Switching from Pegasys to Pegintron after weak 4

[JamesJ2013]

Hello All,
Im 39 years, 87 kg, and 179cm. Being treated for the first time for Genotype 3. After weak 4 of Pegasys+800mg Riba, my HB went down to 10.2 from baseline 12.2, WBC to 3.3 from baseline 5.9 and platelets to 51 from baseline 124. My ALT however, came down within the normal range. My doctor switched me to 80 mcg Pegintron wirh same dose of Riba. Can someone please tell me if its OK for me (in terms of chances of achieving SVR) or advise something better?Thanks.

[JamesJ2013]

Hello again,
I got a second opinion today and the new doctor was surprised to hear about switching to low dose Pegintron. So he immediately put me back on pegasys and assured that the two low dose Pegintron shots that I already had, won't make any difference to the end result if I continue with Pegasys for rest of the treatment. And  he also said that 800 mg Riba was sufficient for me as I got UND at week 4. Thanks all for your help and support. Much satisfied now.

[can-do-man]

A second opinion is always a good ideal under these conditions. And yes breakthroughs do happen (virus will return during this low dose period) and something like this could cause it.... Now keep in mind this is not very a common thing to happen. Also remember just because one is UND does not mean they are now cured. That is why we see people relapse after treatment stops. As for the meds you are also on it would not be right for me to even comment on those. That would be something to bring up when you get a second opinion......... Hang in there.

[JamesJ2013]

Thanks Can-do-man,
Will have 2nd shot of Pegintron tomorrow (in total 6th) and blood tests on Friday. I hope my HB and platelets are raised. Will definitely talk to my doc and get a second opinion too. Is there any chance that the virus will return during this low dose period?
Secondly my doc is also giving me following meds:
Two tabs of Nuberol forte which consist of
Paracetamol BP:650mg+Orphenadrine Citrate:50mg twice a day
One capsule of Esomeprazole: 40 mg once a day before breakfast.
Are these usual meds/doses?

[can-do-man]

Congrats on your 4 week test, I would not be concerned about your Riba dose as it is standard and your 4 week results show it is doing it's job, my only concern would be to get the interferon bumped back up. Your results show you have a very good chance of becoming cured. I would insist to my doctor not to let you lose that advantage my keeping your dose of interferon so low.......... One would have to guess that your platelet level has rose. Please have him run another blood test to confirm this and ask him to let you increase your interferon level.......... Best to you.

[JamesJ2013]

Hello again,
My post 4-week PCR result  is good. Its <12 IU/ml. Thanks for your wishes. Please guide me for next course of action. As I already mentioned, my doc switched me from 180 mcg Pegasys to 80 mcg Pegintron with same dose of Riba i.e. 800 mg due to low HB and platlets. (I'm 39 years, 87 kg genotype 3). Thanks again.

[can-do-man]

The study authors searched medical literature databases for studies that compared short-term (12 to 16 weeks) vs standard 24 week treatment using pegylated interferon plus 800 mg/day fixed-dose ribavirin for genotype 2 or 3 patients who had achieved RVR. They identified 6 relevant studies -- including a total of 2434 participants -- that reported data on ETR, SVR, and relapse rates.

After achieving RVR, patients treated for a total of 24 weeks were significantly more likely to achieve SVR than those treated for 16 weeks (79% vs 70%; P = 0.008). Conversely, 24 week patients had a significantly lower relapse rate (9% vs 23%, respectively; P < 0.00001). Results did not change when people with genotype 2 vs 3, or those with high vs low baseline viral load, were analyzed separately.

[can-do-man]

If you are UND from your week 4 then I would not be concerned about your Riba dose. I would ask to go on full dose of interferon... If your not UND then extending treatment and upping your Riba to weight based and the interferon would be a must if you were to continue on treatment.

Procrit is the rescue drug here for one's HGB and that is when one's HGB drops below 10... Promacta is for platelets but even here in the states it is not used very often... Myself it seems your doctor jumped the gun on the interferon reduction as many of us that are cirrhotic have platelet counts in the 50's. Mine during treatment got as low as the upper 20's without a reduction and did increase on their own and I ended treatment back in the 50's........ Good luck on your 4 week PCR.

[JamesJ2013]

Hello All,
Someone please help me decide about the right dose and rescue drugs. Thanks

[JamesJ2013]

Thanks can-do-man.
My 4-week PCR result will come in a weeks time and I hope its UND. IMO my dosage should  be a tleast 0.5 ml of 100 mcg intron + 1000mg Riba when my blood counts improved. Please let me know if you differ from it. I don't know about any rescue drugs could you please suggest me some with their benefits so I can discuss that with my doc. Thanks for your support.

[can-do-man]

Your chances will depend a lot on your 4 week viral load, let's hope your UND. It looks as if he changed to Pegintron so he could lower your dose do to your low platelet count..... As for the Riba, while 800mg is standard dosage for type 3 It would also concern me being the weight you are. If you are not UND at week 4 you need to have a good talk to your doctor. Do they have the rescue drugs there?

Wishing you the best

[JamesJ2013]

Thanks for the response Dee. No he made it clear in the very beginning that he was going to put me Pegasys 180 ug and 800 mg Riba. Later he explained that he was changing it to Pegintron because of my low blood counts. But one thing I don't understand why he is giving me 800 mg Riba? I,m 87 kg. Shouldn't it be around 1000 or 1200 mg? And one more thing I wanted to ask: Should I increase the Pegintron dose when my blood counts are improved? Thanks again.

[Dee1956]

Hello,I would think your doctor would know the right way to treat you however Pegintron is weight based so the dose would go down

When I treated with Pegasys 180 and 1000 of riba.  That was right for me at the time though  I treated again and was put on Pegintron, it was 135 and riba 800mg

Is it possible he wanted you on Pegintron all along but there was a mixup with his staff?  I had that problem is the only reason I am asking.
The doc wanted me on Pegintron but his staff requested Pegasys.

I am sure others will be along to help you very soon. Hang in there
Dee