Aa
Your "Great" labs might mean the opposite of what you think they do.
Always killed me when people here report that my doctor said "my labs look 'great"" or that "my hemoglobin is great" -- when in fact an association between anemia and riba absorption has been known for some time. Now, we have the logical association between anemia/riba absorption and SVR. Bottom line IMO is that having little or no anemia should at least signal a discussion with your doc about increasing your riba dose, regardless if it's weight based. Espeically if your viral decline isn't what it should be. Also note Procrit's role in keeping people on tx with their anemia. Thanks to "CoWriter" for bringing this particular presentation to my attention.
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Oral Presentations
http://www.kenes.com/easl2009/Orals/276.htm
Session Title: Parallel Session 15: HEPATITIS C VIRUS NATURAL HISTORY AND THERAPY
Presentation Date: Apr 25, 2009
HEMOGLOBIN DECLINE IS ASSOCIATED WITH SVR AMONG HCV GENOTYPE 1-INFECTED PERSONS TREATED WITH PEGINTERFERON (PEG)/RIBAVIRIN (RBV): ANALYSIS FROM THE IDEAL STUDY
M. Sulkowski1, M. Shiffman2, N. Afdhal3, R. Reddy4, J. McCone5, W. Lee6, S. Herrine7, S. Harrison8, W. Deng9, C. Brass9, K. Koury9, S. Noviello9, J. Albrecht9, J. McHutchison10
1Johns Hopkins University School of Medicine, Baltimore, MD, 2Virginia Commonwealth University Medical Centeru, Richmond, VA, 3Beth Israel Deaconess Liver Center, Boston, MA, 4University of Pennsylvania Health System, Philadelphia, PA, 5McCone Endoscopy Center, Alexandria, VA, 6Clinical Center for Liver Diseases, Dallas, TX, 7Thomas Jefferson University, Philadelphia, PA, 8Brooke Army Medical Center, Fort Sam Houston, TX, 9Schering-Plough Research Institute, Kenilworth, NJ, 10Duke Clinical Research Institute, Durham, NC, USA
Background and aims:
Peginterferon (Peg)/ribavirin (RBV) causes significant hemoglobin (Hb) decline leading to side effects and RBV reduction in ~30% of patients (pts). The effect of Hb loss on sustained viral response (SVR) is unknown.
Methods:
3070 HCV genotype-infected pts were treated for 48 weeks with Peg2b 1.5 or 1.0mcg/kg/wk + RBV 800-1400mg/day, or Peg2a 180mcg/wk + RBV 1000-1200mg/day. Anemia was defined as Hb 3 g/dL, 43.7% (984/2250); ≤3 g/dL, 29.9% (231/773) (P8 weeks):
Anemia/no EPO, 59.3% (162/273);
Anemia/EPO, 55.0% (116/211); P=0.33.
Among anemic pts, EPO was associated with less early (< 0.001).
Conclusions:
Among HCV genotype 1-infected pts treated with Peg/RBV, the magnitude of Hb decline is strongly associated with the likelihood of SVR.
The effect of EPO varied by time to anemia;
no benefit was observed for pts who became anemic after treatment week 8.
These data suggest that Hb decline may be a pharmacodynamic marker of treatment effectiveness and that the primary effect of EPO was to prevent treatment discontinuation in pts with early anemia.
