PEGASYS VS PEGINTRON 2B

[RALPH44]

I heard pegasys has less side effects and does less damage to the organs then pegintron 2b. My viral load is only 500,000 and doctor isn't even going to start treatment till 2008 so why would he put me on the harsher one. How many are taking the peg 2b. and has anyone tried both or heard the same thing? If it is true I opt for the less harsh one

[timothy141]

Did I understand correctly your a G3 and your VL is 385?

[mrdasti]

Thanks Dear
i am just asking Pegasys is suitable in HCV viral load 385 ?

[pooh55811]

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[mrdasti]

Please give me guideline, i am infected with HBV viral load (1124  IU/ml) and HCV viral Load (385  IU/ml) gynotype is "3" .in ultrasound report is Possibly chronic Disease. my weight is also 100 + my Doctor recommended Pegasys is not suitable and advise Pegintron.

kindly some one give me guideline for my followup

[beth82463]

my husband had a liver transplant sept 10 2007 he was never treated before for hep c . 3 weeks after transplant hep c came back at a viral load of 10 mill. treating with pegintron and ribo. at 10 weeks  he is still in the 6mill  has had to get many units of blood  as well as nupagen shots white blood count down to .9 . his dr told him he has only seen a couple of people with hep c that is so aggressive.  any one else in the same boat or know of anyone ? they say that the pegintron is the best for him and that if that isn't working the pegasus won't work either.   beth.
'

[niceguy2007]

umerises, are you from Pakistan?  from what i gather, your symptoms sound surprisingly similar to mine before treatment.  I had genotype hepatitis C genotype 3a virus, which you probably have too if you are from Pakistan.

[umerises]

I need some informaiton. I am 27 years Old.  I felt symptoms of aching, sever headaches, eye aches, Backaches, joint aches, some times liver ache, general body aching. looks eyes are burning. Feel severe weakness and tired all the day. Want to sleep more. some times chest ache on my right side. If mistakenly my finger pushes strognly on table or some thing hard matter. i feel more pain than ever.  My doctor told me I got hepatitis C virus. I can not concentrate my studies and my Lab work very well. I feel some times temperamental mode Off. My SGPT, and ALT, all liver enzymes reported in the Normal Range. Doctor has also done my Viral Load test. For what I am waiting?. Can any body tell me, " When my liver enzymes are normal, then Why I am feeling these pains and symptoms????

[niceguy2007]

i used pegasys 180mcg for 24 weeks.

i weight roughly 60kg and therefore received a high dose of pegasys.  

doctors have not been able to explain my reaction to the drug.  my first 2 shots of pegasys caused intense burning in my entire body exactly 20 minutes after the shot.  this lasted for about 40 minutes each time.  

it also caused throat constriction, difficulty breathing and minor hives.  

but the most telling symptom was the burning feeling that i felt deep in the gut, as well as in my limbs, face, and tongue.  my vision was also affected and the field of vision actually trembled, which was really scary.

[gauf]

This will actually be my third time around. I wish us all good luck.

[FlGuy]

We share similar profiles. I'm geno 3.  Here's to the second time around and triumph of hope over experience!

[gauf]

I share your tox history to a T. 2b relapser. Increased riba from 800 to 1000, and went from pegasys to pegintron for 24 weeks. I too was und after 12 wks and throughout. Relapse at 6 mos post. Going back to pegasys and riba to 1400/1600 for 48 weeks.  I am 240 pounds. I am going with pegasys though because I relapsed the first round on it but VL just 250,000 at 6 mos. The pegintron at 24 week treatment had a VL of 4 mil at 6 mos. So, feel the pegasys worked better.

[sosad]

sorry it took so long to respond I was away for a few days  I was a genotype 2b and relapsed after the first 24 weeks of treatment I was und throughout the 24 weeks but they did not do pcr until 12 weeks so I do not know if I was an early responder.  When I retreated I did have and increase in the riba dose from 800 to 1000. No other modifications to tx.  I do have early cirrhosos and both the doctor and I feel that might have contributed to relapse.  While on the second round of tx I had many more parts of my body affected by the meds hopefully my liver has had some rest from the virus and my und will continue post tx.

[beamishboy]

my docs-syracuse univ -are doing a trial comparing the two.....

[drofi]

yes, I hope all these studies will be done soon after marketing authorisation as investigator initiated trials.

[jmjm530]

Interesting, or what about the reverse. Do 12 days (instead of ten weeks) of Telaprevir to knock the virus down and then follow-up with 24 weeks of SOC to kill off any resistent strains, assuming an RVR. The shorter TElaprevir course should circumvent the Vertex rash that many have gotten.

