Which interferon 2nd round?

[Myown]

For those who don't know, I am a relapser. Geno 2b 24 weeks weight based tx, RVR, 4 weeks post UND and then relapsed around 8 weeks post. I had a high VL of approx 8 million.

My question is, does it matter which interferon I use for this second tx? I feel it doesn't matter that I use the same (Pegasys) cause I did respond and PLUS Pegasys was very easy for me whereas Pegintron - I don't know if I will tolerate that as well and this time it will be 48 weeks of tx.

The doctor that I initially tx with says stick with the Pegasys - all that is needed is longer tx. The consultation that I just recently had said do Pegintron (but we all know these doctors have their favorites for obvious rea$ons. I don't think (?) it matters cause I DID respond and maybe longer tx will do the trick, but was wondering if any of you guys have an opinion one way or the other. BTW the new consult finally agreed and  said "okay he'll let me use pegasys but if I was overweight he'd use Pegintron. So its up to me. Still might tx where I originally treated or maybe with one of the new consults - one more consult coming up.

Anybody have any thoughts? I know sometimes you guys switch interferons, but its not like I didn't respond, I responded well, but maybe cause my vl was so high that I relapsed? - just guessing.

[Myown]

ARrrr, no pony. Thats sad. A barn without horses and not even a pony. Just motorcycles. Maybe next year. I thought you were thinking about maybe getting horses again?

[mikesimon]

No & No.  Mike

[Myown]

Okay, glad we're fine. Very happy about that. Mike and I had a very nice Christmas too, thanks. I wonder if that little girl "M" got a pony for Christmas. I have a feeling someone would have bought her one if she asked. lol

[mikesimon]

We're fine and I do appreciate your comment. Karen and I had a wonderful Christmas and I hope you did as well. Mike

[Myown]

mirceani,
glad to hear you are responding with pegasys. Wow thats strange that there was no response to the pegintron. Who knows at this point? Its all crazy stuff, No rhyme or reason some times. In 5 years your body can go thru alot of changes and possibly your body as far as hormones etc was better primed for what these meds need to work. Who knows? Thank you for your response and I wish you the best


Michael,
yeah I guess your surgeon wouldn't mention micro's being you didn't have it. I don't know its strange. It could possibly be from the interferon. I think I read that somewhere - who knows.

And yes I like the idea of the pegintron going into places where maybe the pegasys doesn't reach. Michael I really don't know which way to turn as far as which peg. It really is up to me at this point. I did convince the other doc so if I tx at the same place he of course wants pegasys and the other doc said he wanted pegintron but will go along with my request for pegasys.

I don't care if I feel a bit of the physical sx if it means I will clear. As a matter of fact if I had a choice I would rather have a little of the physical then the mental stuff,attitude and all of that. I'm finally feeling like my ole self and have to go back to the mental mess again soon.

Ya know what I am going to do. I am going to ask if I can get a few pegintron shots here and there with my tx and see what they say. if I can get a doctor to go along with it maybe I should then use that as the deceiding factor of who to tx with.  Mirceani says he didn't get a response from pegintron at all and that is scary. At least I know pegasys I responded to. Well I appreciate your input Michael, I really do. I don't want to be mad or have a wall between us. I do always want to remain friends,if you want to - too. And I apologize for anything I said that may have hurt you, I do. These meds never effected me physically, but it definitely made me short tempered, (or shorter I should say) and very moody.

So I hope we can continue to be friends. Life is too short to walk past someone you like and pretend not to like him.

Hope you and Karen had a nice Christmas.