------------------
Oral Presentations
http://www.kenes.com/easl2009/Orals/276.htm
Session Title: Parallel Session 15: HEPATITIS C VIRUS NATURAL HISTORY AND THERAPY
Presentation Date: Apr 25, 2009
HEMOGLOBIN DECLINE IS ASSOCIATED WITH SVR AMONG HCV GENOTYPE 1-INFECTED PERSONS TREATED WITH PEGINTERFERON (PEG)/RIBAVIRIN (RBV): ANALYSIS FROM THE IDEAL STUDY
M. Sulkowski1, M. Shiffman2, N. Afdhal3, R. Reddy4, J. McCone5, W. Lee6, S. Herrine7, S. Harrison8, W. Deng9, C. Brass9, K. Koury9, S. Noviello9, J. Albrecht9, J. McHutchison10
1Johns Hopkins University School of Medicine, Baltimore, MD, 2Virginia Commonwealth University Medical Centeru, Richmond, VA, 3Beth Israel Deaconess Liver Center, Boston, MA, 4University of Pennsylvania Health System, Philadelphia, PA, 5McCone Endoscopy Center, Alexandria, VA, 6Clinical Center for Liver Diseases, Dallas, TX, 7Thomas Jefferson University, Philadelphia, PA, 8Brooke Army Medical Center, Fort Sam Houston, TX, 9Schering-Plough Research Institute, Kenilworth, NJ, 10Duke Clinical Research Institute, Durham, NC, USA
Background and aims:
Peginterferon (Peg)/ribavirin (RBV) causes significant hemoglobin (Hb) decline leading to side effects and RBV reduction in ~30% of patients (pts). The effect of Hb loss on sustained viral response (SVR) is unknown.
Methods:
3070 HCV genotype-infected pts were treated for 48 weeks with Peg2b 1.5 or 1.0mcg/kg/wk + RBV 800-1400mg/day, or Peg2a 180mcg/wk + RBV 1000-1200mg/day. Anemia was defined as Hb 3 g/dL, 43.7% (984/2250); ≤3 g/dL, 29.9% (231/773) (P8 weeks):
Anemia/no EPO, 59.3% (162/273);
Anemia/EPO, 55.0% (116/211); P=0.33.
Among anemic pts, EPO was associated with less early (< 0.001).
Conclusions:
Among HCV genotype 1-infected pts treated with Peg/RBV, the magnitude of Hb decline is strongly associated with the likelihood of SVR.
The effect of EPO varied by time to anemia;
no benefit was observed for pts who became anemic after treatment week 8.
These data suggest that Hb decline may be a pharmacodynamic marker of treatment effectiveness and that the primary effect of EPO was to prevent treatment discontinuation in pts with early anemia.
Not a big jump to speculate that those genotype 1's with little or no side effects after a few weeks may not be absorbing enough ribavirin and therefore may have less of a chance of SVR. Of course there are exceptions, as we all react differently to anemia, but at a minium someone with little or no side effects should be xtra vigilant about having their hemoglobin checked and if little or no drop from pre-treatment baseline, then discuss with medical team about increasing ribavirin.
Thanks jmjm
It seems to me that there are a lot of factors at play in determining your chance of SVR. For some reason the medical community sees this as a one size fits all. With all the info avaiabile it would seem a persons odds of SVR should be known quite early in the treatment and should stop the treatment when indicators point to a bad outcome. Humm a little common since would go a long way.
Ron
It seems to me that there are a lot of factors at play in determining your chance of SVR. For some reason the medical community sees this as a one size fits all. With all the info avaiabile it would seem a persons odds of SVR should be known quite early in the treatment and should stop the treatment when indicators point to a bad outcome. Humm a little common since would go a long way.
Ron
it would seem a persons odds of SVR should be known quite early in the treatment and should stop the treatment when indicators point to a bad outcome.
-------
Yes, but conversely some markers (like lack of hemoglobin decline) can also be used to tweak treatment if hemoglobin is monitored weekly and compared to baseline. Little or no decline, then up the ribavirin, as opposed to telling the patient "your labs look great". Duh.
Also, if a patient has a prior track record with treatment, then the old records can be examined to see what the hemoglobin reaction was the first time. In this case, if not a sufficient decline the first time, then a higher initial dose of ribavirin should be considered.
Moving along to the more speculative -- and in cases where a more aggressive approach is desired for any number of reasons -- we go into the area starting tx using higher than weight-base dosing as well as pre-dosing ribavirin prior to treatment so that the serum riba levels are up there by the first injection. And based on what we know, you might consider pre-dosing ribavirin until you have at least a two-point drop from pre-tx baseline, i.e until you are anemic. To boost serum ribavirin levels even more, one might consider the use of Procrit (epo) at some early point or even prophalactively.
