Reduce Riba and Peg

[kally291]

Hey,

I just got email from my dc. He said according to my lab result, he decided to reduce my Riba to 600mg per day and Peg 90 mcg per week, which is a huge decrease from my original medication. My original medication is Riba 1000mg, Peg 180 mcg. My dc made these change due to my low WBC 1.5, Hemo 9.1, platelet 83, neutrophils 54%. I understand my dc need to do something considering my CBC. But I just afraid lowering the meds will hard to achieve SVR.
I'm on week 7, geno type 1b, VL 27,116 ,HCV log 4.433. And I was UND at week 3.
I will meet him tomorrow, but I don't fully trust his words. Because he always throw the decision back to me instead giving a good suggestion. I read some post on this forum said if reduced Riba in the first 12 week would have less chance to achieve SVR. Can anybody give me some comments if take my dc's suggestion or taking some rescue meds?

Thanks to you all!!!!

[jules2551]

That sounds like a real good idea! I would read carefully the links that Hrsepwrguy sent you.....and like Cando said your ANC and platelets are good so no need to reduce INF. Ask him about Procrit for HGB instead of reducing drastically

[Lindaz]

Kally I know how you must be feeling but as others have suggested go with what your medical teams says.  It is a risk that your bloods will drop too much and then treatment will have to stop........it's much better to be safe and dose reduce.  I had 16 weeks of my hb levels under 10 and had to have weekly bloods to determine the dosage.  I never had to reduce as I was always on 800 ribas per day but was always thinking and worried and at the same time, prepared to dose reduce if I had to........  My HB dropped to 8 at the last week of treatment so I was told to stop ribas.
Good Luck and try not to worry
xx

[kally291]

Thank you Jules, I think I need to talk to my dc tmr, see if I can only reduce the riba first and keep an eye on my lab result. I don't want to stay in the mode worried about the virus relapse sometime.

[jules2551]

Your ANC is .81, platelets 83 ang HGB  is 9.1 so these numbers look good for now where you have wiggle room.  You will probably feel wiped out with the HGB going down. Like others said I would be concerned with drastic dosage reductions.  I would be hesitant on reducing so quickly.

[kally291]

Hey Asle,
I agree with you. Before today, I was happy cause I can only do 24 week tx. But once I reduce the dose, I don't know if I need to back to 48 weeks. Until now, I don't feel any terrible side effect except nausea, feel refuse to eat 20g fat. No rash. Sometimes feel tired and sleepy. But during week day I was energetic and continue going to school and doing my experiment work.  

[asle]

You'd think, that with only 5 more weeks to go on Incivek, and your bloods being Ok really, that no reduction in the Interferon would be necessary. This reduction in both Riba and Interferon is your doctor putting all your eggs in one basket. It leaves nowhere for anyone to go if there is a drastic fall in Hemaglobin levels.
Gee, I was at Hgb 86 and platelets 60 before my riba was reduced. My bloods then fell to hgb 75 and platelets 55 before I had a transfusion. No reduction in Interferon. The doctor needs to go gently gently in his reductions.

[kally291]

Hi, thank you for your links. I should done more research before I start asking stupid questions. But do you have any idea about reduce Peg? How will that affect my treatment?

[kally291]

hey, I was shocked when I received his email. I only saw people reduced to 135 mg, Haven't seen reduced to 90mg. I don't know how it will affect my treatment. I''m starting worried about I cannot get UND on week 8's report.

[can-do-man]

Hi, the only concern I would have is the drastic dose reduction in the peg as your platelets are fine and your ANC is still good...

Best to you

[hrsepwrguy]

The language in the last of that post is a little much so here is the short version, in incivek trials they used riba reduction to manage anemia and they claim it had little to no effect on SVR rates

Also in victrelis trials they used riba reduction as well as procrit to manage anemia and SVR rates were about the same for both groups

[hrsepwrguy]

Hey kally, actually your doc is following the recommended dose reduction set forth in the prescribing guidelines, follow the link and you can see, look at table 3

http://www.drugs.com/pro/copegus.html

8.2.2.2 Treatment and Management of Anemia

During the telaprevir clinical program, hemoglobin was monitored and RBV reduced in accordance with PEG-IFN/RBV prescribing information. If ribavirin was permanently discontinued for the management of anemia, telaprevir was also to be permanently discontinued. If telaprevir was discontinued for anemia, patients may have continued treatment with peginterferon alfa and ribavirin. Ribavirin could be restarted per the dosing modification guidelines for ribavirin. The dose of telaprevir could not be reduced and telaprevir could not be restarted if discontinued. In the telaprevir clinical program, erythropoietin stimulating agent (ESA) use was generally prohibited.

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AntiviralDrugsAdvisoryCommittee/UCM252562

[kally291]

Thank you! I think I found the chat in my riba box. I said under 75kg should take 1000 mg. But I still have the question about reduced the dose of my meds. Can I SVR after reduce both of these meds. I know I will keep on Incevik

[Reidmusic]

I don't know what to tell you about questioning your teams' competence. Make sure you keep getting copies of everything and be super-vigilant. You have to be your own advocate and make sure that everything is being considered and all advice and treatment is in your best interest. This forum gave me so much knowledge that my NP and doc didn't really have to explain much to me. I was the one making suggestions for rescue meds and asking them what our strategy and bottom lines were. I'm not saying I knew it all, but I was definitely on top of my treatment and was a highly informed patient.

[kally291]

Hey Reid, I feel I have a lot of question marks in my mind now. I don't know if my dc and nurse are trustable enough now. Not bc the riba amount, but the nurse gave my Health Center the wrong blood draw chat. I called her and she said she forgot where my chat is. Luckily, I have one copy by my own. BTW, I know my WBC and RBC are close to the normal low range before my tx. So I cannot find a excuse to say he need increase the amount of riba.

[hrsepwrguy]

"Am I getting the wrong info?"

That depends on which makers prescribing info you look at, rebatol (merck) says 800 for your wt, copegus (genetech) says 1000

[Reidmusic]

Hi Kally, 800 mg. sounds right for your weight, but maybe some of the more astute members will give you more input. I can't find my dosing charts and I may have thrown them out. Online, I never know which sources to trust, so I'm hesitant to just send you a link to a chart. Hopefully someone will post a better answer for you.

[kally291]

Hey Reid,

Thank you for your sharing. I just found out that people under 134lb only need 800mg riba. My weight is only 118lb. I don't know why my dc gave me 1000mg riba. Am I getting the wrong info?

[Reidmusic]

I started on PegIntron at 120 mcg. based on my weight of 176 lbs. at the start of treatment. When my platelets went down to the 60's, I was told to reduce to 80 mcg. I did 150 mcg. by mistake in week 5, went down to 105 mcg. in week 6, then did 96 mcg. from weeks 7-24. In a few weeks, I ended up losing enough weight so that 96 mcg. was the proper weight-based dose for me. So I did reduce my shots, but not as much as they told me to. I just wasn't comfortable with it and my platelets weren't dangerously low. My platelets stabilized on the reduced dosages. It looks like you're on Pegasys so your numbers are different.

I also was told to reduce my ribavirin from 1000 mg. a day to 800 mg. a day when my hemoglobin dropped to the 9's. I did this for 18 days and as soon as my hgb. went back over 10 I went back to my full dose. I was undetected at weeks 4, 12, and 24 and will test in Sept. for SVR.

I was very reluctant to reduce my dosages, but I didn't want to have my blood levels to go into dangerous territory either. I'm not saying you should do this and following your doctor's advice is your best bet. I'm just telling you my experience and how I dealt with dose reductions.