Aa
Riba reduced - hmg hitting 9
Had a bout of diahrrea for a week then went to see my Doc. Weight went down to 106lbs at 5''7". I am weak and nasty. I called the doctor because the flipping and flopping in bed was driving me crazy at night. The Doc told me he had been trying to reach me for a week because my blood results showed my hmg was close to 9 and he wants me to take only 3 riba a day instead of my usual 5. Didn't change the albumininterferon of 900. He also suggested Tylenol/PM to fall asleep. He wants me to come in for blood only the day after Thanksgiving.
I feel like this was a major set back for me. I dislike the idea of reducing my meds. I was undetectible at week 12 and thought I was on my way. Now at week 17, everything has changed. My question is - How should I feel about this?
I feel like this was a major set back for me. I dislike the idea of reducing my meds. I was undetectible at week 12 and thought I was on my way. Now at week 17, everything has changed. My question is - How should I feel about this?
106 lbs equals 48 kg. That is 20.75 mg ribavirin per kilo if you take 1000 mg a day; 16.6 mg per kilo with 800 mg riba; 12.45 mg per kilo with 600 mg riba.
For geno 1's a dose of 13-15 mg per kilo is often recommended. So it seems to me you can safely reduce your riba with one pill a day down to 800 mg, perhaps even with 2 pills down to 600 mg.
Normal dose below 65 kg (143 lbs) is 800 mg, so you seem to have been heavily dosed from start. Any special reason for that?
For geno 1's a dose of 13-15 mg per kilo is often recommended. So it seems to me you can safely reduce your riba with one pill a day down to 800 mg, perhaps even with 2 pills down to 600 mg.
Normal dose below 65 kg (143 lbs) is 800 mg, so you seem to have been heavily dosed from start. Any special reason for that?
With Copegus you get 1000 mg riba up to 75 kg, so if that is the brand of riba you are taking, that would explain your dose. Copegus and Rebetol are just different brand names of the same drug though, so I figure you can safely follow the more detailed weight based dosing of Rebetol, which is as stated above 800 mg riba below 65 kg.
I guess a lot of docs, including the one at our clinic are dosing everyone with RIBA at top dose regardless.
It makes no sense to me, a little 106 lb woman is double saturated compared to a 230 lb hulk....but they are dosed the same.
2 possible reasons, one is, effectiveness in study results seems to indicate heavy dosage gives best results acroos the board. second is they may be trying to cover themselves legally. Like say someone doesn't go UND on 800......then who gets blamed for resistence? Not that they'll ever admit that, but I think they would rather HAVE to cut someback because od sides, than to start out lower and then get blamed for treatment at too low a dosage. the INF I'm assuming was weight based all along.
the procrit epo we were told are expensive and insurances don't like to cover them, therefore they are never offered up front, you have to tank, suffer, wait, get approval, suffer, wait some more.
since cost and insurance companies were the main reason given, that's not likely to change anytime soon.
I think smaller women should get blood drawn more often, since small frame means less marrow to make new blood, they are at greater risk.
It makes no sense to me, a little 106 lb woman is double saturated compared to a 230 lb hulk....but they are dosed the same.
2 possible reasons, one is, effectiveness in study results seems to indicate heavy dosage gives best results acroos the board. second is they may be trying to cover themselves legally. Like say someone doesn't go UND on 800......then who gets blamed for resistence? Not that they'll ever admit that, but I think they would rather HAVE to cut someback because od sides, than to start out lower and then get blamed for treatment at too low a dosage. the INF I'm assuming was weight based all along.
the procrit epo we were told are expensive and insurances don't like to cover them, therefore they are never offered up front, you have to tank, suffer, wait, get approval, suffer, wait some more.
since cost and insurance companies were the main reason given, that's not likely to change anytime soon.
I think smaller women should get blood drawn more often, since small frame means less marrow to make new blood, they are at greater risk.
Just munched my entire post. Grr.... My laptop is broken on account of I fell asleep with it a few nights ago (nothing unusual there) but it fell and landed on its spine and is now kerput. So I'm dealing with this flatscreen keyboard mouse in the bed kinda situation, (cpu on the floor) and its not super stable, lol
Plus I have another raging effing migraine, my second of the week, I've already been to the ER for one once this week, and I took the two shots, the epogen and pegasys, and lo the bone pain, and ok. Enough griping.
