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Hep C Discussion Forum -> On Treatment -> Dose Reduction vs Red & White Blood Cell Stimulators
Post Info TOPIC: Dose Reduction vs Red & White Blood Cell Stimulators
Dose Reduction or Blood Cell Stimulators [5 vote(s)]

dose reduction
60.0%
blood cell stimulating drugs
0.0%
both
40.0%
stopped treatment
0.0%
Isiscat2011


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RE: Dose Reduction vs Red & White Blood Cell Stimulators
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Piggles925 wrote:

I have read that anemia in Hep C treatment actually predicted SVR, so I am not too worried about it.

http://www.gastrojournal.org/article/S0016-5085%2810%2901222-9/abstract

Careful what you read.  That study was conducted on 118 people in 2010--before the triple therapy was even approved. 

From what I recall, the Incivek trials showed that people who did not experience anemia were as likely to achieve SVR as those who did.  So, this type of data is tricky to interpret, and it is designed to be that way.

 



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Isiscat2011


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Piggles925 wrote:

I learned in my treatment teaching session that my doctor prefers dose reductions for both riba and interferon to red and white blood cell stimulating drugs due to their side-effects.

Same with my doc.  But, "prefers" doesn't necessarily mean he won't do it; I'm sure it depends on the situation and the doctor.  When I inquired further, doc said he has prescribed them for hep c tx in the past, so he probably would under the right circumstances, as long as patient understood the risks. These drugs are not FDA approved for this tx so that is a consideration.

I also had severe anemia, very low platelets, and was beginning to experience decreases in white blood cells. I received blood transfusions and some dose reductions of both riba and interferon, but the  blood problems alone were not the reason for the tx discontinuation, and I doubt it usually would be.

I would opt for transfusions over substantial and continued dose reductions.  Transfusions carry some risks but fewer than the blood cell stimulating drugs.  Problem is transfusions are expensive and many insurance companies won't approve except in rare circumstances.

When adding drugs that carry possible adverse inter-drug reactions and side effects (including those that are potentially life threatening) you have to weigh the options carefully.  For example, for someone who has no liver disease and is asymptomatic for Hep C, it makes less sense to increase the risks than it would for someone who has late stage liver disease. 

For some people it may be worth the risk to add the additional drugs, but not for all.  Lots of people are facing these questions now.  Tough decisions for sure.

 

 



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Sunrise747


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When I hit 8.5 hgb at wk 11 my doc sent me for a 2-unit transfusion which worked wonders.  I went from near-crawling to 30-minutes walks in 24 hours.  She had already reduced me to 600 mg riba where I remain.  She seems unconcerned about the lower dose but I am and would like to creep it back up to maybe 800.  I also took one shot of procrit which made my bones ache mildly affter a week or so, which lasted for 2 wks.  Last blood test was 2 wks ago and I was at 11.2 hgb.



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Geno 1B Relapser 2001. Started Incivek 12-16-11. 57 yr old male.  Last biopsy 2000 -stage 3 fibrosis. UND Wk4, 12, 18, 26.  Did 34 weeks.  Still UND at 12-wks post.
news


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My CRNP does both. She has prescribed procrit but advised me frequently on when and how to use it. But first she reduced the riba doseage from 1200mg to 600mg per day. Once the hematocrit began to come up she asked me to stop the procrit and is now gradually increasing the riba dose because I demanded it. The evidence and opinions are still a little unclear about dose reductions, so I am campaigning for the highest riba dose I can tolerate (up to 1200mg/day, of course). Right now things are looking OK, and I feel good.

Alan



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Geno 1A  Started Pegasys/Ribavirin/Incivek Nov. 20, 2011 .  Completed July 28, 2012 (36 weeks). For a treatment history, see:  https://jshare.johnshopkins.edu/xythoswfs/webview/_xy-9921874_1

SVR on January 14, 2013!!
innerview


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My doc, and I believe all drs. in Sweden only use dose reduction. My dose of Riba was lowered in week 3 to 800mg (4 pills) a day. My Interferon was lowered to 135 in week 5. My blood counts are stable now but low.

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Peace, Mark

1A, stage 2/3, TT, began TX with Incivo 1/31/12, Week 4 VL<15, week 7 UND, week 12 UND, week 18 UND!!! End of Tx July 31 VL UND!!!  I had to do 26 weeks total and was on half Riba and half Interferon for most of Tx. 12 week post Tx VL UND!
Piggles925


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Just curious...

My riba dose was reduced last Monday from 6 to 4 pills a day because my hemoglobin went from 13.5 to 8.5 in 3 weeks.

I have read that anemia in Hep C treatment actually predicted SVR, so I am not too worried about it.

http://www.gastrojournal.org/article/S0016-5085%2810%2901222-9/abstract

I learned in my treatment teaching session that my doctor prefers dose reductions for both riba and interferon to red and white blood cell stimulating drugs due to their side-effects.

Wanted to know what other people's MDs are doing when their red and white blood cell counts start getting too low...



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~Ms. Piggles

HCV+ since 1988.  Genotype 1b.  Last viral load UNDETECTABLE at week 7 of treatment.  Last liver biopsy 2/0.  IL28B TT. 

Started triple drug therapy with Incivek 2/23/2012.  Taking it day by day.
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