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Pegintron vs. Pegasys
Mike I know I sent this to you in a message (my mistake) I wanted it to post so I am resending it to get some additional help from people
I read your post from Feb 7th regarding no difference between Pegintron vs Pegasys saying that both meds can cause Zero viral load, but people that were on pegintron usually had worse side effects and ended up stopping treatment after 12 weeks due to safety reasons. In 2005 I was on Pegintron and had to go off after 12 weeks because my Platelets dropped to 25000 from the 87000 that I had when I started. However my viral load dropped in the 12 weeks from 590,000 to 289 almost undetectable. But as I said I had to go off treatment due to Platelets. In Sept 2007 I was admitted to the hospital with Varcies and bandings and have been back to the hospital every month since and had one, two or three, bandings everytime. I started my new Hep C treatment on Nov 24th using Pegasys. My viral load count in the hospital in Sept was 362,000. But by the time I started treatment in Nov it was 167,000 so we had a significant drop after my stay in the hospital. This could have been because of the 8 units od whole boold I recieved as well as the Platelet transfusions but I don't know. The point is that when I started my treatment on Nov 24th I have had very little side effects or illness with the Pegasys. After 5 weeks of treatment my Viral load had dropped to 83,000 and then at 12 weeks it only dropped to 39,900 so I am not even close to a 2 log drop even if we use the lower numbers from November before I started treatment. My Dr wants to continue treatment for three more months to see if we can get to a Zero Viral load and then hopefully continue treatment for 72 weeks instead of the normal 48 weeks. My thoughts are (and this is my question) I think I should go back on the Pegintron because I became almost undetcatable last time even though it was more dangerous. I would even think it might not be a bad idea to switch back and forth if my Platelets get low, once I am undectable. I dont know what to do but I was wondering what you and Jim might think about this. Thanks for your help.
I read your post from Feb 7th regarding no difference between Pegintron vs Pegasys saying that both meds can cause Zero viral load, but people that were on pegintron usually had worse side effects and ended up stopping treatment after 12 weeks due to safety reasons. In 2005 I was on Pegintron and had to go off after 12 weeks because my Platelets dropped to 25000 from the 87000 that I had when I started. However my viral load dropped in the 12 weeks from 590,000 to 289 almost undetectable. But as I said I had to go off treatment due to Platelets. In Sept 2007 I was admitted to the hospital with Varcies and bandings and have been back to the hospital every month since and had one, two or three, bandings everytime. I started my new Hep C treatment on Nov 24th using Pegasys. My viral load count in the hospital in Sept was 362,000. But by the time I started treatment in Nov it was 167,000 so we had a significant drop after my stay in the hospital. This could have been because of the 8 units od whole boold I recieved as well as the Platelet transfusions but I don't know. The point is that when I started my treatment on Nov 24th I have had very little side effects or illness with the Pegasys. After 5 weeks of treatment my Viral load had dropped to 83,000 and then at 12 weeks it only dropped to 39,900 so I am not even close to a 2 log drop even if we use the lower numbers from November before I started treatment. My Dr wants to continue treatment for three more months to see if we can get to a Zero Viral load and then hopefully continue treatment for 72 weeks instead of the normal 48 weeks. My thoughts are (and this is my question) I think I should go back on the Pegintron because I became almost undetcatable last time even though it was more dangerous. I would even think it might not be a bad idea to switch back and forth if my Platelets get low, once I am undectable. I dont know what to do but I was wondering what you and Jim might think about this. Thanks for your help.
I replied to your message so it's in you inbox. In short, I suggested asking about an increase in Pegasys dose. I question whether a change in interferon would yield better results if the dose of Peg-Intron was a standard dose. You platelet count would be taxed further with a Peg increase so you would need to be monitored weekly for platelet count, prothrombin time, CBCs and viral load. Basically, you're in a tough place and there are no easy answers. If you weren't having the issues that you are having this would be one of those times when I would suggest waiting for newer drugs. But, I don't know whether you have the time to wait. I went into more detail in my personal message but this basically sums up what I wrote to you. Mike
I thought I should paste my message to you here so members could see what I wrote and correct any mistakes or add their own perspectives and opinions.
