Aa
Your "Great" labs might mean the opposite of what you think they do.
Always killed me when people here report that my doctor said "my labs look 'great"" or that "my hemoglobin is great" -- when in fact an association between anemia and riba absorption has been known for some time. Now, we have the logical association between anemia/riba absorption and SVR. Bottom line IMO is that having little or no anemia should at least signal a discussion with your doc about increasing your riba dose, regardless if it's weight based. Espeically if your viral decline isn't what it should be. Also note Procrit's role in keeping people on tx with their anemia. Thanks to "CoWriter" for bringing this particular presentation to my attention.
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Oral Presentations
http://www.kenes.com/easl2009/Orals/276.htm
Session Title: Parallel Session 15: HEPATITIS C VIRUS NATURAL HISTORY AND THERAPY
Presentation Date: Apr 25, 2009
HEMOGLOBIN DECLINE IS ASSOCIATED WITH SVR AMONG HCV GENOTYPE 1-INFECTED PERSONS TREATED WITH PEGINTERFERON (PEG)/RIBAVIRIN (RBV): ANALYSIS FROM THE IDEAL STUDY
M. Sulkowski1, M. Shiffman2, N. Afdhal3, R. Reddy4, J. McCone5, W. Lee6, S. Herrine7, S. Harrison8, W. Deng9, C. Brass9, K. Koury9, S. Noviello9, J. Albrecht9, J. McHutchison10
1Johns Hopkins University School of Medicine, Baltimore, MD, 2Virginia Commonwealth University Medical Centeru, Richmond, VA, 3Beth Israel Deaconess Liver Center, Boston, MA, 4University of Pennsylvania Health System, Philadelphia, PA, 5McCone Endoscopy Center, Alexandria, VA, 6Clinical Center for Liver Diseases, Dallas, TX, 7Thomas Jefferson University, Philadelphia, PA, 8Brooke Army Medical Center, Fort Sam Houston, TX, 9Schering-Plough Research Institute, Kenilworth, NJ, 10Duke Clinical Research Institute, Durham, NC, USA
Background and aims:
Peginterferon (Peg)/ribavirin (RBV) causes significant hemoglobin (Hb) decline leading to side effects and RBV reduction in ~30% of patients (pts). The effect of Hb loss on sustained viral response (SVR) is unknown.
Methods:
3070 HCV genotype-infected pts were treated for 48 weeks with Peg2b 1.5 or 1.0mcg/kg/wk + RBV 800-1400mg/day, or Peg2a 180mcg/wk + RBV 1000-1200mg/day. Anemia was defined as Hb 3 g/dL, 43.7% (984/2250); ≤3 g/dL, 29.9% (231/773) (P8 weeks):
Anemia/no EPO, 59.3% (162/273);
Anemia/EPO, 55.0% (116/211); P=0.33.
Among anemic pts, EPO was associated with less early (< 0.001).
Conclusions:
Among HCV genotype 1-infected pts treated with Peg/RBV, the magnitude of Hb decline is strongly associated with the likelihood of SVR.
The effect of EPO varied by time to anemia;
no benefit was observed for pts who became anemic after treatment week 8.
These data suggest that Hb decline may be a pharmacodynamic marker of treatment effectiveness and that the primary effect of EPO was to prevent treatment discontinuation in pts with early anemia.
------------------
Oral Presentations
http://www.kenes.com/easl2009/Orals/276.htm
Session Title: Parallel Session 15: HEPATITIS C VIRUS NATURAL HISTORY AND THERAPY
Presentation Date: Apr 25, 2009
HEMOGLOBIN DECLINE IS ASSOCIATED WITH SVR AMONG HCV GENOTYPE 1-INFECTED PERSONS TREATED WITH PEGINTERFERON (PEG)/RIBAVIRIN (RBV): ANALYSIS FROM THE IDEAL STUDY
M. Sulkowski1, M. Shiffman2, N. Afdhal3, R. Reddy4, J. McCone5, W. Lee6, S. Herrine7, S. Harrison8, W. Deng9, C. Brass9, K. Koury9, S. Noviello9, J. Albrecht9, J. McHutchison10
1Johns Hopkins University School of Medicine, Baltimore, MD, 2Virginia Commonwealth University Medical Centeru, Richmond, VA, 3Beth Israel Deaconess Liver Center, Boston, MA, 4University of Pennsylvania Health System, Philadelphia, PA, 5McCone Endoscopy Center, Alexandria, VA, 6Clinical Center for Liver Diseases, Dallas, TX, 7Thomas Jefferson University, Philadelphia, PA, 8Brooke Army Medical Center, Fort Sam Houston, TX, 9Schering-Plough Research Institute, Kenilworth, NJ, 10Duke Clinical Research Institute, Durham, NC, USA
Background and aims:
Peginterferon (Peg)/ribavirin (RBV) causes significant hemoglobin (Hb) decline leading to side effects and RBV reduction in ~30% of patients (pts). The effect of Hb loss on sustained viral response (SVR) is unknown.
