Aa
Undetectable at 4 weeks
Actually lab was drawn at 24 days, so a little early.
Stage 2, genotype 1b, partial responder, treated 24 weeks in 2006 with interferon and ribavirin
Starter triple tx with incivek 1/13
VL 3,163,936
Male 54
HGB has dropped from 15.3 to 11.4
Decreasing ribavirin from 1200 to 600 mgs to increase HGB while on incivek
next lab 2/20
322 more incivek pills
43 more interferon shots
and alot more ribavirin
Sx are what they are, but undected tilts the scale.
This forum is great.
Stage 2, genotype 1b, partial responder, treated 24 weeks in 2006 with interferon and ribavirin
Starter triple tx with incivek 1/13
VL 3,163,936
Male 54
HGB has dropped from 15.3 to 11.4
Decreasing ribavirin from 1200 to 600 mgs to increase HGB while on incivek
next lab 2/20
322 more incivek pills
43 more interferon shots
and alot more ribavirin
Sx are what they are, but undected tilts the scale.
This forum is great.
" I believe the <10 thresehold is what insurance companies will approve. The 600 seems to to be the thresehold in article, so would be more comfortable with 800-1000 if it has to be reduced at all"
Yes, it does seem that the insurance companies are governing our treatments. I have had big issues with that this treatment. Problem with dropping the riba that fast (besides being underdosed) is that it may keep the hgb over 10 and preclude the procrit. I am afraid I am not too good at doing wht the doctor says. He has reduced my riba from 1200 to 1000 and increased my procrit to every 5 days ( order arrives today). Although I reduced dose some - on the days I didn't think I could make it through with out, I still take the 1200.
note to cheesegrator on "Am I mistaken to say they found that ribavirin is essential to this combo working?"
No, I think you got it. Although interferon may issue the knock out, riba is going to pick up the pieces for the duration. We cannot treat without it. I still think the medical profession is piecing this all together themselves with the addition of the PIs and there are a lot of hole floating around!
note to lookingforward on "I didn't know that a Hmg of 11.0 was considered to be low yet. That is where mine is but dr didn't seem to be concerned"
How do you feel? I think it is significant that the HGB dropped so quickly from 15 to 11 in ski. You could be just fine. One good thing about anemia is that it is a predictor of treatment success.
Will re "Given your previous treatment was not sucsessful and the fact you are still only 4 weeks in to this therapy and not yet anemic,,possibly a further converstaion with your doctor about such a drastic reduction would make sense .
Spot on as usual
Yes, it does seem that the insurance companies are governing our treatments. I have had big issues with that this treatment. Problem with dropping the riba that fast (besides being underdosed) is that it may keep the hgb over 10 and preclude the procrit. I am afraid I am not too good at doing wht the doctor says. He has reduced my riba from 1200 to 1000 and increased my procrit to every 5 days ( order arrives today). Although I reduced dose some - on the days I didn't think I could make it through with out, I still take the 1200.
note to cheesegrator on "Am I mistaken to say they found that ribavirin is essential to this combo working?"
No, I think you got it. Although interferon may issue the knock out, riba is going to pick up the pieces for the duration. We cannot treat without it. I still think the medical profession is piecing this all together themselves with the addition of the PIs and there are a lot of hole floating around!
note to lookingforward on "I didn't know that a Hmg of 11.0 was considered to be low yet. That is where mine is but dr didn't seem to be concerned"
How do you feel? I think it is significant that the HGB dropped so quickly from 15 to 11 in ski. You could be just fine. One good thing about anemia is that it is a predictor of treatment success.
Will re "Given your previous treatment was not sucsessful and the fact you are still only 4 weeks in to this therapy and not yet anemic,,possibly a further converstaion with your doctor about such a drastic reduction would make sense .
Spot on as usual
I think at the next appointment, start the process for procrit. I did that last time and had no issues with it. I believe the <10 thresehold is what insurance companies will approve. The 600 seems to to be the thresehold in article, so would be more comfortable with 800-1000 if it has to be reduced at all.
I have been with this doctor for about 8 years. He is the #2 doc in the area with Hep C patients and also has a large HIV caseload. He has been great to work with and trust him. This will be a good topic of discussion.
This treatment is such a pain and the results are currently very favorable; want to keep it that wat.
I have been with this doctor for about 8 years. He is the #2 doc in the area with Hep C patients and also has a large HIV caseload. He has been great to work with and trust him. This will be a good topic of discussion.
This treatment is such a pain and the results are currently very favorable; want to keep it that wat.
