What are the facts regarding the lowering of Ribovarin with anemia during Invivek treatment.

[yodennis]

I'm going from 1200 per day to 800 (as well adding Procrit secondary to a progressive anemia over my 7 weeks of triple therapy (undetectable at 4, previous partial responder, cirrhosis) where I have gone from a hgb of 13.4 to just below 9 with a drop each week. Are there any factual resources regarding an anemia responsive Ribo dose reduction and SVR rates? Thank you. d

[Tippyclubb]

I was in a triple therapy trial ( Telaprevir ) almost three years ago.  Like you  my hgb tanked in the ninth week and had to do a riba reduction.  I was on tx for 6 months and I was dose reduced for almost half of it, 11 weeks.  I was reduced from 1000 to 600 for 6 weeks and 800 for 5 weeks.  It took six weeks for my hgb to get back above 10.  I was in a trial that did not allow the use of Procrit so I had to reduce.

Yes, I was very worried about SVR, but 2 1/2 years later and I am SVR.  

Good luck to you and hopefully you can tx for 6 months and be done.

[yodennis]

   Are you reading that Procrit is a hindrance to SVR or did you mean to say Procrit is less effective at mitigating anemia than Riba dose reduction?....... I am referring to your sentence: "I have looked at their charts that show a higher rate of SVR with dose reductions than those with procrit use." d

[frijole]

I have read two different articles from clinical care options that express dose reduction as an acceptable way to reduce anemia.  I have looked at their charts that show a higher rate of SVR with dose reductions than those with procrit use.  However I just can't wrap myself around this.  I don't think any doctor would be able to convince me that it won't matter.  

frijole

[crossroadsec]

I watch the anemia threads like a hawk. I'm cirrhotic and anemic. I took my dose reduction in RIBA n peg. Still had 12 week UND. Lol. 33 weeks to go.. Keep ur chin up. Karen

[yodennis]

Indeed your observation is wise and grounded in reality relative to SVR but what can I do in this immediate catch 22 moment. While I am a modestly competent researcher and advocator for the best outcome I am so drained that I am forced to take the hepatologists advice relative to the Ribo reduction from 1200 to 800. At least until I see my absolute trajectory of reduced hgb weekly stabilize and increase a little. I get me labs emailed to me weekly after which I research and advocate. When and if the Procrit and/or reduced Ribo mitigates the anemia I will minimally go to 600 and 400 daily then hopefully back to 1200. My doc ordered the 400 twice a day reduction in 200 mg tabs so I could increase the dose easily contingent on my hgb. I wish I could get the Procrit before monday: This and 3 yo twins, a full time job, and vanity that still drives me to the gym (anemically) a couple of times a week! Thanks can-do

[can-do-man]

Recommendations
Modest RBV dose reduction (200-mg increments) is a good approach for managing anemia in boceprevir- or telaprevir-treated patients, as it does not appear to affect response. Some clinicians may choose to use erythropoietin, particularly for severe or symptomatic anemia. However, use of erythropoietin for HCV anemia is off label, and care should be taken to not allow the hemoglobin to exceed 12 g/dL.
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%206.aspx
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However people with cirrhosis had much lower SVR rates, being your also a previous partial responder dose reducing would be the last thing i would want nor did my doctor think it would be a good ideal in my case.

However

[yodennis]

I saw this below submitted by coeric  in another thread asking a similar question which I much appreciated reading. Not that I take the dose reduction casually: thank you. p.s. Usually I research before asking but this anemia is devitalizing cognitively too........
"Ribavirin dose reductions and interruptions are sometimes required with standard Peg-IFN/RBV treatment and were also reported for telaprevir-based regimens containing Peg-IFN/RBV. In Study 108, 57% of subjects had at least one RBV dose reduction with or without at least 1 dose interruption (Table 9). However, the rates of SVR24 among these subjects were not adversely affected by ribavirin dose reductions."

[yodennis]

Oops (anemia brain): that is Hepatologist guided/prescribed

[yodennis]

p.s. Of course this was hematologist guided! d