Aa
Dosage reduction. Cr@p. Impact??
Well, I finally pushed my luck. I just got the call. I've been so obsessed with the damn lymphocytes and whites and it's my reds that got me. I'm down to 9.6 and they are forcing a ribavirin dosage reduction. I have to go from 1200mg to 1000mg immediately and indefinitely. Trial protocol. Not procrit. Ribavirin reduction. My ANC is 1.8 and my lymphocytes are down to .4 .. so no INF reduction because my ANC rebounded enough to offset my lymphocytes.
Indefinite riba reduction. I'm very strong about my feelings on the importance of riba.
I don't go for my next blood test until July 4th and they are reducing it until I get the results of that test back
Today is Week 17. I was UND by Week 6.
Most of you know I'm on the R1626 trial. My choice here is to go with the dosage reduction .. or ... not. Which means dropping the trial.
I would like to have your feedback on the potential impact of a dosage reduction at this point, for about the two weeks I'm facing right now and potentially longer. I'm thinking...as long as I can get back to normal after July 4th, I'm good. Longer than that .. I don't know.
I would appreciate any input, thanks.
The odd thing .. is that I feel pretty good. Not like I'm doing anything overly physical but I'm working fulltime and staying very busy. I'm starting to think I've turned into a tx automaton. Just keeping on keeping on.
Trish
Indefinite riba reduction. I'm very strong about my feelings on the importance of riba.
I don't go for my next blood test until July 4th and they are reducing it until I get the results of that test back
Today is Week 17. I was UND by Week 6.
Most of you know I'm on the R1626 trial. My choice here is to go with the dosage reduction .. or ... not. Which means dropping the trial.
I would like to have your feedback on the potential impact of a dosage reduction at this point, for about the two weeks I'm facing right now and potentially longer. I'm thinking...as long as I can get back to normal after July 4th, I'm good. Longer than that .. I don't know.
I would appreciate any input, thanks.
The odd thing .. is that I feel pretty good. Not like I'm doing anything overly physical but I'm working fulltime and staying very busy. I'm starting to think I've turned into a tx automaton. Just keeping on keeping on.
Trish
Gosh girl..
Uhmmm...
I don't know the answer....
I've seen both reach SVR ---- but I've seen both fail.
And I don't know if there are any stats that I can find that will tell a full picture enough to help you decide.
I think each person is going to react differently based on their genetics... Like Side Effects and things...
I think you're going to have to choose for yourself in this.
But -- whatever you choose - and no matter the outcome - We WILL be here for YOU!
Love you,
Meki
Uhmmm...
I don't know the answer....
I've seen both reach SVR ---- but I've seen both fail.
And I don't know if there are any stats that I can find that will tell a full picture enough to help you decide.
I think each person is going to react differently based on their genetics... Like Side Effects and things...
I think you're going to have to choose for yourself in this.
But -- whatever you choose - and no matter the outcome - We WILL be here for YOU!
Love you,
Meki
can't trust those things; reminds me of the big "IT LIES" sign on the scale at my Drs office.
Sounds like you've got much better things to attend to, but you should be able to get at the full text by clicking on the "full text ...interscience" icon at the top right of the pubmed page (alternately go to the hepatology journal site and navigate to 2007, vol 46 issue 4).
If that fails (hepatology in the past was not free access) let me know and I can forward the pdf.
Sounds like you've got much better things to attend to, but you should be able to get at the full text by clicking on the "full text ...interscience" icon at the top right of the pubmed page (alternately go to the hepatology journal site and navigate to 2007, vol 46 issue 4).
If that fails (hepatology in the past was not free access) let me know and I can forward the pdf.
Willing, thanks for talking kilograms.
In my head .. (maybe it's a woman thing) my 77kg interprets to me as the "160 pounds, give or take" that my female mind thinks I am.
On the scale at the doc's, I am 77kg. That's still within your quoted range.
Willing, your reference only goes so far as to say the weight-based range is 800-1400 mg/day. That is the abstract part at your link. I'm trying to find the extended details that go with that, seems to quote the WIN-R study. I'd like to read what dosage goes with what weight.