[mirceani]

I did Pegintron 5 years ago , for 8 weeks only - no response
Currently on Pegasys - cleared at week 8, and alrady at week 12.
Will continue full 48 weeks

[mikesimon]

I think Peg-Intron is weight based  because it is metabolized by the kidneys whereas Pegasys is metabolized in the liver. You are right about distribution - Peg-Intron is distributed throughout the body and Pegasys is distributed to the blood and organs. I used to think that might make a difference and, perhaps it does, but I am inclined not to think so these days. I was always impressed with the blood-brain barrier argument. My experience with both drugs convinced me it isn't an issue and, likewise with the distribution characteristics in general. I think the two drugs work equally well but, having treated with both, the tolerability difference was quite significant for me. Pegasys was like a walk in the park compared with Peg-Intron. Perhaps my reaction was purely personal but I know several people who report the same experience. Mike

[mikesimon]

No, he has never mentioned microgranulomas. My biopsy never showed that particular feature so it wasn't something we would have discussed. I have read a little about them in transplant related articles and my recollection is that this feature isn't very specific. I believe it has been associated with non alcoholic steatohepatitis as well as NAFLD and autoimmune disorders but, I seem to recall reading somewhere that microgranulomas might sometimes simply suggest prior hepatic injury - I am not at all  certain about this though or really, any of this post. It's a subject I feel confident to discuss.  Mike

[Myown]

CS "Pegintron tends to wander about our bodies more which is why its weight based."

Thats the one thing that makes me want that one - thinking of nooks and crannies, lymph or wherever the virus might hide.

Tough decision. I hate decisions especially when one doctor says Pegasys and the other says Pegintron - though he will give me Pegasys if thats what I want. The other thing is how the pegasys lasts longer in the blood stream that makes me want that one. So as usual I am confused as to which way to go. When the time comes, I'll just have to jump in and not look back.
Thanks for your advice. I really appreciate it. If you think of anything else just flag me or email me. Thanks again.

FloridaMouse
I'm glad to hear they are letting you tx! So they are going for the Pegasys this time for you and extending. I'm glad to hear that you have a plan in place and I wish you the very best. I'll be routing you on from the side lines. I hope and pray things go smoothly and that you are SVR when your tx ends.

Thanks for the info.

[FloridaMouse]

I can only share with you the course that was planned out for me this time around.  My first round I did 48 weeks of PegIntron/Riba.  I did clear at week 12 and remained clear throughout treatment.  I relapsed 5 months post and also managed to get active Rheumatoid Arthritis.  I have a Stage 3, Grade 3-4 liver with bridging fibrosis and 50% necrosis.  

My local GI would not treat me because of the RA unless I got the go ahead from a major teaching/research hospital.  I was seen at Shands at the University of Florida by the same doctor Lady Lauri sees.  I first saw one of his internist who confirmed that they would not treat me because of the RA.  My heart sank.  The Dr. Nelson came in after looking at my biopsy slides and told me I didn't have a choice.  

If I choose to do nothing ... I could expected to be cirrhotic within 5 to 7 years and that in 7 to 10 years it will be life treatening.

I am not a candidate for infergen because of the RA.  It was decided not only put me on Pegasys intstead of PegIntron this time but to also extend my treatment to 72 weeks.  The thinking is that the different drug may be just different enough to do the trick with the extended treat.

Keep on keep'in on.

Missy (Mouse)

[CockSparrow]

The difference between the two interferons is one amino acid and that in the non binding region. This is from memory so it might be two amino acids. Not much of a difference just enough to not break Patent laws. Now this difference actually had an effect even in the mono days as 2a was anecdotally reported to have less sides. I know I had more Sx with Intron-A than with pegasys. The Riba Rage was more noticeable with Intron-A, which was a bit weird as I wasn’t taking Riba. Also suffered fatigue and insomnia on Intron-A, didn’t with Pegasys.
With the addition of the Peg molecule the difference is more marked.

Pegintron has a 12kda Peg Molecule and in the lab at least show greater antiviral activity. The down side to 2b is that at the end of the week only about 10% or less remains and this is probably of little therapeutic benefit to some at least.
Pegasys has a 40Kda Peg Molecule and stays in your system longer. At the end of the week around 40% remains. It is also slower to reach maximum serum concentration, 6 weeks or so.

