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1986676 tn?1329866071

Pegasus Reduction

What do you guys know about reduction of Pegasus during treatment.
Does it impact SVR rates?
My doctor plans to reduce because of  my very low neutrophil count.

Reva
13 Responses
163305 tn?1333672171
Treatment is a crap shoot.
There's a chance of reduction affecting your clearing the virus.
On the other hand we had a member who's pegasys was reduced from week 2 by half, and he still was und at week 4.

Why does your doctor want to reduce your dosage and how far along on tx are you?

1995824 tn?1330382649
Can only speak from experience....to a degree. My Pegasys was lowered from 180 to 135 mg, in part due to the rash debacle. It has been lowered for three weeks now. I have six weeks of treatment left. The doctor is going to increase the dose back to 180 this week and see how I react. Although my rash was largely a severe reaction to the Incivek, he wanted to give my body a chance to clear the majority of the rash.  We could not rule out the role that the ribavirin and the interferon may have played in my allergic reaction to treatment.
As a side note, the rash is not entirely resolved. The place on my right arm that we suspected might be an injection site reaction, continues to grow in size - every time I  have a shot, although i am taking those in the belly now. From the size of a quarter, it is now the size of a Krispy Kreme donut, red, raised a bit, hot to the touch, itchy, and scaly. I'm off to see the dermatologist again tomorrow.
1748829 tn?1338040641
I've been worried about the same thing I was told last week if my wbc and neutrophil count didn't come up or went down further they would pull my shot all together, no reduction no rescue drugs offered. I wish there was a straight forward answer I don't have one, and unless I missed it no one else does either I think for me though I don't want to stop any of the Meds until I am sure I'm svr. Maybe someone else will comment and give us advise.
446474 tn?1446351282
"The absolute neutrophil count (ANC) is the measure of the number of infection-fighting white blood cells in your blood.

What does it mean to have a low ANC or an ANC lower than 500?

The normal neutrophil count is 2,500-6,000.  When you have 1,000 or fewer neutrophils, your risk of infection is increased. When  your ANC is lower than 500, you are at risk for getting a serious infection. This condition
is called “neutropenia.”  If you are neutropenic and develop a fever or signs of infection, contact your doctor immediately.You may be given antibiotics to fight the infection."

Here is the standard protocol. Individual doctors may modify it according to their own experience.
----------------------------------------------------------------------------------------------------
PEGASYS
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to use PEGASYS safely and effectively.

http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103964s5204lbl.pdf

Adult Patients

When dose modification of PEGASYS is required for adverse reactions (clinical and/or laboratory), initial dose  reduction to 135 mcg (which is 0.75 mL for the vials or adjustment to the corresponding graduation mark for
the prefilled syringes) is recommended. Dose modification to 135 mcg per week can also be achieved by using  a 135 mcg/0.5 mL strength disposable autoinjector. Dose reduction to 90 mcg (which is 0.5 mL for the vials or  adjustment to the corresponding graduation mark for the prefilled syringes) may be needed if the adverse  reaction persists or recurs. Following improvement of the adverse reaction, re-escalation of the dose may be considered.

PEGASYS Hematological Dose Modification Guidelines

ANC <750 cells/mm   Reduce to 135 mcg

ANC <500 cells/mm   Discontinue treatment until ANC values return to more than 1000 cells/mm. Reinstitute at 90 mcg and monitor ANC.
------------------------------------------------------------------------------------------------------
Does it impact SVR rates?
I would think it depends on a number of factors...if triple therapy, when and how long and how much it is reduced. Other may have better info on this.

Hector
1669790 tn?1333666195
Hi Riva,
I don't recall reading any studies related to the reduction of interferon and SVR rates.  As Hector mentioned it above, it would also depend on many factors.  Also, what week of tx are you in and what week did you have your first und?  And how low is your ANC currently?

Is neupogen an option to bring up the ANC?  My ANC dropped at week 8 of tx (Inf/Riba) and stayed down throughout 48 week tx.  My doc didn't want to dose reduce, so went with 2x per week neupogen, then once per week the final few months.  My ANC was consistantly low (<300) and would quickly rebound after the neup.  It allowed my to go through tx without any reductions.   Would it have been better to dose reduce rather than use a rescue drug???  As OH said, it's a bit of a crapshoot.
1986676 tn?1329866071
I think I need to talk to the doctor before the Pegasys reduction.
I know my Neutrophil count was extremely low. I was taking Neupogen
and it was working. However, my neut count dips as soon as I take the next Pegasys Injection.

At first I was sent pre-filled syringes, then they started sending vials with dull "horse" needles. For all I know I may have given slightly less than what I should have been taking. In the past my low Neutrophil count has been
controled with Neupogen. I was taking only 1/2 doses because a whole
dose makes my neuts. sky rocket and my heart race.

My concern is my VL was less than 43 at 1 1/2 weeks and remained the same at 4 weeks. They are suggesting a reduction even before I'm technically undetected. I not sure but with all the added patients I think the doctor is being a lot more conservative this time around. My original VL
was 3,000,000 so it came down real fast. (in less than 2 weeks)
This is the second time treatinf gor me. Use Neupogen before, but had to end at 12 weeks. My Neutrophil count is low even when not on treatment.

I think the nurse has far too many patients now and I think my care has
become a little loose. I'm going down to the office and ask to speak with the
doctor before changing the Pegasys dose

Reva.





Reva











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