changing peg-intron shot day

[hiya24]

I am interested in moving my peg-intron shot night from Friday  to Sunday now that my kiddos will be back in school.  My doc recommended doing it over a couple of weeks (i.e. go to saturday one week and then sunday the next).  This sounds reasonable to me but just wanted to see if you guys have been any experience with doing this or have any advice.  I guess my biggest concern is that I don't want to risk my peg levels getting too low.

Many thanks. Anna

[jmjm530]

Anna,

What week are you at and have you had another PCR? If I remember, you were at the limit (2) last time and some speculation it could be testing error. If you haven't, I'd get re-tested ASAP.

-- Jim

[hiya24]

Thanks again Jim. Your comments are always very knowledgable and provide a good view at the issues from many sides.

I guess I am feeling a bit concerned that since I am a slow responder that the peg-intron choice may have been wrong so I am looking for support one way or the other. I realize that there is a lot not known about how these drugs really work and it seems clear that many specific factors may play a role (age, weight, genotype, general health, liver status, etc...).  Being an optimist at heart, I am trying to remain mentally positive about my current tx but am realistic in knowing that I need to understand the options if the PEG-Intron course doesn't do the trick.  Everyone here has certainly helped me with that.  I guess we all need to blow off some steam about this stuff from time to time...I am no exception.  Thanks for listening.  Anna

[hiya24]

Good memory, Jim...how do you do it on this stuff? My brain is fried half the time...LOL

You are right, I was at 2 IU/ml at 25 weeks which my doc said is still detectable. I know some assays are not as sensitive and therefore patients can also be considered clear is they are lower than 50 IU/ml.  It's hard to know whether or not I should be considered clear with 2 IU/ml but my doc is 100%

So, I am going tomorrow for my next quant. PCR. (week 33 right now).  My doc wanted me to wait until the end of the August to make sure I had some time from the last one.  The plan is to retest every month for a few months to see if I clear. I have asked her to contact a heptologist at Hopkins (recommended by the support group I've been going to) to get advice regarding treatment extension, med changes, increase dosing etc.... so hopefully I will know more in a few weeks.  

Thanks for asking about it.  Anna

[jmjm530]

" What seems weird to me about it is that if pegasys is more long lasting than pegintron, why isn't everyone on pegasys? "
---------------------

Pegasys may be more longer-lasting but Peg Intron may hit the virus harder, earlier in the cycle. Take your pick which is better. Actually, a number of studies favor one over the other which confused me no end when I was trying to decide which way to go.

Also, keep in mind many doctors -- especially at the larger research hospitals -- are affiliated with, and have studies funded by one drug or another. Therefore, you find a lot of docs who exclusively prescibe Pegasys, or exclusively go with Peg Intron.

In my case, my doctors work mostly/and do studies with Pegasys which I ended up taking. However, when pressed, I was told that the choice was mine between the two pegs. However, the NP did kept hammering me that the sides would be better with Pegasys, so in the end that's probably what made the difference.  

Other factors like your weight can also enter in the decision.
Peg Intron is weight-based dosing and Pegasys is one dose fits all. So, if you're overweight, you might pick Peg Intron for more drug delivery, while if you're normal or underweight, Pegasys will deliver more. Of course, you could always off-label dose either drug (double-dose Pegasys multi-week dosing of Peg Intron) and some do. In fact, I've heard some doctors using BOTH pegs in combination to take advantage of their unique qualities.

So the question of which is really better probably will remain a question. The Ideal study is too biased and there's just too much money involved for a real shoot out.

Also, they're probably just too many variables involved. One might be better for this person with this viral strain and the other for that person with that strain.

I'd like to say this question will be moot soon, as newer, better non-inteferon drugs start moving out of trials. But it appears that at least for a short time, these newer drugs will be paired with one peg or another.