Pegasys stays in you blood stream and is cleared mainly by your liver. PegIntron is cleared a lot more by your kidneys. Pegintron tends to wander about our bodies more which is why its weight based.
In the Lab at least PegIntron has shown greater Anti-Viral activity than Pegasys, but this hasn’t translated to the real world.
Now despite these differences the SVR rates are bout the same. Only Pegasys tends to have less side effects.

In your situation I would stick with Pegasys as its already shown to get you UND and quickly. Somehow I would also try and factor in the other peg though.

Not easy is it

All the Best
CS

[Myown]

Hi JIm,
I don't have fatty liver, the iron was just checked and thats fine. yes stupid me put on extra weight prior to tx and still didn't get back down yet, but thats no biggy I will prior to tx. My insulin was supposed to be checked this last visit - hopefully thats fine. I still have this fear of DHEA being so high cause I read that when people take DHEA supplements ( I don't - mine is just high on its own) that the DHEA hinders absorption of medicine. Evidently doctors/science know very little about dhea. It is the foundational hormone. Whats also interesting is I read it helps your body fight virus's . Maybe thats why mine is wacking out - who knows.

But yeah I definitley woud like to get some extra riba in me. Even if the doctor says no, when I go for my baseline vl, i can always wait a few days before I do the shot and take 3 days or so of riba without him knowing. If I take it prior to baseline he would probably see a drop in my hemo and then know I'm cheating - who knows. I'm tired. Just got back from my mother in laws so I am rambling. Well I always ramble, but I'm tired too. Oh and yeah, I do keep up with the labs even after I am UND.It was just a pain waiting for results where I was txing so thats another reason I still might make the switch to this other doc. I'll see how it goes.
'll keep ya posted as to whats what. Hope you had a Merry Christmas.

Hi CS, goofy,,,yeah I would like to DD at least a couple times. And this molecule thing as far as the Pegintron is going to be buggin me. Maybe I am better with the smaller molecule. But then didn't I read that the pegasys lasts longer in your system? I don't know I think I read that. I wish I could alternate a different interferon every week. I don't know why they don't do that with us all anyhow. They'd all still get their money. I agree with you CS - I did RVR so there needs to something else thrown in to the mix. I feel that too. Goofy you seem to think that way too. Yeah I'm feeling I need something extra. I really have to talk like a Dutch Uncle (as my daddy dearest would say) in order to convince my doctors to bring it up a notch.


Hello Michael, hope all is well,,, I was told  the Teleprix is not for geno 2's. Three of the rock star type doctors told me - so I guess its true. These doctors told me there is nothing out there for me and that the only thing I have is SOC. This last one said I have mild damage and I could wait, but what would you be waiting for he said, cause there is nothing for you. He said by the time any trials are completed for geno 2's it will be a while and then he said I would have to wait until a study with that drug for geno 2 relapsers, which could be years. So this stuff has to work for me or else I'm up a creek is basically what it comes down to.

Btw has your surgeon ever mentioned anything about microgranulomas? From what I have read they are seen (rarely) in post transplant patients. I'm trying to figure out or find out why these little tumors form and why would I have them being I am not a post transplant. I see that some people with NAFLD have them too, but I don't have fatty liver either. Just wondering. If you hear anything I'd appreciate you letting me know. Thanks.

[mikesimon]

As I see it she has 3 choices.
1) Treat with either Peg and Riba and extend treatment. I doubt seriously that it makes any difference in terms of efficacy which Peg she chooses. I think the discussion about Pegasys vs Peg-Intron in terms of efficacy is superfluous.
2) Get into a trial and hope that she's getting ribavirin
3) Wait until Teleprevir is available and then treat.

Given the fact that she was a RVR, I can't see any advantage to double dosing with either Peg or with both Pegs. If she wants to pre-dose with Riba it can't hurt (in terms of efficacy, that is) and it could conceivably help - though I doubt that it would.
I think that, if she's going to treat without a PI in the mix, then she must extend to get a different end result and it's really that simple.

