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?

[mikesimon]

8.5? I don't know what your baseline Hgb is but 8.5 was too low for me. At 9.5 I would sit in my car for 10 minutes trying to get the energy to walk the 100 feet to my office. I guess it's a very individual thing. I was lucky to get Epogen. It made a world of difference and, in my opinion, didn't expose me any unnecessary risks.
The problems I have seen with epoetin alfa occurred in renal impaired patients, cancer patients, patients with cardiac disease, uncontrolled hypertension, clotting issues or a history of stroke or seizures.
I am likely missing some disorders but I cannot recall seeing any of these epoetin issues in patients who treated for TX induced hemolytic anemia. I would guess that some do exist but I can't remember reading about them.

Mike

[Rockerforlife]

10 is the magic number,mine was 10 average all the way tru TX...i was lucky.

[Trish77]

I have already told you...in my case it wasn't a tolerability issue.  I was tolerating just fine.  I was on procrit to keep my hgb above dosage reduction level as are a number of people.  Tolerability is relative as well.  If an hgb of 11 as a man lays you flat, then it lays you flat.  No point in pretending it doesn't and just looking at a number and treating based on what you SHOULD feel like.  I'd be repeating comments I've already made to say more so I'll leave it that we have different viewpoints on this.

[jessiejames1973]

balancing correct

i am not suggesting procrit is not used, just use with caution 10 is the cut of hence why i said ABOVE  10 is a bad idea , yes i know it takes time to work but 10 is easily manageable for a female in particular in fact 8.5 is doable i know plenty of people including men who coped on 8.5!!!!!!!!! here in the uk it is not dished out, sometimes to the detriment sometimes for good reason , the OP is und at wk 13 now wk 54 a small drop would not be an issue , also hb tends to stabalise with in a gram so they would not see a big drop, also the OP has a HB of over 11 why do they need to risk a stroke ???? they dont do they

[Trish77]

You're ignoring the dosage reduction we're trying to avoid.  Many of us on procrit were on it above 10.0 to AVOID dropping into a range where a dosage reduction might be required.  Procrit takes awhile to kick in - 3 weeks is the norm - for me it took six weeks before any significant change.  Once our hgb levels were at a certain place, maintenance doses of procrit were necessary to keep those hgb levels up and out of dosage reduction territory.  Stopping procrit completely tends to drop the hgb back down again and same problem is back.  We're trying to get a cure here and hopefully to only have to do this treatment once. It's definitely a balancing act.

[Trish77]

Eureka, I realize also that saying "what would I do if it were me" is easier when it's not me.  Joey_M's point on QOL is valid in context and it's finding that balance you're talking about that we all run into on treatment -  between getting rid of the virus, not compromising our health too much and not compromising QOL beyond a mentally healthy place.  Hard stuff.  Good luck to both of you in determining what's right for you.

Trish