Anyone...I would like to know the statistics on SVR rates for Geno 1's re-treating. Will research it, however if someone has them at their fingertips, I'd appreciate it.
Pro..thanks for those numbers..I'll be looking into that closer for better perspective. As for the trial, they've said they still plan to use the numbers regardless, that the 12 weeks is still relevant. Remains to be seen, doesn't it. Guess we'll see the SVR rates based on 12 weeks and go from there.
Willy ... thank you. For everything.
Not deciding anything, just gathering info. Really, I should have thought about this harder in the last number of weeks as I could have gotten an INF reduction at any moment. Maybe that's the optimist side of the optimist-realist in me. So anyway, I'm going to think it all through as that is still on the table week to week so I might as well get 'er all done at once, as far as the thinking it out goes.
A quick thanks to everybody who's been tossing their thoughts into the pot, I am most grateful.
I'll have to set this aside for the moment, as my blue Ninja is an hour away from coming back from her winter sojourn in the back of my buddy's truck, all repaired and ready to ride, thanks to the generosity of the buds in my sportbike group. Jimmer had a kidney transplant and he's just got the biggest heart. Have to make dinner to say thank you.
Jim...I tend to agree. If not on the trial, I wouldn't be getting rescue drugs or dosage reduction at this point regardless of the numbers simply due to my own tolerance. I'm thinking I better not slow down...that's the key. :)
Very grateful, thanks all.
Trish
In my head .. (maybe it's a woman thing) my 77kg interprets to me as the "160 pounds, give or take" that my female mind thinks I am.
On the scale at the doc's, I am 77kg. That's still within your quoted range.
Willing, your reference only goes so far as to say the weight-based range is 800-1400 mg/day. That is the abstract part at your link. I'm trying to find the extended details that go with that, seems to quote the WIN-R study. I'd like to read what dosage goes with what weight.
Anyone...I would like to know the statistics on SVR rates for Geno 1's re-treating. Will research it, however if someone has them at their fingertips, I'd appreciate it.
Pro..thanks for those numbers..I'll be looking into that closer for better perspective. As for the trial, they've said they still plan to use the numbers regardless, that the 12 weeks is still relevant. Remains to be seen, doesn't it. Guess we'll see the SVR rates based on 12 weeks and go from there.
Willy ... thank you. For everything.
Not deciding anything, just gathering info. Really, I should have thought about this harder in the last number of weeks as I could have gotten an INF reduction at any moment. Maybe that's the optimist side of the optimist-realist in me. So anyway, I'm going to think it all through as that is still on the table week to week so I might as well get 'er all done at once, as far as the thinking it out goes.
A quick thanks to everybody who's been tossing their thoughts into the pot, I am most grateful.
I'll have to set this aside for the moment, as my blue Ninja is an hour away from coming back from her winter sojourn in the back of my buddy's truck, all repaired and ready to ride, thanks to the generosity of the buds in my sportbike group. Jimmer had a kidney transplant and he's just got the biggest heart. Have to make dinner to say thank you.
Jim...I tend to agree. If not on the trial, I wouldn't be getting rescue drugs or dosage reduction at this point regardless of the numbers simply due to my own tolerance. I'm thinking I better not slow down...that's the key. :)
Very grateful, thanks all.
Trish
Given the last posts by willing and Proactive would it be fair to say that even given the dose reduction you will still be above 100% compliance on your RBV dosage? (maybe you've been doing 120% of what you should have been). Just another way of thinking about it. If so you will still be marching ahead doing 100% of both dosages IFN and RBV w/ regard to weight based dosing. It may not be as bad as was first thought.
Willy
Willy
To state the obvious, nobody can say for sure what the impact of a riba dose reduction will be for you, however it has been fairly well determined that weight-based riba is the way to go, so any dose reductions are not ideal. Having said that, a guy in my trial got reductions in both peg and riba from week 5 right through to the end of his tx and still made SVR.
So maybe ask yourself this. What if you accept dose reductions because of trial protocol rather than clinical necessity and then you have a breakthrough or a relapse? You'll never know if you might have SVR'ed but for those dose reductions. Are you prepared to live with that possible outcome?