Mike

[CockSparrow]

You are right with the percentages its 23%v13% and that come from NV15492 (cant spell Hatzy whetever) and the Manns and or Zeuzem study. Just because they are probably lower in one subgroup doesnt mean this applies across the board. I dont mean it as a statement of fact either, just that the two Pegs are different.
The theory behind using both Pegs isnt that interesting merely an extension of swapping Pegs.
As Myown RVRed and then relapsed i would want to try something a little different than just extending. Extending to me applies more to those that dont RVR.
Hence using both Pegs at the beginning and swapping to the other towards the end. If that dont kill it dont know what will. There isnt much else one can do apart from add alinia at the moment, and thats not proven.

The shrimp was good along with the Bugs, Crab, Scallops and Salmon.
Merry Chrissy to you

CS

[jmjm530]

Wat. You and CS ganging up on a guy with a bad back. On Xmas Eve. Shame.

Look, as Dr. A. and others have once said, if you throw enough sh*t  (meaning drugs) at the virus long enough, you'll kill something (and hopefully not the patient). I think the challenge becomes what to reasonably throw at the virus given the info at hand.

What I've read seem to deal with double-dosing for tx naives or slower responders and not RVRs that we want to turn into "super rvr's", assuming that double-dosing would actually do that.

Personally, if in her shoes -- maybe I do have this high-heel fetish thing -- I'd go for the unproven  pre-dosing riba as opposed to the unproven double-dosing Peg, because riba dosing seems to have more to do with relapse and seems like a good companion to extended tx which does have documentation.

-- Jim

[GoofyDad]

JM: btw double dosing would only make sense if you were a slow responder
GD: Seems to me the object of the doubledosing is to decimate the viral population ASAP to prevent the likelyhood of enough fit-for-replicating straglers mutating around the immune response and creating a resistance. Even though MO saw an RVR (which about 70% of GT 2's see), in light of the relapse, it stands to reason that she might benefit from a super RVR and the rationale behind doulble dosing is as compelling as ever.    

[jmjm530]

Jim Previously: that while the response curve to both pegs is identical, there are fewer relapses with Peg Intron

CS: This isn’t exactly true. G3 HVL has double the relapse rate on PegIntron (26%) than with Pegasys(13%). This has been seen on multiple studies as well.
Might be true for G1s but that probably depends on who is running the trial.
--------------
My quote has to be read in context. (See my prev post). I never intended it to be a statement of fact. As to your figures, I think they would also have to be seen in context, or why would any G3 treat with Peg Intron.

Jim previously: - btw double dosing would only make sense if you were a slow responder.

CS: As MO hit UND early then resistance must have occurred below the limit of detection and as such DoubleDosing with both IFNs has a chance of knocking out those resistant strains early. DoubleDosing with the same drug I would agree with you.
----------------
Interesting theory but all the guidelines I've seen are double-dose for difficult to treat naives or for slow responders; extend for relapsers.

CS: I completely agree with Jims 6 points.

Have to disagree again. Just kidding :) And a Merry Xmas to you as well, so how about a little shrimp on the barbie for me :)

-- Jim

[CockSparrow]

Apart from the bit on hormones, (dont think my progesterone levels are much of an issue for me) I could have written your previous post. We think alike on ",,,,BUT THEY HAVE PROVEN SOC CAN AND DOES KILL THIS VIRUS".

MO - IMO there needs to be more diversity in 'specialists' who are looking into hepatitus and IMO there need to be many, many "Immunologists" on board in studying hep and what are the common denominators inside a persons body in the ones that SVR and the ones who are non responders, and relapsers. The medicine works, but it depends whose body its in - so why not look at the common links in these peoples bodies that fail and also that SVR.
------------------------------------------------------------------
Sending a few of them off to do a KT (Kepner Tregoe) problem solving course wouldnt hurt either.