Anyway, I agree, people who are smaller or just who may start out a little lower on hgb, 12 or so, need to be watched carefully. I was unprepared for the viciousness with which the riba caused hemolysis in my case. Sure I was prepared intellectually, but despite the best efforts of folks like Jim and DebNevada to get me to really understand how it might pan out, you sometimes don't really "get it" until it's you in the ER begging them to just please do the transfusion there instead of hospitalizing you, and Oh PLEASE GOD don't take me off my meds, I promise I'll be good, and take lots of procrit and bring my blood count up...
All of that said, there is, unfortunately, very good evidence that good SVR comes from good riba in many cases. So I do understand why its pushed so. I harken back to the study we all know and love....
http://www.hivandhepatitis.com/hep_c/news/2007/082407_a.html
Use of Epoetin (EPO) to Manage Anemia in Chronic Hepatitis C Patients Treated with Pegylated Interferon plus Ribavirin
Successful treatment of chronic hepatitis C with pegylated interferon plus ribavirin is often limited by anemia. An adequate amount of ribavirin reduces the risk of post-treatment HCV relapse, but the incidence of anemia rises with higher ribavirin doses.
As reported in the August 2007 issue of Hepatology, researchers conducted a study to determine whether using erythropoietin, or epoetin alpha (EPO), with or without a higher dose of ribavirin, could enhance sustained virological response (SVR) rates.
They randomized 150 treatment-naive patients (36% African-American) with chronic genotype 1 hepatitis C into 3 treatment groups:
• Group 1: pegylated interferon alpha-2b (PegIntron) 1.5 mcg/kg/week + weight-based ribavirin 13.3 mg/kg/day (800-1400 mg/day);
• Group 2: pegylated interferon + weight-based ribavirin + EPO (40,000 U/week);
• Group 3: pegylated interferon + high-dose weight-based ribavirin (15.2 mg/kg/day; 1000-1600 mg/day) + EPO (40,000 U/week).
In groups 2 and 3, EPO was started at the onset of therapy in order to maintain hemoglobin levels between 12 and 15 g/dL. When required, the ribavirin dose was reduced by 200-mg steps.
Results
• A significantly smaller percentage of patients in Group 2 compared with Group 1 had a decline in hemoglobin to less than 10 g/dL (9% vs 34%; P < 0.05).
• Fewer patients in Group 2 required ribavirin dose reduction (10% vs 40%) compared with Group 1 patients (P < 0.05).
• Despite this, SVR rates were not significantly different in Group 1 and Group 2 (19% vs 29%).
• However, the SVR rate was significantly greater (49%) in Group 3 (P < 0.05).
• This resulted from a significantly lower HCV relapse rate: 8% in Group 3 vs 38% in Groups 1 and 2 (P < 0.05).
Conclusion
"We conclude that using EPO in all subjects at the initiation of pegylated interferon and ribavirin treatment will not enhance SVR given the same starting dose of ribavirin," the researchers stated. "In contrast, a higher starting dose of ribavirin was associated with a lower relapse rate and higher rate of SVR."
08/24/07
Reference
ML Shiffman, J Salvatore, S Hubbard, and others. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology 46(2): 371-379. August 2007.
Plus I have another raging effing migraine, my second of the week, I've already been to the ER for one once this week, and I took the two shots, the epogen and pegasys, and lo the bone pain, and ok. Enough griping.
Anyway, I agree, people who are smaller or just who may start out a little lower on hgb, 12 or so, need to be watched carefully. I was unprepared for the viciousness with which the riba caused hemolysis in my case. Sure I was prepared intellectually, but despite the best efforts of folks like Jim and DebNevada to get me to really understand how it might pan out, you sometimes don't really "get it" until it's you in the ER begging them to just please do the transfusion there instead of hospitalizing you, and Oh PLEASE GOD don't take me off my meds, I promise I'll be good, and take lots of procrit and bring my blood count up...
All of that said, there is, unfortunately, very good evidence that good SVR comes from good riba in many cases. So I do understand why its pushed so. I harken back to the study we all know and love....
http://www.hivandhepatitis.com/hep_c/news/2007/082407_a.html
Use of Epoetin (EPO) to Manage Anemia in Chronic Hepatitis C Patients Treated with Pegylated Interferon plus Ribavirin
Successful treatment of chronic hepatitis C with pegylated interferon plus ribavirin is often limited by anemia. An adequate amount of ribavirin reduces the risk of post-treatment HCV relapse, but the incidence of anemia rises with higher ribavirin doses.