-- Jim

[hiya24]

Thanks for the structural info on the two forms.  What seems weird to me about it is that if pegasys is more long lasting than pegintron, why isn't everyone on pegasys?  Both are FDA approved for HCV treatment and therefore I would think they have equal efficacy in treating the disease otherwise why don't all docs perscribe Pegysys?.  Before I started tx, I looked at the stats on both and didn't see much of difference (I'm type 1a).

[hiya24]

I am still relatively new with some of the terminology so thanks for keeping me straight !!!  
:)Anna

[MichaelT]

I haven't had Riba-rage for a few years, now. I read the post, thought about it a bit, shrugged my shoulders and moved on... It was right decent of you to clarify the post, though.

Hiya,

Pegintron v. Pegasys. While both are pegylated, they are not created in the same way. If memory serves, the PegIntron is a smaller "package" of protein+polyethelene-glycol than Pegasys. How the body processes each is different. So it takes about a week for Pegasys to drop below theraputic levels and less than that for the PegIntron.

If you want the particulars, you can probably get them searching on the pharmokinetics of pegylated interferon. What is interesting is that how the pegylated interferon does it's thing is very different than how non-pegylated interferon works.

[jmjm530]

Using Cuteus' advice not to use the terms "back" or "forward" -- or "up" or "down" for that matter :) -- you make an interesting point.

If you move your shot day from Friday to Sunday by shortening the time between shots each week to six days, it will take you five weeks to get to your Sunday target day. So by the time you finish your 48th week of treatment, you will be five days short on ribavirin.

Personally, this wouldn't bother me, because I'd rationalize anything lost by the missing five days of riba probably was made up by stacking the five peg shots closer together.

But if it bothers, you, then the solution would be to tag on one extra week of treatment at the end.

-- Jim

[cuteus]

that's why I did not use the terms backward and forward...;-}

[hiya24]

<<<<<Sorry hit enter too quickly on my previous post while making some edits>>> augh!!

I do think Jim's explanation is more literally and less confusing.

Anna

[hiya24]

I realized after thinking about it more last night that moving the shot date 'back' from Friday to Sat to me means that the treatment period will be longer...you are extending the time of total treatment by an extra day. Conversely, moving forward from Fri. to Thurs. for example would shorten the treatment time by a day .  This is why I made an earlier comment about the riba component. If we all kept moving our shot day back (so 6 days in between shots) then the full course of riba would be shortened.  

interpretation is more confusingYou are right Jim,

[jmjm530]

HIYA SAID PREVIOUSLY: "Peg interferon should be taken every 7 days during combo therapy. Moving the shot date back a day would mean that there are 8 days in between two of the shots whereas moving it forward would make it 6 days in between two of the shots."

-----------------------------------
I'm using the term "forward" as synonomous with "ahead" and
"backward" synomyous with "behind". So unless I got it confused...

If you're already in treatment, and your normal shot day is Friday, and you move it back a day (behind a day), your shot day now becomes Thursday. Therefore "moving the shot date back a day" would mean there are 6 days in between two of the shots, not 8 days. Conversly, moving it forward (ahead) to Saturday would make it 8 days in between the two shots.

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REV SAID PREVIOUSLY: With PEG-Intron, which drops off about 5-6 days after the shot (in serum levels in the blood), I would not move it back but forward. Pegasys is different, in that it maintains is serum level concentrations longer.
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With Peg Intron, I would think therefore you would move the shot BACK a day. (From Friday to Thursday.) Moving it back a day means you'd have 6 days between shots. Moving it forward a day means you'd have 8 days between shots meaning less protection for Peg Intron.

FRESHNOBORN...We're not telling you to take your shots every five days. That's a decision for your doctor. We're just offereing some suggestions if you want to move your shot day to a different day of the week. Peg Intron is generally taken every 7 days unless your doctor is following a more agressive protocol.

MICHAELT...

JMJM said previously..."For one time, you're probably right..."
---------------
On re-reading, I realize this could be read two ways :)

Of course, what I meant to say was "If this is the only time you're going to move the shot day, you're probably right. "

###

[fresnoborn]

Thanks a whole bunch. I totally understand now. Thanks for the info. For a minute there, I thought I was doing it all wrong. See ya!