Methods:
3070 HCV genotype-infected pts were treated for 48 weeks with Peg2b 1.5 or 1.0mcg/kg/wk + RBV 800-1400mg/day, or Peg2a 180mcg/wk + RBV 1000-1200mg/day. Anemia was defined as Hb 3 g/dL, 43.7% (984/2250); ≤3 g/dL, 29.9% (231/773) (P8 weeks):
Anemia/no EPO, 59.3% (162/273);
Anemia/EPO, 55.0% (116/211); P=0.33.
Among anemic pts, EPO was associated with less early (< 0.001).
Conclusions:
Among HCV genotype 1-infected pts treated with Peg/RBV, the magnitude of Hb decline is strongly associated with the likelihood of SVR.
The effect of EPO varied by time to anemia;
no benefit was observed for pts who became anemic after treatment week 8.
These data suggest that Hb decline may be a pharmacodynamic marker of treatment effectiveness and that the primary effect of EPO was to prevent treatment discontinuation in pts with early anemia.
Nygirl double dosed riba from day one.
-----------------------------
Could be wrong, but I don't think she double-dosed at all and certainly not from day 1. My recollection is that she started either normal or sub-normal dosing and then boosted the dose after tx began. BUT even if she did double-dose, and I'm pretty sure she didn't -- people metabolize riba quite differently and that is the problem with weight-based dosing. Conceivably a person who double-doses could effectively have a lower serum riba level than someone who single-doses due to a number of factors including kidney clearance per some of the early LIndahl studies.
Trinity: So you're saying someone like myself, who should only be taking 800 mg of riba but taking 1000mg should bump up to 1200 or 1400?
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Not at all. If you're a geno 1 and 800 mg gives you let's say a two point drop of hgb from baseline in a few weeks then its probably enough. Conversly if you took 1400 mg and your hgb curve remained flat after 4 weeks then 1400 might not have been enough. Should add that while hgb drop is adding up to be a very important indicator, it's still a bit crude compared to the actual serum riba levels which unfortunately cannot be measured because of lack of HPLC testing.
From what I've read for well over a year, there are plenty of folks who EVR and SVR on weight based riba dosages and never go anemic.
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Some? A few? Plenty? Are thesse geno 1's? That's the problem with anecdotals :) Regardless, the role of riba and riba absorption is too important not to factor into an individualized tx plan. Since HPLC testing doesn't exist, then hgb drop (anemia) is all we can go by.
-----------------------------
Could be wrong, but I don't think she double-dosed at all and certainly not from day 1. My recollection is that she started either normal or sub-normal dosing and then boosted the dose after tx began. BUT even if she did double-dose, and I'm pretty sure she didn't -- people metabolize riba quite differently and that is the problem with weight-based dosing. Conceivably a person who double-doses could effectively have a lower serum riba level than someone who single-doses due to a number of factors including kidney clearance per some of the early LIndahl studies.
Trinity: So you're saying someone like myself, who should only be taking 800 mg of riba but taking 1000mg should bump up to 1200 or 1400?
----------
Not at all. If you're a geno 1 and 800 mg gives you let's say a two point drop of hgb from baseline in a few weeks then its probably enough. Conversly if you took 1400 mg and your hgb curve remained flat after 4 weeks then 1400 might not have been enough. Should add that while hgb drop is adding up to be a very important indicator, it's still a bit crude compared to the actual serum riba levels which unfortunately cannot be measured because of lack of HPLC testing.
From what I've read for well over a year, there are plenty of folks who EVR and SVR on weight based riba dosages and never go anemic.
----------
Some? A few? Plenty? Are thesse geno 1's? That's the problem with anecdotals :) Regardless, the role of riba and riba absorption is too important not to factor into an individualized tx plan. Since HPLC testing doesn't exist, then hgb drop (anemia) is all we can go by.
The other point not be be missed is that RVR probably trumps anemia as a predictor even though anemia is associated with RVR and now SVR. So in other words, if someone is RVR (but not anemic) , then I'm guessing that there chances of SVR are similar to someone who is RVR and anemic.
by nygirl7
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nygirl7
Female
Stamford - CT
Member since Jan 2007
Mood: nygirl7 Sweepin' up the tombs with your paranoid yups - ST
Journal Entry: "07.08 A lesson that has been shared ..." [Read]
, Jun 22, 2007 12:00AM
To: St. George
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St. George
Member since May 2006
I begged the doctor to give me extra riba instead of the 800 weight based I should have been on.
