6 weeks apt w PA

[hepcat60]

Just had an apointment with my PA.  I was UND at 2 weeks, but due to an error with lab I didn't get 4 week labs.  I was a bit anxious to get my results.  I missed a couple of doses of Riba due to vomiting in weeks 4 and 5.  But good news- at 6 weeks still UND.  Some lowering of hemo and platelets and my dose of Riba is getting lowered from 600 mgs bid to 400 due to rash.  Willl this change lower my chances of SVR?

[pooh55811]

You are Genotype 1 a and a previous non-responder. Did you have a liver biopsy and do you know your liver fibrosis stage?

If it was me, I would be very concerned about lowing the drug dosages.

[pooh55811]

How bad is your rash?

Your rash may be due to Incivek, not Ribavirin, in which case lowering the dosage of Riba would not help. (I am not saying the rash is due to Incivek, but if the rash is due to Incivek, then lowering the Riba dose will not help ... unless the rash is also due to the Ribavirin.) Unless there is something we do not know, I do not understand why he is reducing the Riba dose.

Generally speaking, when taking Inf., Riba, and Incivek, when a rash appears the rash itself is treated with prescription steroid creams and ointments  and a strong prescription antihistamine such as Hydroxyzine. Unless the rash is severe, the medication dosages are not lowered. Actually, you cannot lower the Incivek dose. If the rash is severe, then the Incivek is discontinued (but only if the rash is severe). Most of the rashes can be treated and controlled with prescription steroid creams and ointments and the Hydroxyzine (or equivalent) prescription antihistamine.

I had a moderate to severe rash.
I used Hydroxyzine 50 mg every 8 hours
Fluocinonide Ointment on my body
Hydrocortizone valerate cream on my face
Clobetesol solution on my scalp
These drugs worked for me and I never had to reduce or stop any of the medications.

Here are photos to help you gauge the severity of your rash and also guidelines on managing the rash.

http://gitract.mngastro.com/mngi.nsf/patient_education/324B138CFD286259862578B000766281/$File/Incivek_Rash.pdf

Pick the first site that comes up: Rash Information Sheet

With the rash, one needs to get on top of it immediately and treat it/control it or it will snow ball out of control. The doc should get on board and treat the rash aggressively with the steroid creams and ointments and the antihistamines. Unless there is something we do not know, I do not understand why he is reducing the Riba dose.

Best of luck.

[hepcat60]

Thanks for the information.  I think my dosage was reduced due to rash.  I am  type 1a 3x Incivik. Non responder to Inferferon only in 1996-97.  48 weeks this time.

[Idyllic]

What is your Genotype and which meds are you taking? Also (just out of curiosity) have you treated before?

It says in some places that for dual therapy:

Because there is a clear relationship between ribavirin concentration and sustained virologic response rate, it is preferable not to dose reduce ribavirin if possible, especially in genotype 1 patients.5 In Manns, et al., a regression analysis of sustained virologic response rate and ribavirin dosage shows a clear direct relationship between SVR and dose with a definitive cutoff at a critical dose of 10.6 mg/kg.1 This has led to the argument that adherence to ribavirin dosage improves sustained virologic response rate, although this remains an unproven point to date.6
http://www.hcvadvocate.org/hcsp/articles/Pockros-2.html

But for triple with a Protease Inhibitor (Telaprevir or Boceprevir) a Riba dose reduction is not supposed to

http://www.hivandhepatitis.com/hepatitis-c/hepatitis-c-topics/hcv-treatment/3583-easl-ribavirin-dose-reduction-and-epo-both-work-for-managing-anemia-in-patients-using-boceprevir

There are lots of posts on here related to this topic that elaborate on the guidelines & explain management of hemolytic anemia with the PI's on triple.

http://www.medhelp.org/posts/Hepatitis-C/New-guidelines-say-reduce-Riba-first-for-anemia/show/1620156

http://www.medhelp.org/posts/Hepatitis-C/Procrit-and-ribivirin---dose-adjustment-for-riba/show/1649998