Jim - that while the response curve to both pegs is identical, there are fewer relapses with Peg Intron
This isn’t exactly true. G3 HVL has double the relapse rate on PegIntron (26%) than with Pegasys(13%). This has been seen on multiple studies as well.
Might be true for G1s but that probably depends on who is running the trial.

Jim - btw double dosing would only make sense if you were a slow responder.
Understand where you are coming from but don’t completely agree.
MO RVRed and then relapsed, so extending has an excellent chace of working. However this is no guarantee. As MO hit UND early then resistance must have occurred below the limit of detection and as such DoubleDosing with both IFNs has a chance of knocking out those resistant strains early. DoubleDosing with the same drug I would agree with you.

As for waiting another 6 months or so, that’s what I am going to do. No point rushing in, get any of the host based negatives that you can, in order then have another go at it. I too get a little concerned that people retreat without really working out what needs to change to change the result. There is more to this than just the drugs. I completely agree with Jims 6 points

Anyway its Xmas here so Merry Chrissy everyone.
Now to cook some seafood.
CS

[jmjm530]

Probably should get the common sense portion of my post out of the way first.
Could you refresh us with your biopsy result? Anyway, assuming it was stage 2 or below, are you really prepared for 48 weeks more exposure to interferon. Since treatment you have mentioned a number of symptons that weren't there before treatment. You may have more to add to the list after another 48 weeks.
----------------------------------------------------------------------------------------------
As to your question...

Your first doctor has the classical answer. You responded with Pegasys, tolerated it well, in fact you had an RVR with it -- therefore no reason not to believe you would also RVR with Pegasys again. But because you relapsed, what's needed is to extend to 48 weeks. Can't fault the reasoning and btw double dosing would only make sense if you were a slow responder.

That said, there has been a little ditty floating around the offices of big Peg Intron honchos that while the response curve to both pegs is identical, there are fewer relapses with Peg Intron. Of course no studies on this and the doctors that say this run the Peg Intron trials. I've never heard this from a Pegasys doc.

So you know what I'd do if in your shoes -- other than to look funny in high heels -- I'd go with Peg Intron. I've always liked the molecule better and anecdote shamnecdote, the fact is that you did relapse with Pegasys. But would re-treating with Pegasys be a mistake -- no, it's probably the logical thing to do.

A couple of other things you might check:

1. Fatty liver (steatotis) -- did you biopsy or ultrasound show any indications. Fatty liver is a negative predictor of SVR and is correctable.

2. Iron and Iron Stores -- namely serum iron, Ferritin and TSAT (the latter two not often tested). High iron is also a negative predictor of SVR and is also correctable with phlebotomy.

3. Riba Dosing -- I know you were on weight-based but everyone metabolized riba differently. What you might want to do is review all your previous labs from pre-treatment through week 12 and plot the hemoglobin values. Unless you had a significant hemoglobin decline, consider upping the riba dose. Also, consider pre-dosing ribavirin. I do understand your doctor doesn't believe in it, but that doesn't mean he won't let you do it if you insist.

4. Insulin and glucose levels -- are these in check?

5. You weight. Last time I remember you intentionally gained weight prior to treatment. Not sure if this was such a good idea as -- and this is conjecture only -- it may have altered your metabolic rate temporarily just before treatment. My suggestion this time is to get down to your fighting weight just before treatment and if you get a little skinny during tx, then join the club.

6. Monitoring. I believe you had weekly viral load tests last time. If you re-treat with another doctor, I'd make sure in advance you will get those weekly tests to make sure you respond this time. Also, and not sure if you did last time, viral load should be tested monthly after UND, and all these tests should be the most sensitive possible such as Heptimax or the sensitive LabCorp tests. Especially after UND do not use a less sensitive test. Again, something to be negotiated with your doc prior to treatment.