So he wrote the script for 1,000 a day.
On weekends I took between 1,200 - 1,400 minimum for Saturday and Sunday to try and really double whammy the interferon and kill those little #$@$ that might not want to die!
I have to admit that a couple of times I took 1,600 which is double my dosage but that was sporadic and also on the weekend.
Of course...I had dreadful anemia (dropped from 15+ to only 9 in just over a week and believe me the quicker you drop the worse it is - it was too much for my body to handle and I literally kept fainting).
But - I wanted every bit of meds I could to fight this junk. Dr. Jacobson dropped my riba down to 800 - but that was at week 46, he said at that point I didn't need the extra it was just hurting my blood count and he did NOT want me on Epo 40,000 x 2 a week any longer. He said that you can develop an immunity to the epo and the bad part is that your body naturally produces it...so if you develop an immunity you're in serious trouble and could die.
I hope that is clear for you. It's not like I took a steady 1400 a day - I just took the extras mostly on the weekends but also during the week sometimes.
Debby
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nygirl7
Female
Stamford - CT
Member since Jan 2007
Mood: nygirl7 Sweepin' up the tombs with your paranoid yups - ST
Journal Entry: "07.08 A lesson that has been shared ..." [Read]
, Jun 22, 2007 12:00AM
To: St. George
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St. George
Member since May 2006
I begged the doctor to give me extra riba instead of the 800 weight based I should have been on.
So he wrote the script for 1,000 a day.
On weekends I took between 1,200 - 1,400 minimum for Saturday and Sunday to try and really double whammy the interferon and kill those little #$@$ that might not want to die!
I have to admit that a couple of times I took 1,600 which is double my dosage but that was sporadic and also on the weekend.
Of course...I had dreadful anemia (dropped from 15+ to only 9 in just over a week and believe me the quicker you drop the worse it is - it was too much for my body to handle and I literally kept fainting).
But - I wanted every bit of meds I could to fight this junk. Dr. Jacobson dropped my riba down to 800 - but that was at week 46, he said at that point I didn't need the extra it was just hurting my blood count and he did NOT want me on Epo 40,000 x 2 a week any longer. He said that you can develop an immunity to the epo and the bad part is that your body naturally produces it...so if you develop an immunity you're in serious trouble and could die.
I hope that is clear for you. It's not like I took a steady 1400 a day - I just took the extras mostly on the weekends but also during the week sometimes.
Debby
I believe her entry is consistent which what I said and not that she double-dosed from the beginning or even ever double-dosed at all. Hopefully she will clarify on MOnday
I tend to agree with Jim on this one, based on my personal experience. On my first tx I was dosed at the standard 800mg Rib (Geno 3) and I felt little side effects and my Hb always stayed in a good healthy range. At no stage did I ever achieve UND in my 24 weeks of treatment.
This time round I have been on 1200 Riba (weight based) and have become anemic 3 times. The first time was at week 4 or 5 when dose reduction. This also coincided with becoming UND so that shows me a direct relationship to the efficacy of riba, anemia and outcome.
Each time my bloods have reached up over 10 I have asked to go back up full dose as I really believe it is about the correct riba dosage per individual and the anemia levels are the only way we have here in NZ to gauge response to tx, other than VL testing and LFTs, but LFTs can swing so.....
I also tend to agree that not everyone metabolizes the Riba in the same way and therefore different people have different responses to the same amounts even if they are about the same weight. I have read of a member here who is a small female and was on massive doses of riba whose body metabolized it so fast that it never got a chance to work, she is simply 'immune' to riba, if you will.
This time round I have been on 1200 Riba (weight based) and have become anemic 3 times. The first time was at week 4 or 5 when dose reduction. This also coincided with becoming UND so that shows me a direct relationship to the efficacy of riba, anemia and outcome.
Each time my bloods have reached up over 10 I have asked to go back up full dose as I really believe it is about the correct riba dosage per individual and the anemia levels are the only way we have here in NZ to gauge response to tx, other than VL testing and LFTs, but LFTs can swing so.....
I also tend to agree that not everyone metabolizes the Riba in the same way and therefore different people have different responses to the same amounts even if they are about the same weight. I have read of a member here who is a small female and was on massive doses of riba whose body metabolized it so fast that it never got a chance to work, she is simply 'immune' to riba, if you will.
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