This paper btw seems very consistent with other similar studies, including those that show serum riba levels (via HPLC testing) help deterimine both RVR and SVR. Unfortunately HPLC testing for serum riba levels is not available except in trial situations, but if it were, then one could reasonably pre-dose and keep increasing the riba dose until a set serum riba level was met. At that point, Procrit (epo) could be administered if needed per symptons, and only then would the first Peg injection start.
-- Jim
-------
Yes, but conversely some markers (like lack of hemoglobin decline) can also be used to tweak treatment if hemoglobin is monitored weekly and compared to baseline. Little or no decline, then up the ribavirin, as opposed to telling the patient "your labs look great". Duh.
Also, if a patient has a prior track record with treatment, then the old records can be examined to see what the hemoglobin reaction was the first time. In this case, if not a sufficient decline the first time, then a higher initial dose of ribavirin should be considered.
Moving along to the more speculative -- and in cases where a more aggressive approach is desired for any number of reasons -- we go into the area starting tx using higher than weight-base dosing as well as pre-dosing ribavirin prior to treatment so that the serum riba levels are up there by the first injection. And based on what we know, you might consider pre-dosing ribavirin until you have at least a two-point drop from pre-tx baseline, i.e until you are anemic. To boost serum ribavirin levels even more, one might consider the use of Procrit (epo) at some early point or even prophalactively.
This paper btw seems very consistent with other similar studies, including those that show serum riba levels (via HPLC testing) help deterimine both RVR and SVR. Unfortunately HPLC testing for serum riba levels is not available except in trial situations, but if it were, then one could reasonably pre-dose and keep increasing the riba dose until a set serum riba level was met. At that point, Procrit (epo) could be administered if needed per symptons, and only then would the first Peg injection start.
-- Jim
Look at the serum riba studies via HPLC testing showing RVR and SVR associated with higher serum riba levels. To me, this is the same thing just put another way as in general more ribavirin equals more anemia equals higher serum riba levels equals higher rvr and svr. BTW this is more specific to geno 1's because riba seems to play a more important role in geno 1s
Nygirl double dosed riba from day one. Was on procrit. Late responder...72 wks SVR,
So you're saying someone like myself, who should only be taking 800 mg of riba but taking 1000mg should bump up to 1200 or 1400? I don't think the extra riba would have made any difference. I was a slow responder, and the interferon plays a huge role in this too. Becoming anemic doesn't mean you will RVR, EVR or SVR. It's the combo and the way the immune systems reacts.
From what I've read for well over a year, there are plenty of folks who EVR and SVR on weight based riba dosages and never go anemic.
It may be something to consider but not the rule.
So you're saying someone like myself, who should only be taking 800 mg of riba but taking 1000mg should bump up to 1200 or 1400? I don't think the extra riba would have made any difference. I was a slow responder, and the interferon plays a huge role in this too. Becoming anemic doesn't mean you will RVR, EVR or SVR. It's the combo and the way the immune systems reacts.
From what I've read for well over a year, there are plenty of folks who EVR and SVR on weight based riba dosages and never go anemic.
It may be something to consider but not the rule.
Nygirl double dosed riba from day one.
-----------------------------
Could be wrong, but I don't think she double-dosed at all and certainly not from day 1. My recollection is that she started either normal or sub-normal dosing and then boosted the dose after tx began. BUT even if she did double-dose, and I'm pretty sure she didn't -- people metabolize riba quite differently and that is the problem with weight-based dosing. Conceivably a person who double-doses could effectively have a lower serum riba level than someone who single-doses due to a number of factors including kidney clearance per some of the early LIndahl studies.
Trinity: So you're saying someone like myself, who should only be taking 800 mg of riba but taking 1000mg should bump up to 1200 or 1400?
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Not at all. If you're a geno 1 and 800 mg gives you let's say a two point drop of hgb from baseline in a few weeks then its probably enough. Conversly if you took 1400 mg and your hgb curve remained flat after 4 weeks then 1400 might not have been enough. Should add that while hgb drop is adding up to be a very important indicator, it's still a bit crude compared to the actual serum riba levels which unfortunately cannot be measured because of lack of HPLC testing.