---------------
One last note on the "common sense" part. Even if you decide to treat, you might want to wait another six months to a year -- both to get your body into shape, and to check on any new trial results for the PI's. Hopefully they will be doing something for geno 2's by then and since the magic number for geno 1's seems to be 24 weeks, it wouldn't surprise me if the magic number for geno 2's is 12 weeks.

Happy holidays,

-- Jim

[Myown]

Copy,
Trial? Ya know what though. Trials scare me with the vx-950 cause if you're not getting riba along with the drugs, then what? It may cost you in more ways than one. If you knew you were getting the entire cocktail then at least you have a shot. but I don't like reading all this drug resistant strain stuff, ya know?

CS, Two shots at once?? LOL Yeah, you're right I love the sound of that! ha! But it sounds like fun.


I just feel in a weird sort of position being I was RVR.Thats great in one way of course, but sort of scary in another way cause I think, "what they heck is that all about," I could understand relapse more if I didn't clear until week 7 or something but this is strange.

I wish I could say the riba wasn't weight based or point to something else that was done incorrectly with my treatment, but as far as what they "normally look at" my stats were good and I was good to go. My doctor just feels that txing longer should do it, but I just don't feel comfortable yet with that answer. Its very easy for doctors to just put you back on the tx wagon and pat you on the rear end and say "you're off" as you fade off into the distance.

The thing that I always think about is that doctors are looking for something that will "kill this virus" in us - whether it be a geno 1, 2 , 3 ,or 4 strain and my thinking has always been,,,,BUT THEY HAVE PROVEN SOC CAN AND DOES KILL THIS VIRUS, but not in everyone.
So IMO its not a matter of what do we do to "kill the virus," (cause SOC can and does do that "IN SOME PEOPLE) ,,,,the question is NOT about the meds,,,but about the VESSEL OR BODY that these meds get dumped into.

IMO there needs to be more diversity in 'specialists' who are looking into hepatitus and IMO there need to be many, many "Immunologists" on board in studying hep and what are the common denominators inside a persons body in the ones that SVR and the ones who are non responders, and relapsers. The medicine works, but it depends whose body its in - so why not look at the common links in these peoples bodies that fail and also that SVR.

Unless this is done I feel we will have people that will not clear this virus and continually be told to wait for new drugs or extend tx time (which does work, but not  always as you know). Some people may clear with the drugs as their own body changes hormonally etc as we are changing all the time.

Just one example.. My hormones I know are off kilter due to menopause and I ordered a saliva test last year and this year (saliva is more accurate - shows level in tissues)

Last year my progesterone was 24 (L) and this year it is 485 (normal)

Can this affect tx? Who knows? But do these doctors do a hormone check on all treaters and compare whose hormones were "off" and whose were normal and of these people who faliled tx and who SVR"D?   NO they don't. And if it's mentioned they tell you to see a gyno (as if she can connect the dots with how drugs will or will not work with hep c treatment.:)

Imo everyone should have a hormone profile before and after tx and then lets see who are the relapsers and svr's and maybe there are common denominators. Of course there are many other things to check, but at least its a start. As for me, I am testing alot of different things before I go back on tx so that I have notes to compare along the way. I wish the doctors had more of an interest in doing such things cause sometimes extending the tx time is not the answer and anyone that has treated more than 2 times would say Amen to that, Again, its not whether or not SOC can kill a 1a or 1b strain - it has proved it can,,,,so that is not the problem. Its something in the persons body that maybe needs to be tweaked - who knows what, maybe testosterone level or who knows - just guessing. My Dhea is 3 times higher than normal and has been for quite sometime. No doctor seems concerned as far as how that may have affected my outcome. But, I'm concerned, and I doubt I will start tx until I can figure out how to lower it. I read melatonin might be able to do so, so on my own, i am doing that.

I hope others just don't jump back in without first getting as many tests as they feel needed to see what is going on with their body first - then take the plunge and hope for the best.

Thanks alot!

