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

[PSP-n-Me]

Hi Ralph, I am Beth - Nice to meet you :)

I think it all depends on who the pharma salesperson is that calls your Doctor's office...Most Doctors that treat Hep C, that are not in a big Hospital, have to appoint a Nurse or a PA to deal with those on treatment - here in Ontario the Doctors request a partial payment for that PA from the Pharma's - or in some cases the Pharma's will pay the entire thing, providing the Doctor writes the script for treatment with their product only - In the Clininc I go to they use both, and advise the patient they can choose if they so desire...My Hep Nurse told me that the only "real" difference that she knows of between the two is - Pegasys stores fat in the liver - But, 2 weeks after treatment ends the fat goes away...She also said that her patients have said they felt less side effects from Pegasys (peginterferon alfa-2a) but that is not proven, that I know of anyway...

I use Pegasys becasue that is what my drug plan has on the approved drugs list.

Hope this helps - Beth

[FlGuy]

I've used both and have found that the sides with Pegasys are lesser.  But, like a lot of stuff realted to hcv there are no universal truths.  The meds can affect people differently.  Don't know about the organ damage.

[RALPH44]

Thank you I have not lchecked with my insurance I have crapy blue cross hmo thru the county used to have united they were great but commissioners picked this because they cheep. I have been with my gasto doctor for 7years because I ulcertive colitis so I think if I ask he will change. I heard pegintron 2b is hard on the heart kidneys lungs. I just dont want to get rid of one thing and damage something else cemo did that to my dad

I am so confused

[mikesimon]

I echo FLGuy's sentiments. I have taken both and Pegasys was much easier for me to tolerate. Mike

[RALPH44]

Are you still on treatment? If not which did you say with? I read that for geno 1a pegintron hasa 48% of remition and Pegasys is only 28 %


Shelly

[jmjm530]

How much do you weigh? Peg Intron is weight-based and therefore may give more bang for the buck if you're on the heavy side. Pegasys, on the other hand, is one dose fits all -- meaning more bang for the buck if you're on the lighter side. Both pegs have advocates among some very prominent doctors. If your weight is not an issue, I'd go with the Peg your medical team has the most experienced with. Also, if you're waiting for 2008 to start treating, keep an eye on the Telaprevir trial results by end of this year. If all goes as hoped, they study may produce double the SVR (cure) rates for genotype 1's in half the time. If so, and depending on the amount of liver damage you have, it may give pause to treat now with the current drugs as opposed to waiting for either a Telaprevir trial or when the drug hits the market hopefully in  a few years.

-- Jim

[FlGuy]

I'm on my second round, using Pegasys 2a this time.  But the reason for my relapse was not due to the interferon used the first time (PegIntron 2B).  Reason for relapse was more due to length of tx (24-too short) and amount of riba (fixed dose 800 - too little) given amount of liver involvement (too much).  At least that's what the docs think and I optimistically like to believe.  Few more weeks and we'll see if they are as smart as they think are and as smart as I hope they are.

[moahunter]

I have used both, although on Pegasys I was only on monotherapy. Even so, my experience matches that of others, which is that the side effects are much milder on Pegasys than PegIntron, especially at first.

Pegintron also has an annoying pen application system that, when it works well is good, but is often defective on mixing (I have changed to vial PegIntron due to getting fed up with the pen failing, it requires manual mixing, which is fine with me).

In saying that, PegIntron is working for me, so I am more than happy about it. I was undetectable at 4 weeks and am 24 weeks in now with an ALT of only 22. 24 weeks to go. Side effects are knocking me out energy wise, but I'd rather have a bum year and get rid of this 1A for good.

[RALPH44]

I thought  I posted my weight guess it  didnt show up I weigh about 128. Just had these base line done on my eyes saterday. I started getting this pain in my right side I havent had this since I had my gallbladder out 2 months ago I know it is my liver doctor said I might have that and gosh do my joints hurt I already have 4 buldging disc in my neck I just felt like cramp. What can you do about the side pain? are you all still able to work because I still have to be able to work every day I carry my insurance thru work?

