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Avatar universal

why not use procrit and neupogen before counts drop?

Next time I try treatment I'm going to suggest to my doctor to prescribe neupogen and procrit before I start to get the counts up.  Mine have always dropped into the low range.  I found especially the neupogen made me feel rough after I was already well into treatment and didn't do a whole lot.  Why don't doctors prescribe it before treatment?  Would there be a downside to that?  regards
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Avatar universal
Risks and side effects potentially come with all drugs, just read the package inserts, and in the case of Procrit, the Black Box warnings. That doesn't mean you will have those side effects or shouldn't take it, but something certainly to weigh into the risk/reward equation. As to "11th hour discussions with docs", I've certainly had my share of those (12th and 13th hour as well :) ) but in an ideal world we'd have these discussions in the calm before any potential storms.

-- Jim
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Avatar universal
I know what you mean by 11th hour discussions.  Although I doubt I would have cleared had I handled my treatement differently, I certainly was in pretty bad shape before I figured out some things and by that time it was a little late.  If I get a chance to do the teleprefir trial, certainly I'll be doing some things differently.  Procrit and Neupogen beforehand is one aspect I'm looking at.  

I'm wondering... you mention risks associated with the Procrit and Neupogen.  What are these risks or side effects?  Frankly, and I know a lot of people say this, but it's taking a lot more effort and time for me to return to my old self after the last brutal treatment.  

regards, Bill
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443922 tn?1374157016
I have been on Neupogen since wk 3, 3 times a week, I'm on wk 14 of tx.  My questions are, can you take Neupogen for 48 weeks, when when you know if you can have a dose reduction?  I also wonder about scheduling, since this has been an issue for me, but I have recently started Neupogen on Mon, Wed, Fri., with Lab draw on Tues and injection on Sat.  I'm 1a, had a 2 log drop at wk 8 and am awaiting wk 12 PCR results, unfortunatly till my GI returns from Vacation July 14.

Donnie
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220090 tn?1379167187
Yes, Dr D thought my response was very fast.  I didn't realize that most people took 2 - 6 weeks.  If that is the case then I agree with your entire conclusion.

Eric
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Avatar universal
Actually on second read, it seems you did mean "Procrit" although "responding in 3 days" is not the norm. 2-6 weeks is more like it on average, which makes it a more reasonable choice for proactive dosing than Neupogen.
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Avatar universal
I think you meant "Neupogen", not "Procrit". Hope all is well, Eric !

-- Jim
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220090 tn?1379167187
I agree with Jim about the risks associated with Procrit.  Couple that with the fact that most people respond quickly to it, I don't see the need for treating proactively.  I can only speak for myself - I responded within 3 days - that is I was up and walking in that time.  A bit slowly except for downhill - LOL.  I was lucky that I spent the winter in Florida with no hills.

Eric
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Avatar universal
These drugs do not come without risks, and not everyone will need them,  so that is one important reason, other than cost.

That said, if you already have a history of let's say tanking hemoglobin  per previousx treatment, taking Procrit (epo) prophylactively seems to be a reasonable strategy. It also might be part of a high-dose ribavirin strategy outside of SOC if that's what you and your medical team decide on.

To a certain extent, the same thing with Neupogen, except first I'd want to fully evaluate whether or not the Neupogen was actually needed the first time around. Some studies suggest that infections do not increase with declining ANC caused by the treatment drugs. ANC can also bounce around a lot. For that reason, some of us have had our ANC drop as low as 300-500 without Neupogen intervention or dose reductions.. On the other hand, I've read here of some taking Neupogen and/or dose reductions with ANC around 1000.

The other thing is that Neupogen is fairly fast acting and Procrit (epo)_ can take 2-6 weeks to fully kick in.

All this suggests to me that taking Procrit (epo) prophylactively has some limited merit, but one could probably wait with the Neupogen until blood work demonstrates the need, except I would imagine in very limited circumstances based on either prior sudden drops or some other condition I'm not familiar with.

But back to the beginning, these drugs are not without risks, so the best strategy is to find the absolute best liver specialist (hepatologist) you can, and fully discuss helper drug intervention -- including prophylactive use -- before treatment starts. Unfortunately, too often these patient/doctor discussions are held well into treatment and take a kind of 11th hour flavor with all that involves.

-- Jim
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524608 tn?1244418161
tks Melinda....NP said something about Procrit and also mentioned dose reduction...don't know if I want either of them.
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Avatar universal
It's some kind of fibrosis..I'll go dig it up again and link it if I can...  ~Melinda
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524608 tn?1244418161
? Scarring inside the bones?...please give more info.
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Avatar universal
I'm just guessing here...I think a lot of it has to do with the cost. The procrit is about $1000/ injection, and neupogen around the same. Drs have to justify clearly the use of them to the insurance companies. I know also that Procrit can cause a sort of scarring inside the bones, which could become a problem down the road..I'm not sure about Neupogen...                                                               ~Melinda
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