Resume full dose riba or reduce procrit dose?

[eureka254]

A very informal poll, if you will:

Undetected at week #13, reduced riba from 1200mg to 1000mg since week #30 due to anemia, procrit 2x a week, hgb at 9+ weeks #31-41,  10+ weeks # 42-52, and now, finally at week #54, hgb at 11.3.  (Whew!) Question is:
What would you do if you called the shots (no pun intended)? Resume 1200mg riba?  Space out the procrit?  Reduce the procrit?  None of the above?  

Two things I keep tossing back and forth in my mind is the risk of relapse vs. the risk of procrit use... and I'm aware that members here aren't doctors, but plenty of you know more about treatment than the average GI specialist, and I'd greatly value your feedback.  (And those who don't feel they know much are welcome to comment too :] !) Besides, for the most part, treating hep c seems like a balancing act based on the heaviest data any particular doctor is weighing at that particular moment...  please weigh in (and Brain Mass Index is not a factor).  Thanks!

~eureka
PS: Additional question for those of you who have AFP readings regularly... what's been your highest reading?

[nygirl7]

Can't he just enjoy a higher hgb level for his remainder of tx? "

Something about black box warnings over having epogen have you go up and over 12 is important althought I can't remember exactly what it is.....epo is a dangerous drug - even though it is an absolute miracle worker you have to be VERY careful how high your hemo goes.

I agree with not dose reducing to get SVR but as well doctors are pretty leery of epo just cause of that reason.

" I think, especially in light of what Mike posted, the rule of thumb of 100% of the drugs 100% of the time as much as possible"

I agree with this I"ve never understood the 80/80/80 because it almost makes you feel like you can screw up and miss a couple and not have it matter.....like a permission or something It is CRUCIAL to bev 100% compliant to beat this crappy disease (as best as anyone can be compliant anyway)

[Trish77]

"I seriously doubt that increasing riba back up at this point would have any impact on his odds of SVR. "

I disagree.  He's at Week 54 out of 72 and went UND at 13 weeks.  I think, especially in light of what Mike posted, the rule of thumb of 100% of the drugs 100% of the time as much as possible, the impact of relapse here considering his advanced stage and what it would mean to retreat, I would want to hammer it, if it were me, as long as it's tolerated and not risking overall health.  

If quality of life is so compromised that it threatens adherence to treatment, that's a consideration.  If I'm going to compromise one or the other, it's going to be quality of life for awhile - I say that while recognizing it is an entirely personal decision and that is my opinion only.

Trish

[Joey_M]

I would also consider the quality of life issues here. Not sure why your husband needs to do anything differently than he is now. Can't he just enjoy a higher hgb level for his remainder of tx? I seriously doubt that increasing riba back up at this point would have any impact on his odds of SVR.

[RCM829]

I believe your husband is treating for 72 weeks.

Therefore, I would increase Riba to 1200 mg. and watch HGB closely. Hit this thing with everything you've got Eureka.

I'm rooting for you...

[newleaf09]

I hold to the full riba concept.  There have been studies relating reduced riba to potential relapse.  I'd try to get back to full riba dose and if you can hold hgb up, then I'd see about reducing the procrit frequency.  My doctor was okay with reducing the peg (and I was reduced for about 2/3 of my TX) but adamant about staying at full riba.

[nygirl7]

"The thing is, reducing the procrit or raising the riba is both going to like result in a decrease in hgb potentially.  I think I would rather have a decrease in hgb from increased tx drugs hitting my system if I had to pick one and if the decrease is not so much, then bonus to have the extra tx drugs working on the virus. "

AGREE. I took epogen for 69 weeks of treatment at full dose (Plus) riba.  At week 46 Dr. J made me drop some riba (I was taking way over my weight based) and it helped a lot. However at week 46 I figured it was alright to finally do this and I was still over weight based anyway.  He insisted that too much epo for too long was a risk that shouldn't be taken. I believed him but had already been UND for what 22 weeks at least and I knew I was going to do the extra six months at weight based - not UNDER.

Good luck.