From what I've read for well over a year, there are plenty of folks who EVR and SVR on weight based riba dosages and never go anemic.
----------
Some? A few? Plenty? Are thesse geno 1's? That's the problem with anecdotals :) Regardless, the role of riba and riba absorption is too important not to factor into an individualized tx plan. Since HPLC testing doesn't exist, then hgb drop (anemia) is all we can go by.
-----------------------------
Could be wrong, but I don't think she double-dosed at all and certainly not from day 1. My recollection is that she started either normal or sub-normal dosing and then boosted the dose after tx began. BUT even if she did double-dose, and I'm pretty sure she didn't -- people metabolize riba quite differently and that is the problem with weight-based dosing. Conceivably a person who double-doses could effectively have a lower serum riba level than someone who single-doses due to a number of factors including kidney clearance per some of the early LIndahl studies.
Trinity: So you're saying someone like myself, who should only be taking 800 mg of riba but taking 1000mg should bump up to 1200 or 1400?
----------
Not at all. If you're a geno 1 and 800 mg gives you let's say a two point drop of hgb from baseline in a few weeks then its probably enough. Conversly if you took 1400 mg and your hgb curve remained flat after 4 weeks then 1400 might not have been enough. Should add that while hgb drop is adding up to be a very important indicator, it's still a bit crude compared to the actual serum riba levels which unfortunately cannot be measured because of lack of HPLC testing.
From what I've read for well over a year, there are plenty of folks who EVR and SVR on weight based riba dosages and never go anemic.
----------
Some? A few? Plenty? Are thesse geno 1's? That's the problem with anecdotals :) Regardless, the role of riba and riba absorption is too important not to factor into an individualized tx plan. Since HPLC testing doesn't exist, then hgb drop (anemia) is all we can go by.
The other point not be be missed is that RVR probably trumps anemia as a predictor even though anemia is associated with RVR and now SVR. So in other words, if someone is RVR (but not anemic) , then I'm guessing that there chances of SVR are similar to someone who is RVR and anemic.
by nygirl7
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nygirl7
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Mood: nygirl7 Sweepin' up the tombs with your paranoid yups - ST
Journal Entry: "07.08 A lesson that has been shared ..." [Read]
, Jun 22, 2007 12:00AM
To: St. George
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St. George
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I begged the doctor to give me extra riba instead of the 800 weight based I should have been on.
So he wrote the script for 1,000 a day.
On weekends I took between 1,200 - 1,400 minimum for Saturday and Sunday to try and really double whammy the interferon and kill those little #$@$ that might not want to die!
I have to admit that a couple of times I took 1,600 which is double my dosage but that was sporadic and also on the weekend.
Of course...I had dreadful anemia (dropped from 15+ to only 9 in just over a week and believe me the quicker you drop the worse it is - it was too much for my body to handle and I literally kept fainting).
But - I wanted every bit of meds I could to fight this junk. Dr. Jacobson dropped my riba down to 800 - but that was at week 46, he said at that point I didn't need the extra it was just hurting my blood count and he did NOT want me on Epo 40,000 x 2 a week any longer. He said that you can develop an immunity to the epo and the bad part is that your body naturally produces it...so if you develop an immunity you're in serious trouble and could die.
I hope that is clear for you. It's not like I took a steady 1400 a day - I just took the extras mostly on the weekends but also during the week sometimes.
Debby
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nygirl7
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Mood: nygirl7 Sweepin' up the tombs with your paranoid yups - ST
Journal Entry: "07.08 A lesson that has been shared ..." [Read]
, Jun 22, 2007 12:00AM
To: St. George
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St. George
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I begged the doctor to give me extra riba instead of the 800 weight based I should have been on.
So he wrote the script for 1,000 a day.
On weekends I took between 1,200 - 1,400 minimum for Saturday and Sunday to try and really double whammy the interferon and kill those little #$@$ that might not want to die!
I have to admit that a couple of times I took 1,600 which is double my dosage but that was sporadic and also on the weekend.
Of course...I had dreadful anemia (dropped from 15+ to only 9 in just over a week and believe me the quicker you drop the worse it is - it was too much for my body to handle and I literally kept fainting).