I question whether the 2 types of interferon affect platelet count significantly differently, if at all. I found the sides a lot easier with Pegasys but my platelet count dropped equally with both drugs - Peg-Intron and Pegasys. I was in the low 20,000s while on Pegasys but I was allowed to continue. As a matter of fact, my transplant team never mentioned my platelet count as a concern. I suspect that has a lot to do with 1) liver transplants often have suppressed bone marrow so they see this stuff more often than general hepatologists and 2) although my platelet count was low I think that my clotting time wasn't dangerously slow but this is pure speculation on my part. I seem to recall that I was tested for prothrombin time and perhaps the results were assumed tolerable. Again, this is pure speculation but it's the only thing that makes sense to me.
My understanding is that both Pegs reduce viral load similarly once you get passed a week or so - this has to do with the phamakinetics of the two drugs and frankly, I do not recall clearly the time frame. I think that Peg-Intron might work a little faster right out of the gate but overall I think that both drugs work equally well. I'm sure you know by now that there are no hard and fast rules with treatment so it's possible that a switch might be beneficial but I haven't seen any evidence that would incline me to believe that it would.
You are in a class of hard to treat patients. Obviously cirrhosis is at play and that makes successful treatment very difficult and the odds of success go down significantly. Keeping in mind your previous problem with platelet count (you didn't mention your platelet count during this round), I wonder whether your doctor has discussed increasing your Pegasys dose. Since you ARE responding, albeit too slowly, perhaps an increase in your Peg would accelerate your viral decline to the point where you have a shot at SVR. At the rate you are responding it seems very unlikely that you will be successful with your present drug dosing. My guess, and that's all that it is, is that a switch in Peg without an increase in your dose would not yield the type of results that would justify continuing treatment. You may become undetectable by week 24 with your current regimen or with a switch to Peg-Intron at a comparable dose but I think that either drug at standard dosing will not be enough. And, I don't know that an increase would get you where you want to be or whether your platelet count would drop so much that your doctor would discontinue your treatment. You are in a very tough place Easy but you already know that quite well. If I were you I would at least ask about increasing Pegasys from 180 mcg to 360 mcg weekly and getting weekly labs to monitor your platelet count, prothrombin time, CBC and viral load. That way you'll see whether this approach garners better results and whether you can tolerate that dosage. At the point where you are it's probably more art than it is science. I wish you good luck and I apologize if I have not been more encouraging. I really don't know that you have a choice about this. You need to do something about the virus if at all possible.
Mike
I question whether the 2 types of interferon affect platelet count significantly differently, if at all. I found the sides a lot easier with Pegasys but my platelet count dropped equally with both drugs - Peg-Intron and Pegasys. I was in the low 20,000s while on Pegasys but I was allowed to continue. As a matter of fact, my transplant team never mentioned my platelet count as a concern. I suspect that has a lot to do with 1) liver transplants often have suppressed bone marrow so they see this stuff more often than general hepatologists and 2) although my platelet count was low I think that my clotting time wasn't dangerously slow but this is pure speculation on my part. I seem to recall that I was tested for prothrombin time and perhaps the results were assumed tolerable. Again, this is pure speculation but it's the only thing that makes sense to me.
My understanding is that both Pegs reduce viral load similarly once you get passed a week or so - this has to do with the phamakinetics of the two drugs and frankly, I do not recall clearly the time frame. I think that Peg-Intron might work a little faster right out of the gate but overall I think that both drugs work equally well. I'm sure you know by now that there are no hard and fast rules with treatment so it's possible that a switch might be beneficial but I haven't seen any evidence that would incline me to believe that it would.
