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?

[jessiejames1973]

the risk of stroke for one!!!!  increase risk of cancer later in life the list goes on ,  hb of 10 might not be great but it is doable for most people especialy females

[RCM829]

I agree with Trish.

Risk of relapse - no matter how small - far outweighs quality of life issues.

Further, my doctors have done a great job of keeping my HGB within range (we keep it between 10 and 12) with a Procrit injection every  two to three weeks. For me, it's kept me active and most importantly, able to continue treatment. I have had no side effects from it.

[FlGuy]

It's a good idea to get knowledgeable advice and a good idea to understand the rules of the game. There is nothing wrong in not getting hemoglobin whacked on treatment.  I saw a hematologist for the blood side of things and we agreed that my hgb would stay between 11 and 12.  He did a great job with the Aranesp (not Procrit) and I stayed in range the whole time.  Since I got it in a clinical setting (his office) it was handled on the medical side of insurance and he was allowed to administer under 12.  If he had prescribed Procrit he'd have to wait until 10 and then I'd have to pay an Rx copay.  The Aranesp in the office I got sooner and cost free. Being functional in tx2 made a big difference.

[Trish77]

"epo given when Hb IS ABOVE 10  is a bad idea above 11  is stupid and above 12 dangerous, "

What do you base this on? Many persons on HCV treatment are on procrit above 10.0 and for males, 11.0 can be quite low for hgb.  Furthermore, many HCV patients are on maintenance doses of procrit for a significant portion of their treatment above the 10.0 level you've stated as being a bad idea to prevent hgb from dropping too low, which it would do without that procrit maintenance dose.

This is a previous discussion on procrit and ribavirin dosage reduction here and a number of the posters had procrit above that 10.0 mark.

http://www.medhelp.org/posts/Hepatitis-Social/How-long-can-you-take-Procrit/show/646267

I only went below 10.0 once.  They reduced my ribavirin at that point at 13 weeks.  After that week, my hepatologist put me on procrit and I stayed on it for most of the rest of my 34 weeks to keep me above 10.0 to avoid dosage reductions as the trial mandated they were required when hgb dropped below 10.0.  When they took me off procrit for a time, my hgb dropped close to that 10.0 mark after getting up around 13 or so.  He put me back on it and I stayed on it until treatment stopped for me.  It had nothing to do with tolerability, I was managing okay with my hgb staying in the 10's most of the time.  It had everything to do with avoiding dosage reductions and is a very valid use of procrit.

[jessiejames1973]

epo given when Hb IS ABOVE 10  is a bad idea above 11  is stupid and above 12 dangerous,

[Trish77]

Well, the 80/80/80 rule was the MINIMUM - preference is 100/100.