But - I wanted every bit of meds I could to fight this junk. Dr. Jacobson dropped my riba down to 800 - but that was at week 46, he said at that point I didn't need the extra it was just hurting my blood count and he did NOT want me on Epo 40,000 x 2 a week any longer. He said that you can develop an immunity to the epo and the bad part is that your body naturally produces it...so if you develop an immunity you're in serious trouble and could die.
I hope that is clear for you. It's not like I took a steady 1400 a day - I just took the extras mostly on the weekends but also during the week sometimes.
Debby
I believe her entry is consistent which what I said and not that she double-dosed from the beginning or even ever double-dosed at all. Hopefully she will clarify on MOnday
I tend to agree with Jim on this one, based on my personal experience. On my first tx I was dosed at the standard 800mg Rib (Geno 3) and I felt little side effects and my Hb always stayed in a good healthy range. At no stage did I ever achieve UND in my 24 weeks of treatment.
This time round I have been on 1200 Riba (weight based) and have become anemic 3 times. The first time was at week 4 or 5 when dose reduction. This also coincided with becoming UND so that shows me a direct relationship to the efficacy of riba, anemia and outcome.
Each time my bloods have reached up over 10 I have asked to go back up full dose as I really believe it is about the correct riba dosage per individual and the anemia levels are the only way we have here in NZ to gauge response to tx, other than VL testing and LFTs, but LFTs can swing so.....
I also tend to agree that not everyone metabolizes the Riba in the same way and therefore different people have different responses to the same amounts even if they are about the same weight. I have read of a member here who is a small female and was on massive doses of riba whose body metabolized it so fast that it never got a chance to work, she is simply 'immune' to riba, if you will.
This time round I have been on 1200 Riba (weight based) and have become anemic 3 times. The first time was at week 4 or 5 when dose reduction. This also coincided with becoming UND so that shows me a direct relationship to the efficacy of riba, anemia and outcome.
Each time my bloods have reached up over 10 I have asked to go back up full dose as I really believe it is about the correct riba dosage per individual and the anemia levels are the only way we have here in NZ to gauge response to tx, other than VL testing and LFTs, but LFTs can swing so.....
I also tend to agree that not everyone metabolizes the Riba in the same way and therefore different people have different responses to the same amounts even if they are about the same weight. I have read of a member here who is a small female and was on massive doses of riba whose body metabolized it so fast that it never got a chance to work, she is simply 'immune' to riba, if you will.
The whole thing is very Judeo-Christian. You must suffer to get to heaven (SVR n this case).
I do hope everyone was informed of taking food with the riba to slow it's absorption and keep it circulating in the blood longer.
I do hope everyone was informed of taking food with the riba to slow it's absorption and keep it circulating in the blood longer.
The whole thing is very Judeo-Christian. You must suffer to get to heaven
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LOL. Yes, unfortunately that is true in many cases because anemia is not fun.
As to the riba, taking the riba along with a meal with a decent amount of fat does increase the bioavailbility of ribavirin, meaning that more is accessible to the system.
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LOL. Yes, unfortunately that is true in many cases because anemia is not fun.
As to the riba, taking the riba along with a meal with a decent amount of fat does increase the bioavailbility of ribavirin, meaning that more is accessible to the system.
I have believed for quite a while that, in the absence of plasma level testing for ribavirin concentration, hemoglobin drop is the best indication that one is adequately dosed. In fact, we've had this discussion before and I thought the general consensus was that anemia is an indication that we're not under-dosed and that SVR is more likely. I have seen the experts suggest this - perhaps the same ones cited above so I always accepted the premise. I know that Jim has always thought this too.
My experience with multiple treatments seems to corroborate this.
You gotta love a little anemia.
Mike
My experience with multiple treatments seems to corroborate this.
You gotta love a little anemia.
Mike
From study posted above:
"no benefit was observed for pts who became anemic after treatment week 8."
"Anemia was defined as Hb 3 g/dL, 43.7% (984/2250); ≤3 g/dL, 29.9% (231/773) (P8 weeks).."
