treatment options?????

I am a 53 yr old female genotype 2b with stage 4 hep c early cirrhosis. Met with my GI yesterday, ready to start treatment. First he wanted to start a lower dose of pegasys and copeg and increase to full dose over a couple of weeks. Then he decided to just start me on pegintron combo, his reason being he can start me on full dose. I have read of how much harder pegintron sx's are and it scares me. What are the other differences in the two treatments with regards to SVR and relaspe and benifits for my liver.  If I'm going to do tx I want it to be the most benifical to my liver as it can be. Pegintron I understand is metabolized in the kidneys and Pegasys in the liver.  I have also read that they can switch meds during tx is that true. Any and all information and thoughts on the subject would be greatly appreciated.

God bless

[scruffy]

I don't understand his unwillingness to start you on full dose pegasys. I tx'd with pegintron. If I had it to do again I would choose pegasys just from the general consensus of milder side effects. I also understand that pegasys lasts a bit longer so MAY have a small edge in effectiveness.(maybe) Whatever drug is used I would demand to start at full dose unless there are extenuating circumstances I don't see here. frank

[jmjm530]

I would think it would be the other way around. Where you could make a greater case for initial low dosing of Peg Intron.

Like Scruffy said, try and get started on a full dose of Pegasys full riba if you can.

You mention you're a stage 4. Is your tx plan 24 weeks? You might consider extending it to 48 weeks because of your level of liver damage.

Also, try and get a viral load test at week #4 to chart your progress. A lot of docs only test at week #12 unless you make a specific request.

[HepCinLA]

Not sure if this is correct, maybe someone here can clarify, but I was told that w/ Peg the riba dosage is weight based vs. one size fits all w/ Pegasys.  Intuatively, that would mean to me that if a large and small person were given equal doses of pegasys and it's riba equivalent than the larger person would experience fewer sides.  I guess it also depends on your general health and if you have any other co-existing illness.

[friole]

I think the Riba is weight dosed in either one.  But the Pegintron is weight dosed and the pegasys is not

[cuteus]

Riba is wt based wether you are on Pegasys or pegintron. the interferon dosage differs between the two. Pegasys is the same dose regardless of size.

[MichaelT]

Taking off from Scruffy's comment, Pegasys really does last the week. PegIntron should probably be dosed twice a week, but there has historically been a dearth of rationality in this area. What this means is there is a more constant level of interferon, the body basically adapts to a new level of the stuff, and you cope with it. Having the body react to different levels of interferon is - well, look at it this way, it is like catching the flu/begin recovery/catch the flu again/ begin recovery... It is better to just catch the flu and deal with it rather than catching it 24 or 48 times in as many weeks. The flu analogy is because when you catch the flu and feel achy and yukky, it is do to elevated interferon levels.

Personal opinion aside, one treatment is not superior to the other as far as outcomes. Personal opinion back in play, I'd go for the Pegasys since there are less severe side-effects; if I'm going to experience side-effects, the milder the better!

Remember, too, some people have little or no problem on treatment - you may be one of them! I certainly pray that is so.

[sosad]

Thank you for your insights. I am in pretty good health aside from the damage to my liver which the doctor feels is somewhere between stage 3 and stage 4 closer to stage 4. I think his main goal is to make sure I'm able to finish tx without any reduction  in meds during tx. He says there is always the possiblity that I could go from compensated to decompensated during tx. My feelings are if the sx are easier on one med than the other it would be easier to finish tx. We are shooting for 24 weeks. but I'm so confused about the different meds I do not know what to ask for.

[sosad]

I think you might have misunderstood He wants to start me on full dose pegintron. He wanted to start me on a lower dose of pegasys. I do not understand what the difference in the two is that he would start me on a lower dose of pegasys and full dose of pegintron. I am neither heavy or thin I weigh 150lbs.

[cuteus]

I would listen to jm's suggestion for going longer if your body can handle it. to reverse the fibrosis. My GI practice was commenting on the increase in relapsers in their practice, including geno 2s.
consider going for damage reversal

[jmjm530]

HepCin,

Like other have said, Pegasys is one dose fits all and Peg Intron is weight based. Therefore, an argument could be made that Peg Intron is potentially more effective if you are quite overweight. Conversely, Pegasys might be better if you're under the mean weight. On the other hand, there's nothing to say you have to take the standard prescribed doses of either.

Sosad,

Like Cuteus reinterated, really consider 48 weeks of tx. You've got very advanced cirrhosis therefore are a candidate for relapse with only 24 weeks. And regarding the drugs again...both are probably equally effective but probably less sides with Pegasys. There is no reason anyone can think of why you would start (Pegasys)  at a lower dose and not another. You may want a second medical opinion on this.

Good luck!