Procrit to treat anemia

[AJB100]

Is there a standard protocol for use of Procrit for treating anemia caused by HCV meds?  My provider has a criteria for initiation (< 9.5 hemoglobin), but then gives it for only one week and waits till it returns to very low level.    

[nygirl7]

Oh by the way...see if you can get it preauthorized by your insurance company.  It is very expensive (epogen was a box of ten for over $6,000 and only lasted me five weeks) and i had a bit of trouble but my pharmacist helped me big time to get it to go through.

And if you can then perhaps if this doctor doesn't go through with it you can find a hemotologist who understands the need for the meds when you are under ten........which feels pretty damn bad as I remember.

Also, GrandOak was right it's not just the actual number you are at it's how fast it goes down that does matter.  For instance if you were at week 30 at 10.5 you would perhaps be OK but at week 4.....it hurts to go any lower than that if it makes sense.

[GrandOak]

Like the others, for me it took about 4 weeks to show any changes in dosage and at peak I was on 100,000 a wk and was splitting injections across the week to try an keep a more consistent level since doctor did not want to go higher.

I do know that PI for Procrit claimed 2-6 weeks for effectiveness since it varies for each individual.

Like NYGirl, mine only got to 10.5 one a good day even with the rescue med.

You may want to talk with your doctor as most look at the rate for drop rather than using a threshold because of the lead time.


I also echo NYGirls warning to not let them cut your Riba, as it's PI suggests because this is what my first doctor did before dropping me because HGB continued to drop.  I can't say for sure that it resulted in compromising my TX.  However, I do know that my VL drop slowed down significantly at that point and never really did recover, even after switching doctors to get on Procrit to fight the anemia.

I spent several months stepping up Procrit and Riba to the point where doctor did not feel comfortable in raising Procrit, but I did reach full Riba again.  But by then the virus must have had chance to catch on and my VL leveled out and actually began to rise during final 12 wks of TX at full med dosage.

Not trying to cast a cloud on your TX, but to emphasis NYGirls warning with my own experience as I still question if things might have been different had I been going to a doctor who knew enough to use Procrit earlier?

I do know that their concerns over usage is the result of a few FDA warnings which were issued when I was on TX about possible long term cardio problems with it's usage.  But also recall that those were not related to studies/cases where Procrit was being used to fight anemia in chemo TX's, such as is the case for HCV TX.

Wish you well!!

[AJB100]

Thank you all for the thoughtful input.  Much appreciated!

Alan

[newleaf09]

Procrit use is at the doctor's discretion as jd says. Most set 10 as their level to begin using it. I used it at 10.8 fairly early in treatment. It took 3-4 weekly shots to start working for me.   My medical team's goal was to get me over 11, at which time the shots were stopped.  Later use was started when I was at10.2.  I think they just gave it to me when I seemed the most drug-out and miserable.  Obviously your provider is unaware of how miserable an HGB of 10 is.

I'd suggest that you search for some treatment guidelines on the use of rescue drugs for HCV treatment.  I just doubt that you will find them on a site that your doctor would believe.

[jdwithhcv]

Using Procrit with treatment for HCV is an off-label use of the drug, so there is no standard protocol per se.  That said, like Bill's doctor, mine prescribed Procrt when my hgb went below 10, and would have stopped it if my hgb went to 12 (it never did) because of the risk of clotting.

When I first took Procrit my hgb kept dropping and I had to have transfusions when I got into the low 7s.  Procrit takes a few weeks to work because it stimulates the bone marrow to produce red blood cells and they take about 3 weeks to develop.  

[nygirl7]

Mine dropped rather drastically (from 15+ to 9 in ten days) so I really can't speak to that but I can tell you it does take several weeks depending on the person to see the results.  It's not just a quick energy fix, the bone marrow has to start doing a major job to make you red blood cells or something absolutely spectacular.  One week really wouldn't do an awful lot - in fact i was on it for a total of 69 weeks.

But it worked fantastically and I was able to continue treatment.  Still taking it my hemo only went to about 10.5 (you do not want it to go too high too fast) the whole time...but i was on a lot of riba for my weight.

Don't let them drop your riba level if you can help it.....especially in the first 12 weeks of treatment which are most crucial.

GOOD LUCK!

[Bill1028]

I was given procrit as soon as my HGB went under 10.  It takes about 2 to 4 weeks of procrit to see results.