neupogen

[Archer_]

I posted some weeks back "treatment options" when deciding whether to proceed with present 2x tx or wait for Telaprevir. Am stage 4 (metavir) with portal hypertension, varices developing (fortunately not osoephogeal yet) - also have high bp (managed by meds) and brain aneurism. Platelets 68, neuts 1.6, hgb 13.9.. Have decided to do 2x in may/june and test my response. If unimpressive by week 4 I would cease then, but, in Aus. will need to treat for at least 12 weeks to be categorised as a non-responder or will render myself ineligable for further & PI treatments.

To optimise my prospects I would prefer to avoid dose reduction, at least for the intial 12 week period so have been making enquiries re growth factors (rescue drugs). The are generally unavailable here unless prepared to pay for them privately. Have been trying to cost what a ceiling amount might be for a 12 week period to see if I can organise sufficient funds. Neupogen in prepared syringes are sold in packs of 10 - $1504 for 3000mcg/.5ml shots and $2407 for 480mcg/.5ml shots. I realise that amount required is case dependant but wouldnt mind any info which might assist me to at least get some idea of the range which may generally apply. (will I need shots daily, weekly etc) If anyone here has had neupogen and are prepared to share their details I would be interested and appreciative. This may be a fools errand and I may not be able to calculate anything sufficiently meaningful at all - but thought I would at least explore this. Would also be interested in any info (tx details /costs) around Epo and Eltrombopag (Promacta in US) if others have had any exposure to these. With my poor base line bloods - you will understand why I am asking. Thanks & regards Archer_    

[spectda]

I got mine mostly in vials of 300 mcg and some in factory prefilled syringes.

I also had an issue with my anc going very low each week and very high after injection so I injected twice per week. I reused the vial (1/2 each injection) which of course your not supposed to do but I assume is similar to the pharmacy filling their own syringes. Maybe the pharmacy version has a preservative in it and the single use does not.

[hcvJames]

Doesn't anyone get their Neup in vials of 480 mcg?

[Fnzol]

"" The issue with filled syringes, though, is that they outdate in 14 days."

The pre-filled neupogen syringes in my refrigerator have a expiration date of 12/2012 and I purchased them about 4 months ago. do you mean that once they are unsealed?
- Dave "

Read the context:  pharmacy-filled vs. factory-filled.  The pharmacy is filling stock syringes from their own vial.  That makes for a 14-day outdate.  The factory units are filled in a sterile environment, hence the long outdate.  

[hcvJames]

I take Neup, 480 mcg vials, once a week. Like Fnzol my WBC shoots up and out range but falls off by the time of the next shot. Which is fine with me because after being taken off tx for low WBC/ANC I learned never to take a CBC later than 48 hours after taking the Neup shot. Actually 36 hours since I take it around midnight Sun. and CBC's around noon Tue's. (and Interferon shot late Wednesday night.) I took one CBC on a Fri., and was below range already. Since my labs and clinic visits are separate they don't care specifically when labs are take as long the results come back before the clinic. So they always see me in range. Yay.
I can't comment on the cost, Neupogen comes from Amgen's Patient Assistance Program.

[spectda]

" The issue with filled syringes, though, is that they outdate in 14 days."

The pre-filled neupogen syringes in my refrigerator have a expiration date of 12/2012 and I purchased them about 4 months ago. do you mean that once they are unsealed?
- Dave

[Bali05]

Hi Archer,

I have no experience with Neupogen but I just wanted to say I like your tx approach.
From what I can tell you are a CT. My GP told me that in terms of genetics the
middle one like CT is the one that can be influenced the most with external efforts.
Something to do with being able to silence one of the strands in this case the T.
With a TT that is more difficult. So make sure you got all your Vit D,B12 insulin
resistance ect.. in check.

b
wk45

[Fnzol]

I started Neupogen about midway (week 12) when my ANC hit .350.  I did 4 weekly shots of the prefilled 300s.  Weekly CBCs showed that the levels went way up quickly, but also fell off quickly.  I'd hit 1.800-2.100, but then be back below .500 on the cusp of the next shot.

So, we switched to twice-weekly shots of half doses.  Instead of factory-filled 300s, my provider compounding pharmacy makes up 150s and I pick those up, three at a time.  The issue with filled syringes, though, is that they outdate in 14 days.  That's why I get only 3 at a time.  I do Sunday Thursday Sunday and my ANC stays in the 1.30-1.60 range.  Good enough.  

The 4 300s that I got listed for about $1950US total.  The 3 150s are $420.  

I have 4 INF shots left.  Undetected since week 4.  

[Archer_]

Thanks - am most grateful for your effort to provide this information, regards Archer_

[spectda]

I started neupogen at week 6 when my anc went to .28, I had to take 300 mcg once a week for the remainder of treatment. the 300 mcg injection were $525 usd per injection pre insurance. Most doctors will start neupogen when anc is between .3 -.5

I used 40,000 unit procrit injections once weekly when my hgb dropped drastically and after a month the dose was increased to every 4-5 days. The cost for procrit was about $725 USD per 40,000 units pre insurance. Procrit is generally prescribed when hgb reaches 10 g/dl or below.

Promacta is generally not used for treatment of hcv because in trials it was found to be very toxic to your  liver.

I used neumega when my platelets dropped. Neumega is also not often used for treatment as it also can cause edema around your heart and lungs and other places in your body. I don't know the cost unfortunately as I didn't pay for it but have heard it is more expensive then neupogen or procrit.

It's difficult to know if you will need these drugs even if you blood levels are starting low to begin with. Many people with low platelets from cirrhosis pre treatment are able to tolerate interferon without intervention. For those that get to a critical level (around 20,000) dose reducing interferon is usually the only choice.

For those who need these medications the dose and how often they are needed really varies so it will be difficult to know what your response will be until you start.

I am sorry to hear about what you are going through and your condition. Hopefully the treatment will work well for you.

Good luck
- Dave