You are in a class of hard to treat patients. Obviously cirrhosis is at play and that makes successful treatment very difficult and the odds of success go down significantly. Keeping in mind your previous problem with platelet count (you didn't mention your platelet count during this round), I wonder whether your doctor has discussed increasing your Pegasys dose. Since you ARE responding, albeit too slowly, perhaps an increase in your Peg would accelerate your viral decline to the point where you have a shot at SVR. At the rate you are responding it seems very unlikely that you will be successful with your present drug dosing. My guess, and that's all that it is, is that a switch in Peg without an increase in your dose would not yield the type of results that would justify continuing treatment. You may become undetectable by week 24 with your current regimen or with a switch to Peg-Intron at a comparable dose but I think that either drug at standard dosing will not be enough. And, I don't know that an increase would get you where you want to be or whether your platelet count would drop so much that your doctor would discontinue your treatment. You are in a very tough place Easy but you already know that quite well. If I were you I would at least ask about increasing Pegasys from 180 mcg to 360 mcg weekly and getting weekly labs to monitor your platelet count, prothrombin time, CBC and viral load. That way you'll see whether this approach garners better results and whether you can tolerate that dosage. At the point where you are it's probably more art than it is science. I wish you good luck and I apologize if I have not been more encouraging. I really don't know that you have a choice about this. You need to do something about the virus if at all possible.
Mike
Sorry things aren't going as hoped.
Pretty much agree with Mike. On one hand, your chances are not very good even with 72 weeks, given you were still detectible at week 12 which makes you a non-responder. On the other, you are stage 4, so all reasonable cards have to be on the table.
So, double-dosing is one such card, but also is switching Pegs -- perhaps to Infergen, as opposed to Peg Intron. Remember, you were still detectible with Peg Intron at week 12 last time Another card is taking a look at your ribavirn/hemoglobin situation to make sure you're on a maximum, but reasonable dose for your body weight and hemoglobin response. Perhaps with the help of Procrit (epo).
If feasible, the first card I'd play is to get one or more consults from some leading hepatologists, or perhaps you're already seeing one, I don't know.
A really good hepatologist can take a good, hard look at your charts, biopsy reports, etc., and hopefully point you in right directions, one of which may be to stop and wait. But like Mike says, you may not have time to wait and hopefully the doctors will help here.
If you want to go this route, you might want to mention what part of the country you're in and maybe someone will come up with some names. I'm a big believer in more than one professional opinion when things are unclear at important treatment junctures.
All the best,
-- Jim
Pretty much agree with Mike. On one hand, your chances are not very good even with 72 weeks, given you were still detectible at week 12 which makes you a non-responder. On the other, you are stage 4, so all reasonable cards have to be on the table.
So, double-dosing is one such card, but also is switching Pegs -- perhaps to Infergen, as opposed to Peg Intron. Remember, you were still detectible with Peg Intron at week 12 last time Another card is taking a look at your ribavirn/hemoglobin situation to make sure you're on a maximum, but reasonable dose for your body weight and hemoglobin response. Perhaps with the help of Procrit (epo).
If feasible, the first card I'd play is to get one or more consults from some leading hepatologists, or perhaps you're already seeing one, I don't know.
A really good hepatologist can take a good, hard look at your charts, biopsy reports, etc., and hopefully point you in right directions, one of which may be to stop and wait. But like Mike says, you may not have time to wait and hopefully the doctors will help here.
If you want to go this route, you might want to mention what part of the country you're in and maybe someone will come up with some names. I'm a big believer in more than one professional opinion when things are unclear at important treatment junctures.
All the best,
-- Jim
Another thought is adding Alinia to the mix, although frankly I'm really not as up on the trial results as some here. Personally, if I did add Alinia, I wouldn't let it change my tx decision making process, but I'd just add it because hopefully it would have a chance of doing some good without doing any harm. I say this because I sense some people are using Alinia as some kind of magic bullet and nothing I've seen warrants this kind of thinking. So in a hypothetical -- if your medical team told you to stop treating, I wouldn't continue treating just because you add Alinia and count on it to do the heavy lifting. On the other hand, if you're going to treat anyway, Alinia is another card to put on the table.
-- Jim
-- Jim
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