[hiya24]

Peg interferon should be taken every 7 days during combo therapy.  Moving the shot date back a day would mean that there are 8 days in between two of the shots whereas moving it forward would make it 6 days in between two of the shots.  This is only specific for the two shots in reference NOT the entire treatment. The potential risk that some are refering to here is that the amount of the drug in your blood will be decreased more than usual for that one week while the change is being made.  I am not certain whether or not this would potentially compromise chances of SVR since it is a one time thing but there seems to be some data available to show that Peg Intron concentrations in the blood drops after 5-6 days whereas Pegasys does not. The risk is that there could be a weakness in the treatment and the achieving SVR might be compromised. Hope this helps.

[fresnoborn]

thanks, scott. soooo.....I take my peg-intron shot every sunday nite about 9:00. If my shot wears out about every 5 days then I should move it forward to monday nite and then take it again when? the next saturday nite? then again, in 5 days, on thursday nite?

[hiya24]

If you wouldn't mind including the bookmark for the serum conc levels I would really appreciate it.

Do you know why PegIntron drops more rapidly than Pegasys? Is it related to the fact that the Pegasys is a fixed dose not weight specific.

[fresnoborn]

I don't mean to be ignorant,BUT, I don't understand what you are saying. What I'm asking is, what do you mean when you say "every 8 days" "every 9 days"? Am I supposed to be taking my shot every 5th day? How do you come up with saying that someone would be waiting 8 days to take their next shot. please, someone explain this to me.

[Christie2004]

Though it's anecdotal, my husband changed is shot day when he was on Peg a couple different times during that year.  He even skipped one week when he was overseas.

His doc said no big deal.  Just added on an extra week or two at the end.  He's been SVR for 3 years now.

[doll face]

I had to move my shot date not once but twice before and both times my doctor told me the same as yours told you.... move it one day ahead a week.  I also was late for 2 days once because of 911. My meds did not get to me on time. Thank goodness that it was early on in my treatment. Good luck to you.

[jmjm530]

For one time, you're  probably right... but I also think it would depend on what week of tx you're on. Personally, I wouldn't want to go 9 days between shots before I was undetectible. Not sure if I'd want to even after. Why chance it? If it were the longer-lasting Pegasys I'd probably be less fussy. Certainly, if Anna  doesn't
want to go "backwards" then her doctor's suggestion is second best. Stage it over two weeks.

-- Jim

[MichaelT]

As a one-time deal, there is absolutely no reason not to skip the Friday shot and resume on Sunday.

[jmjm530]

Anna,

Yeah, I'd go the other way as well, even though it's more of a PITA.

And if you haven't been having too many problems with side effects, maybe you could even move it backwards two-days at a time meaning you'd be injecting every five days for a while.  Still, best to check with your doc and let them know the plan.

--Jim

[cuteus]

doesn't that mean that you would be taking the shot every 8 days? with pegintron, I read that is not a good idea. you might have to go the other way, doing it thurs, then wed, then tues, etc. Pegintron does not stay in the blood as long as Pegasys does. others might have a different tip.

[hiya24]

Thanks for the input everyone.  I agree that going backward might make more sense but I did that once very early on and I guess I am a little concerned that by doing constantly going back in time,  I will be cutting the riba a bit short.  Actually by going forward to Sunday I will now be back where I originally started ..LOL!

Also, I wanted to mention to everyone that there is what looks to be a pretty comprehensive review on HCV in a recenet issue of the journal Nature (vol. 436 August 18, 2005).  A lot about the current research on understanding the mechanism of our tricky little "friend" and approaches to new treatment. I haven't read through it all yet but so far looks good.

I don't think Nature is available in all bookstores (maybe like Barnes and Noble) but you should be able to find it in a good library or on line at  

www.nature.com


Cheers Anna