Good luck,
dointime
So maybe ask yourself this. What if you accept dose reductions because of trial protocol rather than clinical necessity and then you have a breakthrough or a relapse? You'll never know if you might have SVR'ed but for those dose reductions. Are you prepared to live with that possible outcome?
Good luck,
dointime
80/80 is pretty simplistic but it may be considered in your case if only for a week or two while you research.
Hey, my wording wasn't very precise but the general idea is that in HCV treatment there is some room for adjustments and fudge (maybe even hot fudge) ; ) . 100% compliance is not required. It is a long treatment and many people HAVE to reduce dosages from time to time. The point is that one week of dose reductions (particularly with RBV that has a longer half life than IFN) may not make or break your treatment. I feel better that you are at week 17 and not at week 8 and reducing.
The 80%/80% rule is more like you don't want to really go below those levels as the effectiveness really starts doing a nosedive. I just want to point out that you may have some flexibility given it is a small reduction and that you are at week 17 and not in the very early stages of TX where compliance may be more vital. IF you were to graph your current compliance as of yesterday you would be 100% in compliance, no? That bodes very well for you. In terms of total dosing one week of a small RBV reduction isn't a grand scale change while you decide what's going on.
It's absolutely a personal choice you must make. It's also absolutely one that you need to confer with your doctors on. They may be able to give you some stats on what they think your current chances of SVR are based on comparing to SOC. They don't have past data on how R1626 works on populations but they may also hazard a best guess with this drug as well. There really isn't any data so it would really be a guess. So it goes with my opinion too. I'm just throwing out a few ideas.
I googled "HCV, 80% dosage, 80% of the time" there are quite a few articles which you can read. Some were PDF and so I didn't download them but I'd bet you can find quite a few articles.
Here are a few, you can find more by googling the keywords;
http://www.natap.org/2002/Oct/102402_2.h
http://www.medscape.com/viewarticle/503764_7
Keep in mind they pertain to SOC; you've been on triple therapy for 12 weeks.
Keep in mind that dose reductions are of less importance in the later stages of TX
A near RVR will have a lot of weight in your decision. It's also one reason that I would also agree that it's important to stay proactive and clear this virus THIS TIME. It sure looks as if it is within your reach.
Yes..... I certainly know you will won't make an impetuous decision. ; )
best,
Willy
Hey, my wording wasn't very precise but the general idea is that in HCV treatment there is some room for adjustments and fudge (maybe even hot fudge) ; ) . 100% compliance is not required. It is a long treatment and many people HAVE to reduce dosages from time to time. The point is that one week of dose reductions (particularly with RBV that has a longer half life than IFN) may not make or break your treatment. I feel better that you are at week 17 and not at week 8 and reducing.
The 80%/80% rule is more like you don't want to really go below those levels as the effectiveness really starts doing a nosedive. I just want to point out that you may have some flexibility given it is a small reduction and that you are at week 17 and not in the very early stages of TX where compliance may be more vital. IF you were to graph your current compliance as of yesterday you would be 100% in compliance, no? That bodes very well for you. In terms of total dosing one week of a small RBV reduction isn't a grand scale change while you decide what's going on.
It's absolutely a personal choice you must make. It's also absolutely one that you need to confer with your doctors on. They may be able to give you some stats on what they think your current chances of SVR are based on comparing to SOC. They don't have past data on how R1626 works on populations but they may also hazard a best guess with this drug as well. There really isn't any data so it would really be a guess. So it goes with my opinion too. I'm just throwing out a few ideas.
I googled "HCV, 80% dosage, 80% of the time" there are quite a few articles which you can read. Some were PDF and so I didn't download them but I'd bet you can find quite a few articles.
Here are a few, you can find more by googling the keywords;
http://www.natap.org/2002/Oct/102402_2.h
http://www.medscape.com/viewarticle/503764_7
Keep in mind they pertain to SOC; you've been on triple therapy for 12 weeks.
Keep in mind that dose reductions are of less importance in the later stages of TX
A near RVR will have a lot of weight in your decision. It's also one reason that I would also agree that it's important to stay proactive and clear this virus THIS TIME. It sure looks as if it is within your reach.
Yes..... I certainly know you will won't make an impetuous decision. ; )
best,
Willy
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