starting Pegasys

[couchpotato]

Husband will be starting his second go-around at treatment in the next week or two but looking through all the info provided we can't find any suggestions at how to start. I mean, if he is going to take his shot on Fridays, should he start taking the riba on the Monday before shot night?? Or can he start Friday morning with the riba followed by the shot in the evening? Neither of us can remember how we did it the last time. Lasting brain fog? Naw, just old age!!

Thanks
Mattie

[couchpotato]

Thank-you for all your comments and information. I'm not around here much any more, but appreciate the insights you all can offer.

Good luck to all, be well
Mattie

[kcmike]

hi CP, i to am post-transplant (jan '05).  i'm participating in a schering-plough clinical study (p-09540).  It is titled "Efficacy and Safety in Hepititis C Recurrence Therapy."  as already mentioned, combination therapy is different for TP patients and this study is to get the patient to EOT.  day 1 began with labs, 2 tylenol, Peg-Intron and the Rebetol.  The Rebetol dose is weight based and started at 400mg for the first 2 weeks, 800mg for weeks 3 and 4 and week 5 the full dose.  

there is no SOC for TP patients.  this study protocol does allow rescue drugs such as Procrit and Neupogen.  It also has allowed me when my hemoglobin fell below 9 or hemocrit below 27 to lower my Riba by 200mg.  

i'm not suggesting anything more to your husband than to speak with a hepatologist about this theory.  the study is still open enrolling and the Peg and Rebetol are free!  more info at clinicaltrials.gov for a site near you or just info for your doctor.

Congrats on your SVR and good luck to your husband on his treatment.

[illo]

A newbie here.
I started 2 weeks ago on a friday night with the shot, and Sat AM with the Riba.  No problems.  Doc didn't think it mattered if I did it Fri AM, PM or Sat AM.  It's gonna be a long haul anyway.  Mike is right, check with people with TP experience.  

Best of luck!  Keep us posted and glad to hear you cleared!

[mikesimon]

I don't think it's a big deal one way or the other. My opinion is that it might be better to start the ribavirin in advance so that he has some plasma concentration of ribavirin when the interferon hits home. Pegasys is reputed to have a longer bioavialability so it might not be all that advantageous but I cannot see how it could hurt. Platelet count is a problem for TP recipients. It was for me but my center didn't get worried about it. I got as low as 23,000 and I never heard a cautionary word about it. I think the real problem transplant recipients face is tolerating the TX. The odds of success are pretty much in line with non transplants when the recipients are able to tolerate the treatment, but the percentage who are able to tolerate TX is rather low so the total success numbers get skewed downward and it can appear more discouraging than it probably is. As always I wish your husband good luck. Although Pegasys does impact the CBC like Peg-Intron I found it much easier to tolerate and I hope your husband finds it easier as well. Mike

[couchpotato]

Thanks Mike. We will of course check with the TP center first, I think the idea of starting the Riba first is the right way to go.

Be well
Mattie

[FlGuy]

Typically, riba starts when the peg starts.  As a transplant pt there may be different protocols to follow.  Mike Simon and Bthompson may have some experience to share with you.  This treatment, with doc's agreement, I started riba a week before the first peg - but that's not the usual way.

[couchpotato]

Last tx was Pegatron, in '03. He was taken off because of low platelets (20's). Had a liver transplant in Nov. '04. Just can't remember the sequence. Does he do the Riba for the week preceeding the shot? Can't believe there's nothing in the brocures. Maybe it doesn't matter?

P.S. We were both geno type 2's. I tx'd and cleared in Sept. '04. Now he is trying again.

Thanks
Mattie

[FlGuy]

What (like meds, doses, length of treatment etc) will be different this time than the first go 'round?  Did he make it through the full treatment last time?