Aa
pegasys vs pegintron?
My wife is about to start interferon treatment. She has the choice between Pegasys and Pegintron. She has advanced cirrhosis and a fairly low platelet count. Her doctor recommended Pegintron because it is supposedly better for low platelets but everyone in her support group swears by Pegasys and her doctor told her she could use either one. What would you recommend?
Ask your doctor about Infergen. As a four-time loser of treatments, that worked best for me. It nearly eradicated the virus completely, but beware, I was on a dangerous mega-dose and it nearly eradicated me. I had to stop before completion, but perhaps at 15mcg, she could tolerate it...
Ask your doctor if the daily 15mcg would work for your wife. May she beat this. My prayers...
Magnum
Ask your doctor if the daily 15mcg would work for your wife. May she beat this. My prayers...
Magnum
Pegasys is a 'fixed amount' dose, one size fits all. Peg Intron has different doses, based on weight. If your wife is average weight she could concieveably getting 'more interferon' for her weight with Pegasys. On the other end of the scale, if she is more than about 180 lbs then she might be getting 'more interferon' for her weight with PegIntron. Again, not a big significance.
Having done both pegintron and pegasys I found Pegasys alot more tolerable then pegintron but that was me and everyone could be different. With pegintron I had a fever 40 out of 48 wks and with Pegasys I only recall a couple of times I had a fever. I also relapsed on both treatments
You sound like you're on Peg-Intron. There are differences between the 2 drugs notwithstanding the fact that they are both interferons. There was an article at the recent liver convention posted by willing below on the neuropsychiatric effects of the 2 drugs:
Final ID: 393
A Prospective, Double-Blinded Neuropsychiatric Comparison of Pegylated Interferons Alfa-2a and Alfa-2b
D. Sylvestre; 1, 2; A. Smith; 2; L. Barrett; 2; D. Greene; 2;
"Conclusion: This small but rigorous study provides the first direct evidence that PI2a and PI2b may elicit small but
measurable differences in depression, anxiety, and quality of life during HCV treatment. It is unclear, however, whether these will translate to meaningful differences in major neuropsychiatric outcomes. A larger study is needed to assess the magnitude of the differences in the psychiatric toxicity profiles of these medications and to assess any impact on HCV outcomes."
Mike
Final ID: 393
A Prospective, Double-Blinded Neuropsychiatric Comparison of Pegylated Interferons Alfa-2a and Alfa-2b
D. Sylvestre; 1, 2; A. Smith; 2; L. Barrett; 2; D. Greene; 2;
"Conclusion: This small but rigorous study provides the first direct evidence that PI2a and PI2b may elicit small but
measurable differences in depression, anxiety, and quality of life during HCV treatment. It is unclear, however, whether these will translate to meaningful differences in major neuropsychiatric outcomes. A larger study is needed to assess the magnitude of the differences in the psychiatric toxicity profiles of these medications and to assess any impact on HCV outcomes."
Mike
I also did both and I too found Pegasys a lot easier to tolerate - it was day and night. I reached SVR with Pegasys but I did 73 weeks to get there. I relapsed with Peg-Intron but I cleared late and stopped TX at 53 weeks which was shortly after I cleared. Mike
The difference between Pegasys and PegIntron pretty much comes down to brand name and that is about it.
They are both made my different companies but are basically the same exact thing.
However if your wife isn't used to giving herself a shot PegIntron does come in a handy redi-pen too.
Good luck.
They are both made my different companies but are basically the same exact thing.
However if your wife isn't used to giving herself a shot PegIntron does come in a handy redi-pen too.
Good luck.
both of the doctors I asked (Kahn and Jacobson) said the above when I asked. While there are subtle variations they didn't care which I took - and which would be decided by whatever company the medical group that I went to used - which pretty much went by whatever hospital they were affiliated with and basically it was a money issue and that was it (which company the hospital went with).
In my case it was PegIntron that was prescribed. I'm glad because it has the reputation for being "hard core" and I'm such a baby had I known that I would have BEGGED to take Pegasys ;)
In my case it was PegIntron that was prescribed. I'm glad because it has the reputation for being "hard core" and I'm such a baby had I known that I would have BEGGED to take Pegasys ;)
You said:
They are both made my different companies but are basically the same exact thing.
They aren't "the exact same thing" regardless of what your doctors may have told you and that was my point. There is a difference between the 2 with regard to side effects as most people who've taken both will attest to. When one is contemplating treatment it is important to know ahead of time which drug might be easier to tolerate. That does make a difference and that was the point of my post.
Mike
They are both made my different companies but are basically the same exact thing.
They aren't "the exact same thing" regardless of what your doctors may have told you and that was my point. There is a difference between the 2 with regard to side effects as most people who've taken both will attest to. When one is contemplating treatment it is important to know ahead of time which drug might be easier to tolerate. That does make a difference and that was the point of my post.