[drofi]

I think the question of comparing higher doses with lower doses is independent from the other points. Just as you said, the question is how your body tolerates higher doses. My own body accepts higher Ribavirin well, but having 20.000 platelets after starting therapy I decided not to add additional IFN to the180 ug Pegasys, but did not reduce the dosis, although this is a risk.
There are so many studies that should be done. I would like to see a study with Telaprevir as an add-on, not at the start of the therapy. Resistance is the drawback of VX-950, why don't they start to lower the viral load with SOC for 4-8 and add Telaprevir than? The statistical chance to get mutations is lower when the number is lower.

[jmjm530]

How do you then account for better SVR results in the  Pegasys double-dosing studies, or the shorter-course studies CockSparrow mentioned earlier in the thread where SVR rates increased if you weighed less than 75 kgs (165 lbs)? I suppose you could argue it might have been the riba, but more and more seems to point that the more drugs (peg and/or riba), the better the SVR rates. The question then is how much is too much in terms of both QOL and what the drugs do to the rest of the body.

I agree that combining both Pegs would be interesting approach to explore. There are many ways this could be accomplished, from taking both Pegs at the same time -- to starting with one Peg and then switching to another -- to alternating Pegs on a weekly basis.

[drofi]

The idea behind weightbased and fixed dosis is the different distribution in the body. The larger Pegasys (40KD) is distributed in the blood and liver only and the amount of blood and the size of the liver ist not proportional to the bodyweight. You have about the same volume of blood and the same size of the liver, if you are fat or not.
PegIntron is smaller and has another distribution, e.g. into other tissues.
In addition both have a different halflife.
Therefor it could be true, that PegIntron works better to controll the virus in distant reservoirs, but Pegasys works better because of a flat kinetic profile during the week, without a gap at the weekend. The result would be the same efficacy and rate of SVR, but for different reasons.
I would like to see a study with a combination of both Pegs.

Regards, drofi

[jmjm530]

Thanks Mike for the additional research and comment. As we both appear to agree, one Peg hasn't been proven any better than the other, and probably won't be given the way these studies are structured and given the people who sponsor them, i.e. the drug companies.

That said, the drugs are dosed differently, and a number of studies suggest that dosing may have more importance than probably originally thought when these drugs first came on market. Of course this raises the question, why wouldn't a doctor simply prescribe more Pegasys (beyond the 180) for the obsese patient -- and no doubt some may be -- but that takes us beyond the world of SOC.

All the best,

-- Jim

[mikesimon]

I have spent an inordinate amount of time researching the relative effectiveness of Pegasys and Peg-Intron and I want to admit that I think you are correct. Peg-Intron has been shown to be a better approach for obese patients. I agree with you 100%. Mike

[jmjm530]

That was a general comment and not addressed to you at all. Thanks again for your input and study data. We are definitely on the same page.

-- Jim

[CockSparrow]

Jim - I wasn’t saying that you were pushing either Peg. Just that the studies support what you are saying in a roundabout way. Pegasys studies tend to state that SVR is higher when weighing less than 75 kgs and the PegIntron ones tend to say that weight basing tend to even SVR out to an extent.
BTW WBR seems to be more important with PegIntron than with Pegasys. The PegIntron short course studies produced better results than most of the Pegasys studies. Mangia only used 1mg/kg PegIntron and still got excellent results. The Pegasys ones tended to have lower relapse rates for G3s at least.
The Taiwanese Pegasys G2 study also produced excellent results but it used WBR with higher RBV levels than normal. 15.3 mg/kg/day is quite high, which would seem to indicat that pegasys could also benefit from WBR even if the Hadziyannis study thought otherwise.

FYI - G2/3 SOC of 24 Weeks and 800mg RBV was based solely on the Hadziyannis study. There were only 96 patients in the 24 week LD RBV arm. At the time there had been no 24 week PegIntron Studies. Zeuzems was the first and it used a mathematical model based on the Manns study to calculate 48 weeks SVR.

The Manns/Zeuzem and Hadziyannis studies are also an interesting read when comparing results as different factors influenced SVR. For Example Hadziyannis had a 13% relapse rate for G3 HVL Zeuzem had 23%.

For me they both have there place and I would hate to see the marketing campaign of one win the sales war.

Jim - To me, different doses of Peg for different people make sense under the umbrella of individualized dosing
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I totally agree and is one of the reasons why some meaningfull comparisons wouldnt go astray.
CS

[mikesimon]

I want to wish you good luck with your treatment. Mike

[FlGuy]

You wrote that you have very little liver damage - 0. Was that assessment form the results of a biopsy?  If it was a biopsy, you may have the luxury of time on your side.  With '0' damage you could consider waiting for newer drugs that will probably come available in the few years ahead.  If you did not have a biopsy, do you know on what the '0' liver damage was based?  And, that  48% vs. 28% svr rate of PegIntron vs. Pegasys doesn't sound right.