2b, week 7, holding dose's

[Lady Lauri]

  
   Okay! hgb now at 10.3 in 6 week labs. Was told as we have already dose reduced, that if it drop's to 10 or below next labs, they may 'hold dosing' until back up. Confused as has been posted that it could go as low as 8.5 before that happened (but in a trial).
   Now I am worried. I will get shot 8 in before next labs, but very concerned as isn't this when, even with RVR at week 4 , the virus can sneak back in....missing dose's?

  To refresh: 2b, VL at start 1, 550,000
  5 weeks at 180mg Peg/ 800 Riba
  RVR week 4 labs
  Reduced at 6th shot to 135mg Peg/600 Riba

  6 week labs: Posting all
   Glucose: 53 (whats up with that, way low, eating LOTS of suger?)
   T. Protein 6.3
   Alb. 3.7
   LD 161
   T. Bili 0.5
   AST 22
   Alt 12
   Alkphos 59
   GGT   17
   Amylase  54
   NA    135
   K (?) 4.3
   Mag 2.3
   Bun  9
   RBC 3.19
   Hgb    10.2
   Hct     30.8
   Plt       173
   WBC      4.3
   ANC    2.3   (what are these? Where's neuts this time??)

Pigeona, Ladybug….you both had to stop early, both SVR, but why did you have to stop?
Ladybug…think you did the 16 weeks, why was that decided? He did say last week I could just get to week 16 and he’d be comfortable with SVR for me.
I'm stressing :{   Really want to at least get to 13-16 weeks. Any input on how bad this could affect RVR. SVR if I miss a few weeks dosing? OR if I ask if we could try the 90mg Peg/400 Riba first?

                                           Thanks, not happy with this :{                           LL

[Lady Lauri]

Does's to stay the same until next labs, tho I still feel dropping 1 Riba ( for a week or so)
would help Hgb stay or go up! (maybe drop 1 every other day? Desperate to not miss dose's totally!)

CS........"The extracts below come from Accelerate.
Reduced durations of therapy may also be reasonable in patients who have adverse events and are unlikely to tolerate 24 weeks of therapy.
The decision to reduce the duration of treatment must be balanced against the increased risk of relapse. Patients who do not have a rapid virologic response should not be considered easy to cure and should not be offered abbreviated treatment."


  The above is why I figure he reduced both ...."unlikely
to tolerate 24 weeks of therapy." Explained to me that it was okay with my EVR/ RVR and he was not happy with how I was after week 4 into this, labs or not, the 'bedridden' part, sick, etc. I figure he also takes into account keeping weight on a must as not much to spare here and had dropped 6 in @ a week, & by week 4.  (AKA..not eating or puking all food and some Riba up!) 15-20 more lbs. loss on me will be bones.


"However, it is now recognized that small reductions in the dose of peginterferon alfa and/or ribavirin, particularly after patients achieve undetectable HCV RNA, are less likely to impact SVR as long as dosing is not interrupted. "

So, I'll be keeping that in mind.

                              Thanks CS, that was very helpful,      LL

[pigeonca]

That sounds like an excellent plan, at least to my layperson's mind.  Good luck on it.

[Lady Lauri]

"your study won't allow helper drugs so your SVR is in some respects being sacrificed to a certain degree."

Exactly and why I have to take some control here!
My thought (plan?) after info. from you guys and a bit of my own, is the Peg needs to go up, the Riba down 200 more (to 400)  for awhile, to get hgb up.

Sound okay? E-mailing them now, they respond fast, normally.

                                                                                                  LL






E-mailing them now, they respond fast.

[jmjm530]

The reason I suggested seeing a "back up doc" is because in general lowering doses is inferior in terms of SVR than using helper drugs. Problem is that your study won't allow helper drugs so your SVR is in some respects being sacrificed to a certain degree.

That said, as CS studies show, you may be able to get away with a lowered riba dose as long as they don't force you to stop the riba which they apparently have threatened.

But if it were me, the main question to your docs would be why the Peg reduction with such high ANC (absolute neuts). Peg reduction is associated with lower SVR and I'd def bring that up with your doctors.

-- Jim

[Lady Lauri]

Another help the medically illiterate girl question :}

  WOULD that make sense that he cut the Peg also because of UND at 2 weeks?

I had been in bed 9-10 days , with that "Oh God, I gotta walk 12 feet to the bathroom" feeling.
(bed pan anyone, LOL)
When he asked % of time in bed and I said 100%, he said "oh, no, that won't work".

                                                                                                        LL

[Lady Lauri]

  Thank you :)

Always had 'Nuets' on it than had ANC. I do have the list of normal ranges for all.
This medical mumbo jumbo has been quite a learning exp.!

Get my e-mail to you :}  And have a 'light at the end of the tunnel' day :}

                                                                                        LL