.8 to 9.7 - Yaay, so back on full dose from tomorrow

Still waiting for the platelets but neutrophils also went from 0.56 to 0.82
which makes me wonder if in fact Riba does not have some effect on neutrophils as well

[Diana66]

Quick update

As I thought, the doctor decided to drop only to 800, he was also reluctant to go to 600

We will see next week if this makes a difference and if hemoglobin gooes up from 88 (8.8)

I feel pretty ok but I am conserving my energy really and I am doing nothingexcept sitting on a chair and working on my laptop

I have great support at home and food is prepared for me so maybe this helps

[orphanedhawk]

Mine was dropped from 800 to 600. I felt better and it didn't stop my obtaining SVR :)

[uncledudeness]

I am in week18 i think of triple with Inc. my HGB started dropping during my second week. i am at 600mg of riba. they dropped it from 1200 the third week. i finished with the Inc and my HGB is still dropping; It's at 10. today the ins co just approved procrit.  as Hector said, dropping riba is not that much of a problem. just my story, hope it helps. we're all different. good luck.

[Diana66]

Thank you Hector

I am starting today with my reduced dose, just waiting to hear from doctor if I am going for 600 or 800. Looks more like 600mg

[HectorSF]

'what is the standard drop in Riba?  Going down to 800 or straight to 600? '
The standard dose reduction is Hemoglobin  8.5 g/dl = 600 mg per day.

The point is, reducing the the dose of Ribavirin while treating with Incivek does not compromise SVR. If you reduce to 800 or 600 or less.
-----------------------------------------------------------------------------------------------
PEGASYS (peginterferon alfa-2a)
HIGHLIGHTS OF PRESCRIBING INFORMATION

COPEGUS Dose Modifications

See COPEGUS Package Insert for all instructions regarding COPEGUS dosing and administration.

Adult and Pediatric Patients  

Table 6 COPEGUS Dose Modification Guidelines for Adults and Pediatric Patients

Hemoglobin <10 g/dL in patients with no cardiac disease
1 x 200 mg tablet A.M.
2 x 200 mg tablets P.M.
600 mg total

Hemoglobin <8.5 g/dL in patients with no cardiac disease
Discontinue COPEGUS
--------------------------------------------------------------------------------------------
Lowering Ribavirin Dose During Telaprevir Therapy Does Not Compromise SVR in Patients With HCV

'Patients infected with hepatitis C virus (HCV) who reduced their daily ribavirin dose during telaprevir-based triple therapy did not significantly decrease their odds for achieving a sustained virologic response (SVR), according to a study presented at the 2012 Digestive Disease Week meeting.

After analyzing data from several previously published Phase III trials, the investigators found that ribavirin dose reduction, to 600 mg per day or less, had no substantial effect on SVR rates. The results do not suggest that telaprevir can or should be used without ribavirin; rather, they indicate that in cases where a patient is experiencing significant negative side effects from ribavirin, the dosage can be cut back in accordance with the package label without major consequence for SVR rates.'

Hector

[hrsepwrguy]

If you go to the link it explains it all, read the sections numbers provided, there long winded, those are only fragments, here is the short version, HGB declined by 1 gm more than SOC after INC was over, it went back up by 1gm

Have a great day

[Diana66]

Thank you, so it looks that ater I finish the INcivek, hemoglobin should bounce about 10 units. Fingers crossed, I still have though 26 days left, this is a long time. In 4 weeks counts can drop a lot and mine are drifting !!

[hrsepwrguy]

"I wonder if hemoglobin bounces back a little bit after Incivek stops"

8.2.2 Anemia and Hemoglobin Analyses
In Phase 2-3 studies, anemia was managed with RBV dose reductions in accordance with approved RBV labeling. If RBV was permanently discontinued for anemia, telaprevir/placebo had to be permanently discontinued as well. Erythropoiesis-stimulating agents (ESAs) were prohibited from most studies, and their use was reported in only 1.0% and 0.8% of T12/PR and Pbo/PR subjects, respectively. A single study that allowed use of ESAs (Study C208) was not placebo-controlled and is therefore not included in this safety analysis.