Shelly

[Jesser]

I have been on both before and Pegasys was way easier on me than PegIntron.
It is your liver biopsy stage& grade that would hold treatment off until 2008 not
your viral load...what is your stage? and if your liver hurts that's probably
inflammation that would be your grade.  My physician told me (after I told him
"how much I liked the Pegasys better and thought it killed the virus better")
that he started with PegIntron because it clears from the system faster in
case of an emergency ex.like bleeding from low platelets. Dr. Bencil's website
Hepititis Doctor gives you a great comparison of the two. My own personal
experience was I'd take Pegasys anyday. Anti-inflammatory always check
with your doctor first.  I was able to work on Pegasys not PegIntron.
Jesser

[RALPH44]

Talked to my doctor today told him I would rather take the Pegasys because it has less side effects he said there are no studies about that told him I had asked real people who had tried both and they said so he said he is more familier with Peg intron and has a real good success rate and he does not know much about pegasys guess I am stuck

:( Shelly

[FlGuy]

Keep in mind that the pegs can effect people differently and many people use PegIntron without large issue.  In my prior comment, I pointed out that the sides for Pegasys seemed to be less than PegIntron.  That's not to say that PegIntron was not tolerable. It was tolerable for me, but not a lot of fun.  To the side a little bit, I have found that the confidence that you have in your doc (and other tx caregivers) is a very important aspect.  So, if you like the doc, have faith in him and trust that you will do well with him then throwing you lot with him might be a reasonable thing to do. Good luck.  as for being 'stuck', count on it - and you'll be doing the sticking with a half inch needle.

[sosad]

I have used both the sides were equally awful.  When I first treated 24 weeks I had heard the same that pegasys was easier. M y doctor wanted to treat with peg intron I  talked him into letting me use pegasys.  I relapsed within 12 week post tx.  I have just finished 48 wks of pegintron und from day13 through tx going for 12 wk pcr at the end of the month hope this time it will stay clear.

[mikesimon]

What is there to know or be familiar with vis a vis Pegasys or Peg-Intron? You inject the stuff at the prescribed dose and you see how it works. I cannot believe some of the stuff I hear that doctors say. The weight based differences that Jim always alludes to are unsubstantiated as far as I know. I would like to see a study on that issue Jim because I have not seen one. Really, when it gets right down to it all the talk about this hepatologist and that hepatologist might make someone feel better but if you can get a doctor who will give you a script for the treatment drugs and scripts for frequent PCR testing and Procrit and/or Neupogen if you need it what more is there to it? It's not rocket science. I took a test at Medscape on treatment of HCV after liver transplant without even reading the course material and got CME credits and I would bet a lot of people here who haven't been transplanted would have passed that test and received CME credits.  Most of the members here could oversee treatment and the outcome numbers would be the same and probably better than the average MD prescribing these drugs.  Mike

[FlGuy]

In reading your comments, I assume you were a relapsed geno 2 or 3? If that's the case, other than change of pegs and going from 24 to 48 weeks, did you do anything else different the second time?  Like change riba dose, other tx modifications?  I'm heading into week 43 of Part 2 and getting near the scary end.  Did you or your doc think the amount of liver damage (I'm early cirrhosis) was a contributing factor to relapse?

[beamishboy]

just wanted to send ya some goodluck my friend..hope all  works GREAT for you...Doing 48 as oposed to 24 weeks has got to kick them bugs butts..justa long row to hoe..FAREWELL

[rochammer]

Pegasus or Peg-Intron I did both Pegasus for 24 weeks & peg-Intron for 48. Pegasus was easier but I relapsed. I am also a geno 2. The thing I would look at more is the short course of tx for peg-intron vs Pegasus. 12 weeks for peg-intron and 16 for Pegasus. If for some reason you cannot complete the 24 weeks you may have a better shot with Peg-intron. Stuck with your doc if you like him.

It’s time for my one year PCR will see if I am still SVR.

Good luck

[jmjm530]

Mike: cannot believe some of the stuff I hear that doctors say. The weight based differences that Jim always alludes to are unsubstantiated as far as I know. I would like to see a study on that issue Jim because I have not seen one. Really, when it gets right down to it all the talk about this hepatologist and that hepatologist might make someone feel better but if you can get a doctor who will give you a script for the treatment drugs and scripts for frequent PCR testing and Procrit and/or Neupogen if you need it what more is there to it?
-------------------------------------------------------------
Tell you what, Mike. I'll stop talking about what my hepatologist says as soon as you stop quoting yours :)

But seriously, Peg Intron is one dose for all weights and Pegasys is weight-based. No one disputes that.