I don't understand that second line. What is the study's definition of anemia and what does "3 g/dL" mean in the language of my lab reports.
"no benefit was observed for pts who became anemic after treatment week 8."
"Anemia was defined as Hb 3 g/dL, 43.7% (984/2250); ≤3 g/dL, 29.9% (231/773) (P8 weeks).."
I don't understand that second line. What is the study's definition of anemia and what does "3 g/dL" mean in the language of my lab reports.
Well, will play the devils advocate here
While this conclusion is probably correct for geno 1, not sure geno2, or maybe even geno3, need to get to the level of Anemia that geno 1 needs for the best chance at svr.
Also does the damage riba does to ones red blood cell producing marrow ever come back to pre tx levels ?... mine hasn't yet.
HGB was 16.7 before tx, now 4 months post eot (und@12wk post) hgb hovers around 15.
My endurance levels and stamina when running and exercising is not back to pre tx levels yet. I am wondering if it ever will be, and if the hgb killing riba had anything to do with it.
Even though the highest riba levels are associated with the best svr rates... be carefull promoting high dosage riba. My Dr uses procrit, but does so with caution. NP says its a nasty drug.
I know we all want to get a SVR status, but our Dr's are the best ones to make the decisions of what we should or have to tolerate in order to get there.
All I am saying is be very careful with High Riba dosing and Anemia. Dangerously low HGB levels can occur. For someone with stage 0-1 liver disease, and a weak cardio-vascular system, this can't add years of life, and might not be the best compromise...
IMO your Dr should be the one to determine proper riba dose. If you pressure him to up your dose because of studies like the above one,
and you have adverse advents (that might take you off tx or dose reduce) your Dr might not be 100% responsible, and you have no one to blame but yourself.
That being said, I know some of us can, and have, tolerated very high ifn and riba dosage.
All the power to them, and it will probably help them reach SVR.
I just would hate to see the 105lb elderly lady self-increase her dose because of a study like this, along with her less than desired hgb drop, then suffer an adverse advent.
jmho,
apache
While this conclusion is probably correct for geno 1, not sure geno2, or maybe even geno3, need to get to the level of Anemia that geno 1 needs for the best chance at svr.
Also does the damage riba does to ones red blood cell producing marrow ever come back to pre tx levels ?... mine hasn't yet.
HGB was 16.7 before tx, now 4 months post eot (und@12wk post) hgb hovers around 15.
My endurance levels and stamina when running and exercising is not back to pre tx levels yet. I am wondering if it ever will be, and if the hgb killing riba had anything to do with it.
Even though the highest riba levels are associated with the best svr rates... be carefull promoting high dosage riba. My Dr uses procrit, but does so with caution. NP says its a nasty drug.
I know we all want to get a SVR status, but our Dr's are the best ones to make the decisions of what we should or have to tolerate in order to get there.
All I am saying is be very careful with High Riba dosing and Anemia. Dangerously low HGB levels can occur. For someone with stage 0-1 liver disease, and a weak cardio-vascular system, this can't add years of life, and might not be the best compromise...
IMO your Dr should be the one to determine proper riba dose. If you pressure him to up your dose because of studies like the above one,
and you have adverse advents (that might take you off tx or dose reduce) your Dr might not be 100% responsible, and you have no one to blame but yourself.
That being said, I know some of us can, and have, tolerated very high ifn and riba dosage.
All the power to them, and it will probably help them reach SVR.
I just would hate to see the 105lb elderly lady self-increase her dose because of a study like this, along with her less than desired hgb drop, then suffer an adverse advent.
jmho,
apache
"...anemia is not fun."
Jim, how can you say such a thing? Not fun to huff and puff and gasp for air? Not fun to have your vision go out and suddenly hit the floor like a sack of grain? Why, its the best way I know (short of arson) to fill your house with cute firefighters!
I got slammed with anemia early, but then I also got RVR. Could never get my hgb much above 10 so I took procrit for the duration! I did not want to dose reduce and found the tradeoff was worthwhile for me.
jd
Jim, how can you say such a thing? Not fun to huff and puff and gasp for air? Not fun to have your vision go out and suddenly hit the floor like a sack of grain? Why, its the best way I know (short of arson) to fill your house with cute firefighters!