Mike
I treated with Intron A/Ribaviron (Shering's precurser to Peg-Intron) and lasted 2 months before having to quit due to severe side effects. I finished 48/48 of Pegasys 2 years ago. Although it was no walk in the park, the side effects were much more tolerable. I was able to work and go on with my life while on tx. I am 2 years SVR 1A.
Everyone's body chemistry is different. There are slight chemical differences between the two interferons. It's really a decision between you/your wife and Dr. People clear the virus with both medications.
Everyone's body chemistry is different. There are slight chemical differences between the two interferons. It's really a decision between you/your wife and Dr. People clear the virus with both medications.
It is important to ask specifically how your doctor will handle falling blood levels because they will fall. Ask if he prescribes Procrit or Neupogen and at what point he will do so. If he doesn't prescribe, ask if he will refer you somewhere else and HOW LONG it takes to get the appointment. If it takes a few weeks to get in to another doctor, the blood levels are still fallng and your wife may get to a point where dosage reduction may be the only answer. Neupogen works very quickly (wbc) but Procrit (hgb) takes from 2-6 weeks to kick in so you can see the importance of staying on top of blood values.
You don't want any dosage reduction if you can help it. This happened to me. Doc waited til the last minute to tell me he doesn't rx Procrit or Neup and it took a month to see the hemotologist. I had a dosage reduction for a month during the first 12 weeks.
Platelets--Ask him at what point he will pull the plug. A lot of GI's won't go below 50. I, or my Hemo doc, ended up "making a deal" with the GI that once my Platelets got below 50 I would take Neumega, a very nasty drug. Hemo docs are usually more comfortable letting the platelets go much lower.
Just some things to find out before you start. I wish I had asked, lol!
miss
You don't want any dosage reduction if you can help it. This happened to me. Doc waited til the last minute to tell me he doesn't rx Procrit or Neup and it took a month to see the hemotologist. I had a dosage reduction for a month during the first 12 weeks.
Platelets--Ask him at what point he will pull the plug. A lot of GI's won't go below 50. I, or my Hemo doc, ended up "making a deal" with the GI that once my Platelets got below 50 I would take Neumega, a very nasty drug. Hemo docs are usually more comfortable letting the platelets go much lower.
Just some things to find out before you start. I wish I had asked, lol!
miss
Ok guys, I owe you both a thank you. Based partly on comments you made, many weeks back, I deceided to go with Pegasys for tx #2. So far, things are looking up - und at week#2. The better part is fewer sx with Pegasys than with Intron. Thanks for your input.
WAY TO GO!!
Great news!
are the ides easier on Pegasys for you so far? I hear it's easier than this crud.
Im so happy for you.
Great news!
are the ides easier on Pegasys for you so far? I hear it's easier than this crud.
Im so happy for you.
So far, I thinks the sx are less than PegIntron - and I've been double dosing the peg too. I'll see over the next many weeks as I settle in for 'the long haul' and the riba continues to hit the fan. But so far, so good. Thanks.
Don't want to put you on the spot, but which peg would you choose if had to make the choice with the restriction of following SOC guidlines?
I always thought a combination might be an interesting experiment -- perhaps with an initial mixed shot of Pegasys and Peg Intron on day 1 of the week, and then intermittent shots of Peg Intron during the week timed to do as much destruction as possible to the virus. Actual amounts to be decided by body weight and other factors.
I always thought a combination might be an interesting experiment -- perhaps with an initial mixed shot of Pegasys and Peg Intron on day 1 of the week, and then intermittent shots of Peg Intron during the week timed to do as much destruction as possible to the virus. Actual amounts to be decided by body weight and other factors.
MEDICAL PROFESSIONAL
Since very rapid initial viral decline might matter a lot ( think of the now famous trillion mutants) a start with pegintron followed by Pegasys might have been a good choice if someone can play with these things as only few can.
Thats also why some favour "induction therapy": High doses of nonpeg IFN for the first few hours to smash the virus low low before it can breed, then follow with consistent peg or pegasys levels. You probably know that regular IFN 2b is gone from the system within 12 hours!Does not feel that way for the patient - bcause he feels the cytokine storm elicited in the bodywide immune system by that IFN.
BTW in the "pun,etc" comment made at another place the "etc" stood wiildcard for the more esoteric expression that should have been used.I smelled the mouse coming! What percentage of the Big Websters terms are typically understood by the public, when addressed? I kept mine around to kill mice, but it turned out - when I came to read the instructions - that it was meant for cows!
Thats also why some favour "induction therapy": High doses of nonpeg IFN for the first few hours to smash the virus low low before it can breed, then follow with consistent peg or pegasys levels. You probably know that regular IFN 2b is gone from the system within 12 hours!Does not feel that way for the patient - bcause he feels the cytokine storm elicited in the bodywide immune system by that IFN.