Congrats on the UND, great news, I also enjoyed your reference to Oat Willy's in the other post, Onward through the fog, as you can tell I am originally from TX
Thanks for all the comments and had more time to think - responses are not coming fast at this time. For my appointment yesterday, the lab was drawn on 2/6 so likely HGB had dropped even further. So decision was a combination of undectable and rapidly droping HGB. I agree that the 50% dose reduction now seems large. I found this article:
http://www.cghjournal.org/article/S1542-3565(06)01046-9/abstract
Background & Aims: To maximize sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV) infection, treatment with pegylated interferon and ribavirin has been genotype-specific (1 vs non-1). We evaluated the effects of ribavirin and peginterferon alfa-2a dose reductions on SVR in patients infected with HCV genotype 1. Methods: Data were pooled from 569 patients enrolled in 2 phase III trials of 48 weeks of treatment with peginterferon alfa-2a and ribavirin. All patients were evaluated for the effect of cumulative drug exposure on 4- and 12-week responses, and the 427 patients who completed treatment were evaluated for effect of drug exposure on SVR. Results: Of patients who completed treatment, more had reductions (≤97% cumulative dose) of ribavirin than of peginterferon alfa-2a (43% vs 27%). Neither early virologic response nor SVR was affected adversely by ribavirin reductions when the cumulative ribavirin exposure was greater than 60%. The SVR was reduced significantly (P = .0006) in patients with less than the 60% cumulative ribavirin dose and was associated with prolonged periods of dose reduction, temporary interruptions, or premature cessation of ribavirin. Ribavirin dose reductions had minimal impact on SVR in patients who achieved rapid virologic response, defined as undetectable HCV RNA levels after 4 weeks, even when they received less than the 60% cumulative ribavirin dose. In contrast, SVR was reduced markedly in patients who had ribavirin dose reductions and did not achieve rapid virologic response. Conclusions: Minor ribavirin dose reductions to manage adverse events do not appear to affect SVR adversely, unless cumulative exposure is less than 60%. Prospective studies, however, are required to establish the impact of ribavirin dose reduction on SVR.
Next lab 2/20 and appointment 2/22.
These drugs are tough, but a little tougher, so what; would rather keep managing the meds than risk SVR.
Thanks for all the comments.
http://www.cghjournal.org/article/S1542-3565(06)01046-9/abstract
Background & Aims: To maximize sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV) infection, treatment with pegylated interferon and ribavirin has been genotype-specific (1 vs non-1). We evaluated the effects of ribavirin and peginterferon alfa-2a dose reductions on SVR in patients infected with HCV genotype 1. Methods: Data were pooled from 569 patients enrolled in 2 phase III trials of 48 weeks of treatment with peginterferon alfa-2a and ribavirin. All patients were evaluated for the effect of cumulative drug exposure on 4- and 12-week responses, and the 427 patients who completed treatment were evaluated for effect of drug exposure on SVR. Results: Of patients who completed treatment, more had reductions (≤97% cumulative dose) of ribavirin than of peginterferon alfa-2a (43% vs 27%). Neither early virologic response nor SVR was affected adversely by ribavirin reductions when the cumulative ribavirin exposure was greater than 60%. The SVR was reduced significantly (P = .0006) in patients with less than the 60% cumulative ribavirin dose and was associated with prolonged periods of dose reduction, temporary interruptions, or premature cessation of ribavirin. Ribavirin dose reductions had minimal impact on SVR in patients who achieved rapid virologic response, defined as undetectable HCV RNA levels after 4 weeks, even when they received less than the 60% cumulative ribavirin dose. In contrast, SVR was reduced markedly in patients who had ribavirin dose reductions and did not achieve rapid virologic response. Conclusions: Minor ribavirin dose reductions to manage adverse events do not appear to affect SVR adversely, unless cumulative exposure is less than 60%. Prospective studies, however, are required to establish the impact of ribavirin dose reduction on SVR.
Next lab 2/20 and appointment 2/22.
These drugs are tough, but a little tougher, so what; would rather keep managing the meds than risk SVR.
Thanks for all the comments.
Great news being UND!
I didn't know that a Hmg of 11.0 was considered to be low yet. That is where mine is but dr didn't seem to be concerned.
I didn't know that a Hmg of 11.0 was considered to be low yet. That is where mine is but dr didn't seem to be concerned.