I got slammed with anemia early, but then I also got RVR. Could never get my hgb much above 10 so I took procrit for the duration! I did not want to dose reduce and found the tradeoff was worthwhile for me.
jd
Apache: While this conclusion is probably correct for geno 1, not sure geno2, or maybe even geno3, need to get to the level of Anemia that geno 1 needs for the best chance at svr.
--------------
This is correct. The study was for geno 1's and as far as I know the previous studies on serum riba levels via HPLC testing was also for geno 1's. This does of course not mean there is no relevancy for geno 2's and 3's, just perhaps less.
JD: "...anemia is not fun."
Jim, how can you say such a thing? Why, its the best way I know (short of arson) to fill your house with cute firefighters!
----------------------------------------------------
Well, I guess if some cute female firefighters showed up at the house I might revise my opinion :)
-- Jim
--------------
This is correct. The study was for geno 1's and as far as I know the previous studies on serum riba levels via HPLC testing was also for geno 1's. This does of course not mean there is no relevancy for geno 2's and 3's, just perhaps less.
JD: "...anemia is not fun."
Jim, how can you say such a thing? Why, its the best way I know (short of arson) to fill your house with cute firefighters!
----------------------------------------------------
Well, I guess if some cute female firefighters showed up at the house I might revise my opinion :)
-- Jim
I think that there sometime is a misinterpretation of anemia on the board. Not being below 10 doesn't mean one does not have anemia.
I have sometimes myself stated that my blood work is looking good, meaning that it looks good for being on treatment, meaning that I didn't need Procrit, yet. An Hgb of 10.5 is low, anything under 12 is considered low.
Even though I was anemic all the way through tx, I still did not clear at 4 weeks.
Marcia
I have sometimes myself stated that my blood work is looking good, meaning that it looks good for being on treatment, meaning that I didn't need Procrit, yet. An Hgb of 10.5 is low, anything under 12 is considered low.
Even though I was anemic all the way through tx, I still did not clear at 4 weeks.
Marcia
Marcia: Not being below 10 doesn't mean one does not have anemia.
----------------------
To quote from the paper, "the magnitude of Hb decline is strongly associated with the likelihood of SVR. "
So, it's not the absolute number per say, or even the technical definition of "anemia", but how much of a decline from pre-tx baseline that is the main thing. Makes sense since many of us start at much different pre-tx hemoglobin levels.
----------------------
To quote from the paper, "the magnitude of Hb decline is strongly associated with the likelihood of SVR. "
So, it's not the absolute number per say, or even the technical definition of "anemia", but how much of a decline from pre-tx baseline that is the main thing. Makes sense since many of us start at much different pre-tx hemoglobin levels.
Marcia makes a good point.
hgb < 13.2 indicates anemia
hgb < 10 is the criterion for procrit (epogen)
Many people become anemic on tx, however most doctors will not prescribe (nor insurance companies approve payment for) procrit untli hgb drops below 10. As hgb levels rise, many doctors will discontinue procrit because it carries a risk of blood clots.
hgb < 13.2 indicates anemia
hgb < 10 is the criterion for procrit (epogen)
Many people become anemic on tx, however most doctors will not prescribe (nor insurance companies approve payment for) procrit untli hgb drops below 10. As hgb levels rise, many doctors will discontinue procrit because it carries a risk of blood clots.
Another useful marker is creatinine.Patients with anemia and rising creatinine are retaining ribavirin and can tolerate dose reduction without prejudicing SVR.
People are gradually learning that ribavirin plays no part in in viral suppression but a major part in preventing relapse (and break-through).High levels of ribavirin are necessary at the point that viral suppression takes place in order to compromise the design of a successful variant .
A drop in Hgb is indeed a good sign.
People are gradually learning that ribavirin plays no part in in viral suppression but a major part in preventing relapse (and break-through).High levels of ribavirin are necessary at the point that viral suppression takes place in order to compromise the design of a successful variant .
A drop in Hgb is indeed a good sign.
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Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
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Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