[CockSparrow]

The study is from J Viral Hepat. 2006;13(7):435-440. ©2006 Blackwell Publishing
Re-treatment of Chronic Hepatitis C Patients After Relapse: Efficacy of Peginterferon-alpha-2a (40 kDa) and Ribavirin

But you can get it from Medscape.
http://www.medscape.com/viewarticle/537731_print

MO - Do you know how a double dose is usally done. Is it that you allow a certain amount of days in between shots?
------------------------------------------------------
You'll love this, you do it at the same time, well streight after at least. If you think about it the last thing you want is the PegIntron and Pegasys peaks hitting at the same time. Could mean you dont have many good days though.
You wont find any studies to support using both Pegs, so you'll be on your own, you may need to do a bit of join the dots with your Dr, but it does make sense.
Your reason for liking it is pretty much the same reason that I like the idea. The two drugs have different pharmokinetic properties. Basically you are trying to kill one bird with two stones.

Hope this helps
CS

[copyman]

Hi, i'm going to see if i can get into a vx-950 study next year if not then i will tx either way with the present drugs with pre-dosing riba for a week or two, double doseing peg first 4 weeks then going off label adding alaina or statin.i do not want to wait several years for the new drugs. I'm tired of feeling like cr@p everyday.

[Myown]

I did tolerate the tx well - but it did effect me - hemo went down to 9.6 and usually hovered around 10, but I really couldn't complain cause I felt fine. The bone pain the first few weeks I know most people have difficulty with and yes it was a painful, but still and all that kind of stuff doesn't bother me. The blues, moodiness and dark hole that I felt myself in even for a couple months after was what got me the most. Clear thinking then a switch to confusion at the drop of a hat. That type of stuff scares me, but I am feeling pretty normal these days so thats good.

CS...Interesting that you mentioned "followup",,,,,,,,I was talking to my husband about this....I said what happened to those geno 2's that fell in the cracks with that Win R study? STupid me was just sitting across from a doctor who was involved in that study and I am kicking myself that I didn't think to ask him if they took those particular relapsers and then treated them for 48 weeks and what were the results.

If they never did follow up with these people,,,that answer would stink in my book. Even if it wasn't an "actual study" that they conducted, I would think they would want the patients doctor to send results when they finish the 48 weeks back home whereever they live, ya know? (just for the doctors own curiosity.

Can you post where you found this NV15942 study and I will show it to my doctors.

Also I like what you said about doing the Pegintron and Pegasys in a double dose first 4 weeks and ending too.

I know I read the pegintron molecule is smaller and can cross the BBB (if I remember correctly) and that is one reason I would like to use that.

Do you know how a double dose is usally done. Is it that you allow a certain amount of days in between shots?

Have you heard any stories as to how that works with insurance allowing 2 different meds and plus double dosing on top of that. Most of these doctors must have stash in their refrigerators and it s just a matter of convincing them. I know the med assistant usually help, but maybe not if it sounds like "experimental."

Thanks for the input, guys. CS, if you find that study please post it or email me. Thanks alot!!

Ps Copy, I know you are waiting for new meds,,,CS, when are you planning on tx? Wish you the best. Maybe we will be riding the wave at the same time. Thanks again.

[CockSparrow]

Personally i would stick with Pegasys, for the following reasons.
1. You did respond
2. There was a follow on study from NV15942 which treated all the 6 month relapsers with the same regime for 48 weeks and achieved quite good results. OK the downside is that it was 4 of 6 G2s that SVRed but at at least it shows that it can be done.

I'd think about adding PegIntron in a DoubleDose fashion with Pegasys for 4 weeks and also consider finishing off with it for the last month or so. The reason behind finishing of with the other Peg is an attempt to get at any resistant copies as they may not be resistant to the other IFN.
This shouldnt impact your SVR chance as you should already be neg by the time you switch.

Its what i'm thinking of doing anyway.

Weight base the Riba and sit back and enjoy the trip.

All the Best
CS