The delay in getting approval for procrit was discussed; and the quicker response to falling HGB was ribavirin; labs again next Monday, and appointment Wednesday. His data suggests that ribavirin at this stage was less of an impact on SVR; I did procrit before and had no issues with it. Will give another update after next wednesday
Am I mistaken to say they found that ribavirin is essential to this combo working?
If so, is it wise to cut dosage in half?
If so, is it wise to cut dosage in half?
Congrats on the UND. at Wk4 . This is an excellent predictor of success.
I too am curious as to why your doctor is recommending such a large decrease in Riba this early ,when technically you are not anemic.(<10 ).
Possibly because you have dropped 4g in such a short time your doctor is being ultra conservative .however the conventional wisdom seems to be that slight reductions (in 200 mg. amounts) as Pooh and frijole have mentioned can most often be effective in stabilizing HGB. without possibly adversly affecting overall results ( and this is when one becomes anemic which as I mentioned.... you are not.
Given your previous treatment was not sucsessful and the fact you are still only 4 weeks in to this therapy and not yet anemic,,possibly a further converstaion with your doctor about such a drastic reduction would make sense .
Good luck and again congrats on the RVR..
Will
From CCO:
Modest RBV dose reduction (200-mg increments) is a good approach for managing anemia in boceprevir- or telaprevir-treated patients, as it does not appear to affect response. Some clinicians may choose to use erythropoietin, particularly for severe or symptomatic anemia. However, use of erythropoietin for HCV anemia is off label, and care should be taken to not allow the hemoglobin to exceed 12 g/dL.
I too am curious as to why your doctor is recommending such a large decrease in Riba this early ,when technically you are not anemic.(<10 ).
Possibly because you have dropped 4g in such a short time your doctor is being ultra conservative .however the conventional wisdom seems to be that slight reductions (in 200 mg. amounts) as Pooh and frijole have mentioned can most often be effective in stabilizing HGB. without possibly adversly affecting overall results ( and this is when one becomes anemic which as I mentioned.... you are not.
Given your previous treatment was not sucsessful and the fact you are still only 4 weeks in to this therapy and not yet anemic,,possibly a further converstaion with your doctor about such a drastic reduction would make sense .
Good luck and again congrats on the RVR..
Will
From CCO:
Modest RBV dose reduction (200-mg increments) is a good approach for managing anemia in boceprevir- or telaprevir-treated patients, as it does not appear to affect response. Some clinicians may choose to use erythropoietin, particularly for severe or symptomatic anemia. However, use of erythropoietin for HCV anemia is off label, and care should be taken to not allow the hemoglobin to exceed 12 g/dL.
and Skiyaltr:
I started at 15.4 and dropped to 12.8 in 4 weeks and 11.8 in 8 weeks. Then it leveled off and stayed mostly in the 11 range. The lowest it got was 11.1.
It seems like a big drop in the amount if Riba per day. I think they recommend dropping by 200 first, but I am not knowledgeable enough to comment further.
This is one thing I talked to my doctor about at the very beginning of treatment. I told the doc if my Hgb. drops I want Procrit. I said I do not want a big Riba reduction and I do not want to be taken off of any meds and jeopardize my SVR.
I started at 15.4 and dropped to 12.8 in 4 weeks and 11.8 in 8 weeks. Then it leveled off and stayed mostly in the 11 range. The lowest it got was 11.1.
It seems like a big drop in the amount if Riba per day. I think they recommend dropping by 200 first, but I am not knowledgeable enough to comment further.
This is one thing I talked to my doctor about at the very beginning of treatment. I told the doc if my Hgb. drops I want Procrit. I said I do not want a big Riba reduction and I do not want to be taken off of any meds and jeopardize my SVR.
Congratulations. But let me ask you this -- you have only been on treatment for 4 weeks and your HGB was still in the 11s and they reduced your ribavirin 600mg a day already? Did they do it all at once? Normally they would reduce 200mg at a time and see how that worked. I am sure going from 15 to 11 was a rough drop but still I think this is unusual.. What do the rest of you think?
Has the doctor thought about procrit? He might just be fine having achieved UND already but I don't think we can ignore the significance of ribavirin in achieving SVR
frijole
Has the doctor thought about procrit? He might just be fine having achieved UND already but I don't think we can ignore the significance of ribavirin in achieving SVR
frijole
Encouraging news for PR's and relapser's who follow behind. Thanks for sharing. Keep it going!
Yes! Another one beats those alien virus invaders.
Keep your eye on the finish line, SVR in 2012!!!!
Big congrats~
OH
Keep your eye on the finish line, SVR in 2012!!!!
Big congrats~
OH
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