Rescue Meds For Low WBC and Neutrophils

[ActingBrandNew]

My Dr is threatening to stop TX if my WBC and Neutrophils don't go up by next labs. I asked him if there were any rescue meds for this and he said no and the only way to raise my WBC is with nutrition. So, my question is, are there any rescue meds out there that my doctor may not be aware of or any information as to how I can get my WBC count raised. Ive come to far to stop TX. My next labs will be in 4 weeks.

week 13 TX Riba/Peg
Genotype 3a
Baseline 12million
UND 5 weeks
UND 12 weeks
Neutophils (Absolute)  0.8
WBC 1.9

[ActingBrandNew]

I would really appreciate that. I think he will be more receptive if I can back up the info with some links. Thanks so much for your help.

[hrsepwrguy]

IFN/RBV treatment induced neutropenia and its correction with neupogen in patients with hepatitis C.

Sharvadze L, Gochitashvili N, Tophuria A, Bolokadze N, Tsertsvadze T.


Source

Iv. Djavakchishvili Tbilisi State University, Department of Infectious Diseases of Medical Faculty, Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia.


Abstract

The aim of the study was to observe the frequency of neutropenia during Pegylated Interferon/Ribavirin therapy in patient with chronic hepatitis C; to compare the efficacy of two strategies of management of neutropenia--with Interferon dose modification and with Neupogen administration; to compare the effectiveness rate of sustained viral response (SVR) in patients with Pegylated Interferon dose modification and in patients treated by using granulocyte colony-stimulating factor G-CSF-filgrastim. (Neupogen). Study enrolled 47 patients with chronic active hepatitis C, aged 23-64. (38 male and 9 female). All patients had HCV genotype 1b. Significant neurtopenia (ANC<750 mm3) and severe neurtopenia (ANC<500 mm3) developed in 41 of 47 patients (87%). 41 patients with neurtopenia were randomized into two groups. The first group--22 patients who received granulocyte colony-stimulating factor (G-CSF, or filgrastim) 300 mcg s/c weekly for correction of neutropenia and the second group--19 patients treated either with Interferon dose reduction or temporarily inhibit of Interferon treatment. In all 22 patients of the first group neutropenia was normalized without reduction and/or inhibit of Pegylated interferon. Neupogen was well tolerated and in all 22 patients the improvement of quality of life (QOL) was observed. It was concluded that dose reduction or temporary inhibit of Pegylated Interferon in the second group negatively acts on antiviral treatment response in patients with HCV genotype 1. In patients with PEG-IFN/RBV therapy Neupogen effectively manages neutropenia and gives opportunity to maintain interferon dose (without reduction). Neupogen has the potential to improve adherence rates, which may in turn improve SVR.

http://www.ncbi.nlm.nih.gov/pubmed/17660602

[hrsepwrguy]

Blood-boosting Adjuvant Therapies Can Improve Response to Interferon-based Treatment for Hepatitis C

SUMMARY: Use of adjuvant medications such as hormones that stimulate red and white blood cell production allowed chronic hepatitis C patients receiving pegylated interferon plus ribavirin to stay on treatment longer and increased their likelihood of achieving sustained virological response, according to a study published in the April 1, 2010 Journal of Viral Hepatitis

By Liz Highleyman

Standard therapy for chronic hepatitis C virus (HCV) infection, consisting of pegylated interferon alfa-2a (Pegasys) or pegylated interferon alfa-2b (PegIntron) in combination with ribavirin for 24 or 48 weeks (depending on HCV genotype) leads to an overall sustained virological response (SVR) rate of approximately 50%.

Part of the reason for this suboptimal efficacy is that the treatment can cause difficult side effects that cause many people to reduce their drug doses or stop treatment prematurely. But several supportive, or adjuvant, therapies can help patients stay on treatment. These include:

Antidepressants to manage the common side effect of depression (which may be started in advance for prevention);  
Erythropoietin (Procrit, Epogen) to increase production of red blood cells and manage anemia (a side effect of ribavirin);
Granulocyte colony-stimulating factor (Neupogen, Neulasta) to increase production of neutrophils, a type of white blood cell that fights infection.

W.J. Cash and colleagues from Royal Victoria Hospital in Belfast designed a study to assess the clinical impact and effect on sustained response of blood-boosting adjuvant therapies used during treatment with pegylated interferon plus ribavirin.

The analysis included 132 chronic hepatitis C patients (73% men). All but 11 participants were treatment-naive, of whom about 40% had hard-to-treat HCV genotypes 1, 4, or 6. The endpoint of interest was SVR, or continued undetectable HCV viral load 24 weeks after completion of treatment.

Results

57 patients (43.8%) used adjuvant therapies.
The overall sustained response rate was 66.7%, but varied according to HCV genotype:

Genotypes 1, 4, or 6: SVR 50.0%;
Genotypes 2 or 3: SVR 78.2%.

Among all treatment-naive participants, the SVR rate was 68.6%, again varying by genotype:

Genotype 1 (n = 51): 49.0%;
Genotypes 2 or 3 (n = 70): 82.9%.


Based on these findings, the researchers concluded, "With the use of supportive adjuvant therapy, we achieved an overall SVR of 66.7% and in treatment-naive patients 68.6%."

"In genotype 1 patients, SVR rates of up to 46% have been reported in previous studies without the use of erythropoietin and granulocyte colony-stimulating factor," they continued. "We have demonstrated the SVR for genotype 1 can be improved to 50% overall."

Investigator affiliations: Liver Unit, Royal Victoria Hospital, Belfast, UK.

6/25/10

Reference
WJ Cash, K Patterson, ME Callender, and NI McDougall. Adjuvant therapy used in conjunction with combination therapy for chronic hepatitis C improves sustained virus response rates in genotype 1 patients. Journal of Viral Hepatitis 17(4): 269-273 (Abstract). April 1, 2010.

http://www.hivandhepatitis.com/hep_c/news/2010/0625_2010_b.html

[ActingBrandNew]

I appreciate the great info. I'm printing it out and taking it to his office tomorrow as well as faxing it to him tonight. Thank you!

[hrsepwrguy]

No problem, good luck with treatment

[flcyclist]

At around week 8 of 48 week trt my absolute neutrophil count (ANC) went down to 0.35.  I was referred to a hematologist and began neupogen 2x per week which raised the ANC and kept it in the 0.7-1.0 range for the remainder of trt.   It is very concerning that you are being told there are no options.  Most people going through trt are guided by a gastroenterologist, or ideally, a hepatologist.  Should you switch doctors??  I suppose that could depend on the response to your questions and concerns.  You have to do what's best for you since you don't want to have to repeat this trt.

You have the option of neupogen or a dose reduction of interferon (which would make me nervous seeing you're on only Inf/Riba).    Did your doctor discuss this with you?  Also, since your ANC is currently 0.8, and most experienced doctors are ok with it going down to 0.5 before rescue drugs or dose reductions, your doc may be premature in threatening to stop trt.  Considering these facts, I'd be doing some looking at qualified hepatologists just in case your discussion with your doctor doesn't put you at ease.  Good luck moving forward.