BTW in the "pun,etc" comment made at another place the "etc" stood wiildcard for the more esoteric expression that should have been used.I smelled the mouse coming! What percentage of the Big Websters terms are typically understood by the public, when addressed? I kept mine around to kill mice, but it turned out - when I came to read the instructions - that it was meant for cows!
Great news!!! UND at 2 weeks, wow! I'm really happy to hear your sx 's are less with Pegasas. That is what I'm on, so I have nothing to compare to. How's your Hgb? When are you stopping the double dose?
MEDICAL PROFESSIONAL
Here are a few hard facts regarding Pegasys and Pegintron.
Pegasys is a 4o Kilodalton (MW) branched Interferon 2a.It has a volume of distribution ( the amount of body fluid to which it can go) of only 8-12 liter, due due its larger size and its branchedness ( Its not just tall - it is also fat!. That means it enjoys restricted biodistribution ( where it can go) with the highest concentration occurring in the liver.( Where it belongs). It will not reach the brain, but be aware that the brain will still be reached by numeraous cytokines that are elicited secondaryto the action of Pegasys on the immune system.
The pharmacodynamics of pegasys is also quite different than Pegintron. While it increases slower than pegintron in the intial dosing, it will later maintain a fairly high steady state level throughout the week. (Like when you reinject at day 7 the level is still approx 75% of day 1.
Pegintron goes down to almost zero 7days post dosing. But it does reach a much higher peak at redosing than Pegasus. Its volume of distribution is 1 liter/ kg - less than Intron A , but still fairly large ( goes almost everywhere).
These pharmacokinetic facts have theoretical and practical consequences some in favour of Pegasys, some in favor of pegintron.Which advantage matters more - only trials can decide that. The peaks are good to hit harder, the consistency is good to never let the virus of the hook. I do know of studies that Pegintron supressed the virus faster, but also that the viral load followed a sawtoothpenomenon it recovered when the levels fell. Some clinicians feel that multiple dosing is advantageous, but the regular doctor has to follow the standardized protocol that was approved in accordance with the trial protocols that provided the underpinning for these approvals.
With re to side effects - the experience coming from people that had to endure both types of treatment are a good source, maybe better than some of those small trials with depression scales - it is hard to say. In terms of sides - the above facts might explain some of the purported observations.
Pegasys is a 4o Kilodalton (MW) branched Interferon 2a.It has a volume of distribution ( the amount of body fluid to which it can go) of only 8-12 liter, due due its larger size and its branchedness ( Its not just tall - it is also fat!. That means it enjoys restricted biodistribution ( where it can go) with the highest concentration occurring in the liver.( Where it belongs). It will not reach the brain, but be aware that the brain will still be reached by numeraous cytokines that are elicited secondaryto the action of Pegasys on the immune system.
The pharmacodynamics of pegasys is also quite different than Pegintron. While it increases slower than pegintron in the intial dosing, it will later maintain a fairly high steady state level throughout the week. (Like when you reinject at day 7 the level is still approx 75% of day 1.
Pegintron goes down to almost zero 7days post dosing. But it does reach a much higher peak at redosing than Pegasus. Its volume of distribution is 1 liter/ kg - less than Intron A , but still fairly large ( goes almost everywhere).
These pharmacokinetic facts have theoretical and practical consequences some in favour of Pegasys, some in favor of pegintron.Which advantage matters more - only trials can decide that. The peaks are good to hit harder, the consistency is good to never let the virus of the hook. I do know of studies that Pegintron supressed the virus faster, but also that the viral load followed a sawtoothpenomenon it recovered when the levels fell. Some clinicians feel that multiple dosing is advantageous, but the regular doctor has to follow the standardized protocol that was approved in accordance with the trial protocols that provided the underpinning for these approvals.
With re to side effects - the experience coming from people that had to endure both types of treatment are a good source, maybe better than some of those small trials with depression scales - it is hard to say. In terms of sides - the above facts might explain some of the purported observations.
Just kidding of course. The pun/d'ent thing is something of a joke I used in terms of scrutinizing copy -- which btw (scrutinizing copy) is something I only do for a living, and certainly not here where I type sometimes faster than I can think, with the resulting mis-spellings, repetitions, awk constructions, etc. As they say, writing is re-writing, but then again the internet is the internet. Yes, I have one of those Big Westers collecting dust as well which actually came in handy when I had to raise the head of my bed during tx because of reflux. BTW I always thought induction therapy was more in line how I started tx which was double-dosing Peg until for either 12 weeks -- or in my case until non-detc and then going back to a single dose. I suppose it has many variations and the one you outlined seemed more sophisticated. So I imagine ithat the answer to the hypothetical question I asked you -- you do play "dodge ball" quite well :) -- is that you'd use neither. In fact, I could see you permanently hooked up to some sort of real-time PCR machine titering your interferon dose by the hour :)
Be well,
-- Jim
Be well,
-- Jim
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