And there are also some studies that suggest that more Pegasys (double-dosing) produces better results. (See Clinical Options Site.)

I therefore think it's reasonable to speculate that if you're on the light side, you will get more bang for the buck from Pegasys and if you're on the heavy side, you might get more bang for the buck out of Peg Intron -- assuming that you are dosed based on SOC in each case which is how 99.9% of folks are dosed.

Where did I first hear this? From my hepatologist of course, who btw is in the same league as I assume yours is. I then heard it from others as well who heard it from their own doctors.

Are there studies on this? Of course not and you know that. Truth is that the vast majority of studies on the efficacy of these drugs are done/supported by Roache or Schearing and not surprisingly the results of their respective studies supports their own drug.

But again, there are enough studies to suggest that higher doses (Peg and/or riba) produce better results, assuming the patient can and will tolerate the higher doses. In fact, I believe it was Dr. A. from Boston, who made this very statement in a Q&A at a conference that someone recently posted here.

-- Jim

[FrontRangeMom]

Ralph I've used both.  Can't really compare because Pegasys was with Riba, PEG-Intron was without.  I think if you read the package inserts for both you'll find that the safety profiles and adverse events are about the same.  You can get the PI's from the drug company's websites. Some may have the same or different experiences and there is probably no way to predict in advance how you'll react to either.
"Mom"

[zazza]

That talk about weight based dosing, I don't get that either. Pegasys is one dose for all 180 mcg. PegIntron is weight based, maximum dose 150 mcg. So for a lighter person to get Pegasys would be a benefit, but for a heavier person to get PegIntron would still mean he would only get at the most 150 mcg compared to 180 mcg Pegasys.

[jmjm530]

Zazza: PegIntron is weight based, maximum dose 150 mcg. So for a lighter person to get Pegasys would be a benefit
------------------------------------------------------
That was my point. Pegasys would benefit a lighter person and that was the point my hepatologist made to me when I was trying to decide, although at 175 lbs, I was pretty much borderline.

Zazza: but for a heavier person to get PegIntron would still mean he would only get at the most 150 mcg compared to 180 mcg Pegasys.

I don't believe you can compare mcg's of Peg Intron to Pegasys. Different molecules. But the fact that Peg Intron is weight-based seems to suggest that the manufacturer feels that a higher dose of that drug is needed for heavier people.

[mikesimon]

I have quoted my transplant surgeon and I know you don't have one of those but never my hepatologist. I wasn't referring even obliquely to you when I said that about hepatologists - I wasn't even thinking about you. I don't really know who treated you but now that I think about it I would guess Dr. Deitrich but I wouldn't bet money on it. My point was that it doesn't take a world renown hepatologist to oversee treatment.
Mike

[CockSparrow]

Jim - Are there studies on this? Of course not and you know that.
----------------------------------------------------------------------------------------------
There kinda is. All the short course Pegasys studies prodiced higher SVR rates if you weighed less than 75 kgs (165 lbs). There was a Taiwanese G2 study that used WBR and Pegasys for 16 weeks that produced way higher SVR rates than Accelerate. Their assessment of the difference between the two studies was "In the ACCELERATE Trial, the mean body weight of patients with HCV2 was around 84 kg (165lbs), with a mean ribavirin dose of 9.52 mg/kg/day for a daily dose of 800 mg, in contrast to 15.3 mg/kg/day in our study. The difference may explain the conflict in the results between the ACCELERATE Trial and this study."

Using the Manns study for PegIntron stated that the weight based Tx evened out the SVR rates.

Jim - Truth is that the vast majority of studies on the efficacy of these drugs are done/supported by Roache or Schearing and not surprisingly the results of their respective studies supports their own drug.
---------------------------------------------------------------------------------------------------------------------------------------------
This is so true. Some meaniful comparisons wouldnt go astray.
Neither is necessarily better but they are different.

When all said and done though some people respond better with Pegasys others with PegIntron.
CS

[jmjm530]

Thanks for the input. BTW I wasn't pushing either Peg -- for fat or thin people even -- just relating some impressions I've received. After speaking to at least a half-dozen top hepatologists over the years on Peg Intron Vs Pegasys, the one thing I found in common that all had a bias one way or the other, although on further questioning they would admit that the study data was mixed. To me, different doses of Peg for different people make sense under the umbrella of individualized dosing. We're already seeing this with double-dosing or once-every-five-day dosing studies.

-- Jim