8.2.2.1 Hemoglobin Laboratory Results
After completion of telaprevir treatment in the T12/PR group, hemoglobin levels increased to levels observed in the Pbo/PR group over a 12-week period. There were also sharp increases in hemoglobin levels 4 weeks after completion of treatment in subjects who completed either 24 weeks of T/PR treatment or 48 weeks of T/PR or Pbo/PR treatment

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252562

[Diana66]

Absolutely, I am trusting him 100%, if he says 48 weeks than that's what it will be. In my nicest dreams I see only 24 weeks of tx but I am not a gambler so I will never ever take such a risk

The nurse recommend it to reduce Riba to 600mg but I asked that she will check with him first as I would prefer to reduce to 800mg first

[pooh55811]

From a previous post you said, " My fibroscan result of 10.2 kPA is a severe fibrosis but not cirhosis. Cirhosis is 12.5 kPa and over. Normal liver is a 3-4 kPa. So I guess it is a F3."

You have pretty advanced liver fibrosis. That is probably why you are doing 48 weeks. In addition, you have other medical problems (lymphoma) and you really need to rid yourself of Hep C. Doing 48 weeks will hopefully increase your chances for cure, especially considering your fibrosis stage.

[Diana66]

They don't do byopsies here anymore, redundant.

I will do another Fibroscan in a week or two to see if anything changed from last May

Why did the doctor take the decision for 48 weeks? Not very sure, He said something like: if I would be you and have severe fibrosis I would go for 48 weeks. We will see how things go, would be great to do less than 48 weeks and be UND

[BoceprevirGal]

  And yes, many times the hgb bounces back quite a bit, after the PI is discontinued.  The Triple Tx is much more likely to cause anemia, then just the Inf and Riba, I forgot about that, good point!
   I was on the Bocperevir, so I had to go 24 weeks on the PI

[BoceprevirGal]

  I think the Protocol is to go down by one pill, and then see how that effects your hgb.  If you are not feeling bad (I had trouble breathing while in the low 9's) then I dont think it is actually dangerous for you, until it goes below 8~ below 8 is when a blood transfusion is required.
   I reduced my Ribaviran from 1,200 to 800 mgs, on week 19.  It did make
me feel alot better, but it never made my hgb get any higher. This may have been because I also discontinued using the resuce drug, Procrit, at the same time.
   When I reduced my Riba at 19 weeks, I was at 9. Nine weeks later, at my 28 week EOT, my hgb was at 8.9, which totally surprised me. I had thought I was fine, since I had reduced the Riba, and hadn't had any labs done since my 18 week labs. I was back riding my bike and everything.
   Is there any chance that you can Treat for 28 weeks, instead of 48
weeks? I cant remember why your Doctor made thae decision for you to Treat for 48 weeks, without the knowledge of a biopsy.
   We had very similar blood values, and I had a FibroSure test which
told me I had cirrhosis, but my biopsy showed me at a Stage 2, with grade 3 inflammation.  
    

[Diana66]

Thank you for the answer.

Same with you, I thought that 800 is a better thing to do, I am very reluctant to drop to 600mg.

They are not doing Procrit here so is either Riba reduction or blood transfusions, but that is done at around 7.

I wonder if hemoglobin bounces back a little bit after Incivek stops

[Reidmusic]

On 1/1/13 I was told to cut back from 1000 to 800 when my Hgb. hit 9.1. In a couple weeks it came back up to 9.7 so I decided to go back up to 1000 on 1/18. In spite of all the info. and my NP's assurances that ribavirin dose reduction will not reduce my chances for SVR, I don't like the idea of reduced dosages. Many of the knowledgeable old hands on this forum also seem to be against dose reductions if at all possible. I figure if my Hgb. goes down again I will just back off again to 800. I'm in week 18/24 so I figure my risks are minimal at this point. So far, my medical team has been shying away from Procrit because they feel I'm on the borderline.

I think 200 mg. is the standard first reduction for Peg Intron. For Pegasys it may be different.

Good luck with your treatment and it sounds like you've got the right attitude.