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Lowering Ribavirin Dose

Have any of you seen the new study out of Johns Hopkins regarding comparing the two Pegs? Apparently they also looked at lowering the dose of ribavirin (and interferon) when anemia occurs and found that actually improved the success rate of SVR when compared to people who toughed it out and stayed with the same dose.

I was floored when I read this and wish I knew enough to know just how good this study really is. I have a lot of respect for Dr. Sulkowski. Maybe we will get to hear more about this at AASLD.
19 Responses
87972 tn?1322664839
Wow, do you have a link to this? It surely is counterintuitive, isn't it? I wonder how the study was structured... was it sound? Am I asking too many questions :o)? Thanks; I'll keep an eye out for it,

Bill
Avatar universal
That is sure not how it has worked for my husband.  He is now a 3 time non -responder.  This time he is been on interferon since June 2008.  The last 20 weeks he was switched to Infergen because he could never get to nondetectible.  Viral load just stays in the small numbers.  The lowest it got was 80 but last time it went up to 300.  I don't expect they will leave him on it any longer.  We have just tried everything. He has also been on Alinia since May 2009. We predosed Riba and he took a good dose most of this time (1200-1400) but a couple of months ago his hgb dropped to 7.2 and he had to have a transfusion.  They stopped Riba for 2 days and have changed his dose to 800mg. and low and behold his viral load went up instead of down.  Similar pattern in the past.  Ribavirin seems to be pivotol for Joe.  He has taken loads of procrit but eventually it wasn't working well enough to keep him out of trouble.  
I find this study very confusing.  Maybe it is just like this in people that were probably never going to SVR anyway.
Thanks for bringing up so many interesting thing to the board.
Ev
Avatar universal
Here is the link:

http://www.hopkinsmedicine.org/Press_releases/2009/07_22_09.html
87972 tn?1322664839
Banarep; thanks for the link.

Huh;

++++++++++++++++++++++++++++
“In a piece of reassuring news, the study appeared to allay fears about switching to less aggressive drug treatments in response to severe side effects with anemia, showing it can be safe and effective to reduce the does of the antiviral drug ribavirin to doses below those initially prescribed.

Moving forward, researchers say the higher rates of viral eradication in infected people in the early stages of liver disease warrants more widespread screening in people at greater risk of being infected, such as those with liver inflammation, anyone who received a blood transfusion before donor testing for hepatitis C began in 1992, and injection-drug users.

Researchers also found that in the third of study participants whose ribavirin dosage was reduced as a result of anemia, cure rates actually improved to as high as 52 percent, whereas in those whose ribavirin dose stayed the same, cure rates were lower, at 37 percent.

“Contrary to the prevailing belief that ribavirin dose reduction would lead to fewer people recovering from their infection, it actually increased the sustained viral response rate when reduction was used to manage treatment-related anemia,” says Sulkowski, who attributes the onset of anemia as a sign that the body had sufficient ribavirin to fight off the infection.

“Our study shows that in infected people having difficulty tolerating standard dose therapy with peginterferon alfa, we can safely reduce their medication levels,” he says.”
++++++++++++++++++++++++++++++++


This study apparently involved both Schiff and Shiffman as well; all good investigators; it will be interesting to see more.

Bill
179856 tn?1333550962
Maybe they are insuinating less drop outs from the anemia? It sure sounds completely incorrect and against everything we've ever seen previously and I still wouldn't do it if it were me.
Avatar universal
Sorry, I was at the supermarket. Thanks for posting the link. I will try and speak to Dr. Sulkowski in November.
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