As reported in the August 2007 issue of Hepatology, researchers conducted a study to determine whether using erythropoietin, or epoetin alpha (EPO), with or without a higher dose of ribavirin, could enhance sustained virological response (SVR) rates.
They randomized 150 treatment-naive patients (36% African-American) with chronic genotype 1 hepatitis C into 3 treatment groups:
• Group 1: pegylated interferon alpha-2b (PegIntron) 1.5 mcg/kg/week + weight-based ribavirin 13.3 mg/kg/day (800-1400 mg/day);
• Group 2: pegylated interferon + weight-based ribavirin + EPO (40,000 U/week);
• Group 3: pegylated interferon + high-dose weight-based ribavirin (15.2 mg/kg/day; 1000-1600 mg/day) + EPO (40,000 U/week).
In groups 2 and 3, EPO was started at the onset of therapy in order to maintain hemoglobin levels between 12 and 15 g/dL. When required, the ribavirin dose was reduced by 200-mg steps.
Results
• A significantly smaller percentage of patients in Group 2 compared with Group 1 had a decline in hemoglobin to less than 10 g/dL (9% vs 34%; P < 0.05).
• Fewer patients in Group 2 required ribavirin dose reduction (10% vs 40%) compared with Group 1 patients (P < 0.05).
• Despite this, SVR rates were not significantly different in Group 1 and Group 2 (19% vs 29%).
• However, the SVR rate was significantly greater (49%) in Group 3 (P < 0.05).
• This resulted from a significantly lower HCV relapse rate: 8% in Group 3 vs 38% in Groups 1 and 2 (P < 0.05).
Conclusion
"We conclude that using EPO in all subjects at the initiation of pegylated interferon and ribavirin treatment will not enhance SVR given the same starting dose of ribavirin," the researchers stated. "In contrast, a higher starting dose of ribavirin was associated with a lower relapse rate and higher rate of SVR."
08/24/07
Reference
ML Shiffman, J Salvatore, S Hubbard, and others. Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology 46(2): 371-379. August 2007.
yeah, the tylenol PM, pretty freaking funny huh...like if we minimilize what this tx is you'll somehow not get sides.....rolleyes.
alagrl- I get the high dosing...I just gon't get that they don't monitor more closely at first, esp. when other mitigators are present.
Maybe it's the squeaky wheel and you're it....maybe it's you have someone attentive and not innudated with thousands of cases....but for the most part Epo is not forthcoming in a timely manner.
I disagree with the monthly monitoring too...let alone that one guy who went 12 wks. Even if there is slight blood loss, bi-monthly should be minimal, just my opinion.
It's hard to say for certain who's blood will step up to the plate really, given we have been fighting a virus for umpteen years the whole system is basically very worn before most are diagnosed.
I'm on HGH, as you know, because my chicken came before my egg....so my blood so far has held...but that's not a possibility for most to get on,
I think if I were you Lizzbo I'd park myself in your docs office and not leave until I got procrit AND upped the riba AND got a referral to a real liver doctor.
either that or go get a second, and tell them it's an emergency and your current doctor is refusing to treat, chances are they'll get you in that way.
what is his reason for denying you a recue drug.......have you thought of asking him if that is legal?
I would call records, and get all his notes and your labs to date, so you can go to him armed...or to my cousin Vinnie...:))))))))))))
alagrl- I get the high dosing...I just gon't get that they don't monitor more closely at first, esp. when other mitigators are present.
Maybe it's the squeaky wheel and you're it....maybe it's you have someone attentive and not innudated with thousands of cases....but for the most part Epo is not forthcoming in a timely manner.
I disagree with the monthly monitoring too...let alone that one guy who went 12 wks. Even if there is slight blood loss, bi-monthly should be minimal, just my opinion.
It's hard to say for certain who's blood will step up to the plate really, given we have been fighting a virus for umpteen years the whole system is basically very worn before most are diagnosed.
I'm on HGH, as you know, because my chicken came before my egg....so my blood so far has held...but that's not a possibility for most to get on,
I think if I were you Lizzbo I'd park myself in your docs office and not leave until I got procrit AND upped the riba AND got a referral to a real liver doctor.
either that or go get a second, and tell them it's an emergency and your current doctor is refusing to treat, chances are they'll get you in that way.
what is his reason for denying you a recue drug.......have you thought of asking him if that is legal?
I would call records, and get all his notes and your labs to date, so you can go to him armed...or to my cousin Vinnie...:))))))))))))
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