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]

A recent article presented from Journal of Viral Hepatitis concludes:

"....In conclusion, our results have demonstrated that ribavirin is dose-dependently correlated with a relapse in patients with CH-C genotype 1 responding to Peg-IFN plus ribavirin. Maintaining a high dose (≥12 mg/kg/day) of ribavirin during the full treatment period could strongly suppress the relapse in such patients, while Peg-IFN α-2b could be reduced without affecting relapse in patients with c-EVR. This possibility should be explored in a prospective study."

The study attempts to distinguish the Schiff'man et all conclusion that SVR is not impacted by ribavirin dose reduction so long as the cumulative dose is above 60%. Although I was not thoroughly convinced by the argument my personal view is to maintain as high of a ribavirin dose as possible throughout treatment, even if that means supplementing with epoetin alfa.

Read the article as it is rather detailed.


See: http://www.medscape.com/viewarticle/709163

From Journal of Viral Hepatitis
Ribavirin Dose Reduction Raises Relapse Rate Dose-dependently in Genotype 1 Patients with Hepatitis C Responding to Pegylated Interferon alpha-2b Plus Ribavirin

Good luck,
Mike

[Trish77]

I thought about this from the point of view of "what would I want to do if it were me?"  I remember your previous post asking about extending to 72 weeks and I'm thinking that's what the aim is here.   It's also the aim to clear the virus.  So if he's tolerating the procrit right now then I would hold the procrit at current levels and increase the riba and see how he does with his hgb. While it's true that dosage reductions later in treatment have less of an impact than dosage reductions earlier in treatment, considering his stats, I would still aim to hit this thing with whatever he can tolerate.  Depending on what his hgb does, then you can decide to go to maintenance procrit if his hgb holds steady enough.  

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.

The concern for me with lowering procrit only is that it takes awhile to do it's stuff while reducing riba back to current from an increased amount if necessary seems to have a faster result.  So if you need to bring riba back down, you haven't lost much and might have gained a bit from the added riba.  If you're able to add riba with little/tolerable impact to the hgb then maybe you can go to maintenance procrit which would be double bonus - increased riba and decreased procrit.    

Is the risk of procrit use higher to him because of his stats or are you talking risk of procrit use in general?  I'm wondering where your concern is there as a number of people here have been on procrit throughout their treatment and I'm not sure I've read of serious concerns of the ill effects as a result?  

Trish

[FlGuy]

I assume this is about hubby.  Now 41 weeks at UND and 54 into treatment, how many weeks does he intend to go.  And, why?
If he is near the end of  tx, probably not increase riba.  If he is going to say 72 maybe increase the riba and keep steady on the procrit until hgb goes down and then make the procrit increase decision when he gets to a pre-determined level (like 10.5).  My thinking is that if the plan is to be long and aggressive he may as well be long and aggressive.

[jacksonblue]

I think increase riba to 1200 see how hgb holds can always reduce again i personally did not tolerate procrit well ended up damaging valve in leg and had to have surgery most tolerated procrit well from what i have seen here regards steve

[can-do-man]

UND at week 13, already at week 54, myself i would reduce procrit to once a week but would have at least bi-weekly labs to keep an eye on my HGB.

Or one could go back to 1200 and stay on the same procrit, still would want at least bi-weekly labs..............Best of luck to you, looking good.