Skipping Pegasys Dose

[IAmTheWalrus]

I am geno 1, a liver TP recipient, and had an partial EVR to SOC. I cleared at 24 weeks and have finished 49 of 72 weeks currently. Due to a stroke (TIA) a couple of days ago, my liver doc wants me to take a "drug holiday" and skip this week's Pegasys dose. I am reluctant to do this but said I would comply. I am very worried about compromising my chances of SVR and I am not aware of anything that could link the interferon to stroke risk factors.

Does anyone have any information or comment either on the effect of a missed Pegasys dose on SVR or on any link between Pegasys and risk of stroke?

Brent

[jmjm530]

You might want to address this question to Dr. Dieterich in the Expert Forum,
here: http://www.medhelp.org/forums/show/272

All the best with your stroke recovery and treatment.

-- Jim

[comeagain]

Sorry to here about your trouble , just want you to know your in my thoughts and in my prayers.

ca

[Marcia2202]

I'm so sorry to hear that you had a stroke. I wish you a speedy recovery! I agree with Jim, post the question directly to Dr. Dieterich. Here is the link www.medhelp.org/forums/show/272

Marcia

[charm27]

I hope your feeling better soon. I too am sorry about the TIA.
Take care


Charm

[mikesimon]

From: http://www.pegasys.com/hcp/default.aspx

"......During treatment, patients’ clinical status and hepatic function should be closely monitored, and PEGASYS treatment should be immediately discontinued if decompensation (Child-Pugh score ≥6) is observed. Ischemic and hemorrhagic cerebrovascular events have been observed in patients treated with interferon alpha-based therapies, including PEGASYS. Events occurred in patients with few or no reported risk factors for stroke, including patients less than 45 years of age. Because these are spontaneous reports, estimates of frequency cannot be made and a causal relationship between interferon alpha-based therapies and these events is difficult to establish...."

Mike

[child24angel]

Sending hugs and prayers your way Brent. I've very sorry to hear this.
Hugs
Elaine

[Texas714]

I'd look at the info packed with the meds...you know there is always a long list of this could happen or that could happen...Sorry to hear of your troubles...I'd probably listen to my dr.

[fretboard]

I'm very sorry to hear about your difficult time you went thru, going to the hospital and all.  If I was in your same position, I would go with what your doctor said.  Besides, the information mikesimon put up validates your missed dose in my mind, and I certainly think that SOC has to be adjusted and deviated at some point for some ppl, as we are not all the same.
Good Luck  

[zazza]

Could you talk to your doctor about temporarily reducing your dose instead of skipping it? Being a slow responder myself, I think we need our 72 weeks if possible. So sorry to hear about your stroke.

[Marcia2202]

I am definitely not an expert on this, but I thought that the serum half-life of pegasys is 10 or 12 days.  Couldn't it be an idea instead of skipping a shot to move it ahead those extra days and then continue taking the shot on this new day.... Just a thought, which only has to do with logic, but not experience....

Marcia

[IAmTheWalrus]

First, thanks to all of you for your comments, concern and thoughts. And just to be clear, I AM JUST FINE! No damage shows up on MRI of brain and I have no after affects. The loss of feeling and speech only lasted a few minutes with a couple of aftershocks lasting only a few seconds. It was a little scary, but I am fine now.

jmjm - thanks. I should have thought about Dr. D. Good idea.

comeagain - I really appreciate your support. I hope all is well with you. :)

Marcia, Charm - thank you so much for your support.

Texas - Not sure I am up to getting out the giant magnifying glass and going through the fine print that comes with the Pegasys again! It'll be a challenge to my eyesight.

Fretboard - Thanks for the advice. I think I am resigned to this adjustment to SOC at least for now

mikesimon - The Fellow filling for my vacationing hepatologist said much the same, that there were reports linking interferon with ischemic attacks, but it was not clear if there was a coincidental or causal relationship. It looks like my hepatologists are on the right track.

Zazza - I have the exact same concern: I have a lot invested in this treatment and do not want to do anything to jeopardize the chances of SVR. Thanks.

Thanks again for the support! You're all terrific!

Brent

[IAmTheWalrus]

Thanks for the prayers and hugs! I am really praying for Nick. I know he'll get the call soon!

Brent

[eureka254]

So glad to hear that you are OK!  I'm sure that your doctors are being rightfully cautious -- my husband's doctors pretty much echoed what Mikesimon posted above -- his hep doc said there is some evidence that SOC can induce ischemia, but not in a way that's quantifiable statistically. (But enough that some GIs won't treat stroke/cardiac patients.)  

I know you have a tough decision in front of you -- I certainly wish you the best outcome!

~eureka

[IAmTheWalrus]

Thanks for the support. I hope you and your husband are doing well.

Brent

[merryBe]

sorry to hear of your trouble. Hopefully it will be a one time event. Lots of small strokes happen as we age, and often go unnoticed.

there has been some research linking INF to increased risk of stroke.
your doctor probably wants to give it a rest and make sure you speak to him about encephalitis or too much pressure in your brain..there are ways of testing for these.


Interferon regulatory factor-1 may be linked to cerebral ischemia and stroke

July 28th, 2003

Interferon regulatory factor 1 appears to be involved in the mechanisms following cerebral ischemia that lead to cellular damage, and is present in intravascular neutrophils, neurons, and brain inflammatory cells.
According to published research from the United States, "Interferon regulatory factor-1 (IRF-1), a transcription factor that controls the expression of genes related to inflammation