Changes in Peg Due to TIA

[IAmTheWalrus]

Dr. Dieterich,

Thank you in advance for supporting this forum with your expertise.

I am geno 1, a liver TP recipient (9/07), on SOC TX post TP and had an partial EVR to SOC (-2log drop in VL at 12 weeks). I have finished 49 of 72 weeks currently. Due to a stroke (TIA) a couple of days ago, my liver doc wants me to take a "drug holiday" and skip this week's Pegasys dose. I am reluctant to do this will comply. I am very worried about compromising my chances of SVR and I am not aware of anything that could link the interferon to stroke risk factors. I have normal BP and normal lipids. No damage or causes showed up on CT scan or MRI of brain, but bubble echo cardiogram showed possible shunt. I think this will be looked at closer with endoscopic US w/ bubbles next week.

I hope you can answer two questions for me:

1. Being a slow responder, what are the possible effects of skipping Pegasys dose #50 in the 72 week regimen?
2. Is there any reason to suspect that the Pegasys could be related to the TIA, and if not, is there a reason that you would or would not recommend changes to Pegasys doses or schedule?

Thank you,
Brent

[Douglas Dieterich, MD]

Skipping one dose is not a big deal. It is not clear to me if TIA is related to Peg or not, if you may have a shunt. TIA and CVA has been reported in patients taking interferon, though. I think OK to skip one dose now. More than 2 is a problem virologically.
DTD

[IAmTheWalrus]

Thanks for the comment. It is very helpful.

Brent