Any advice for procrit?

[JasmineT]

Hi everyone,  i was hoping some of you may have some advice you could share.  I went in for my week 12 appointment today.  Don't have the blood test results yet but the doctor thought I looked pretty bad and showed signs of anemia.  I am on week 12 with incivek so no surprise there.  She is sending me to a hematologist to get on procrit.  I did some quick googles on procrit and the risk and sides seem a bit scary.  Any advice?  Any questions I should ask?

[JasmineT]

Thanks Hector!  You are such an angel.  That information is great.  I will call my doctor.  It seems a safer route to go too.  I do remember reading about that now too.  I do think she is new to triple but it is disappointing she does not know this.

Many thanks to can do and angel too.  If I do have to move forward with procrit this is very helpful too.

Get well, you are in my prayers.

[HectorSF]

You treatment doctor (gastroenterologist?) should be reducing your ribavirin dosage first before referring you for procrit. Reducing ribavirin will raise your hemoglobin and has no impact on your chances of SVR. This is the method used during the clinical trials to manage anemia, not Erythropoiesis-stimulating agents such as procrit.

Perhaps you doctor is new to treating with the new triple therapy? In the
"old" days (before this Summer) when only peg-interferon and ribavirin was used, reducing ribavirin had a profound negative affect on SVR rates. But with the new Direct Acting Antivirals this is no longer the case.

She might want to educate herself by reading materials on the proper way to manage anemia during treatment with the new triple drug treatment.
From the new AASLD Guideline "An Update on Treatment of Genotype 1 Chronic Hepatitis C Virus Infection: 2011 Practice Guideline by the American Association for the Study of Liver Diseases"

http://www.aasld.org/practiceguidelines/Documents/2011UpdateGenotype1HCVbyAASLD24641.pdf

"in the TVR trials, dose reduction of RBV had no effect on
SVR rates, and therefore dose reduction should be the initial response to management of anemia..." the potential benefits of erythropoietin must be weighed against its potential side effects, the fact that its use in
HCV therapy is not approved by the FDA, and its considerable cost."

Or she can read the prescribing label on INCIVEK which says in Section 5.4 Anemia...
"Hemoglobin should be monitored prior to and at least every 4 weeks during INCIVEK combination treatment. For the management of anemia, ribavirin dose reductions should be used (refer to the prescribing information for ribavirin for its dose reduction guidelines). If ribavirin dose reductions are inadequate, discontinuation of INCIVEK should be considered. If ribavirin is permanently discontinued for the management of anemia, INCIVEK must also be permanently discontinued. Ribavirin may be restarted per the dosing modification guidelines for ribavirin. The dose of INCIVEK must not be reduced and INCIVEK must not be restarted if discontinued."

Erythropoiesis-stimulating agents such as procrit were prohibited from most telaprevir studies, and their use was reported in only 1.0% of T12/PR patients, so there is really little data to indicate how procrit impacts treatment and SRV rates.

----------------------------------------------------------------------------------------------
Sulkowski MS, Reddy R, Afdhal NH, Di Bisceglie AM, Zeuzem S,
Poordad F, et al.
"Anemia had no effect on efficacy outcomes in treatment naive patients who received telaprevir-based regimen in the
ADVANCE and ILLUMINATE phase 3 studies." Journal of Hepatology 2011;
54(suppl 1):S195.

http://www.natap.org/2011/EASL/EASL_41.htm

Results:

"41% (361/885) of patients in the T12PR developed anemia (hemoglobin < 10 g/dL) during treatment.
Seventy four percent (267/361) of T12PR patients with anemia achieved SVR.
Seventy three percent (384/524) of T12PR without anemia achieved SVR."

"Seventy-two percent (260/361) of T12PR patients with anemia had ribavirin dose reduction due to adverse events compared to 11% (60/524) of T12PR without anemia, respectively."

"SVR was achieved by 76% (243/320) of patients with ribavirin dose reduction in the T12PR compared with 72% (408/565) of patients without ribavirin dose reduction in the T12PR."

Conclusions:
In patients treated with telaprevir-based therapy, anemia as well as ribavirin dose reduction had no apparent effect on SVR rates. These data suggest that management of treatment-related anemia with ribavirin dose reduction appeared not to impact SVR with telaprevir-based therapy.

Hemoglobin <10 g/dl is considered anemia.

The dosage of riba was reduced to 600 mg/per day according to “package insert directions”.
Time of first Ribavirin dose modification appeared not to affect SRV rates.
7 days was considered “dose interruption”

76% (24 weeks) and 73% (48 weeks) with “dose interruptions” achieved SVR.


Hector

[child24angel]

Hi can do

[can-do-man]

Go for the procrit, i was on it for many weeks (twice a week) and didn't have any problems, for me it was a treatment saver.

advice using it, let it warm to room temp. and inject it slowly.......... Good luck to you

Hi Angel....

[child24angel]

I believe it take a couple of weeks to kick in.
In addition, from my knowledge and memory
some extreme bone pain for some people.

Always good to have your labs ready when speaking to your
doctor.  

Many here have taken procrit and others will come along and give you
their perspective.

You don't want them to reduce your RIBA .

All my best
Elaine