procrit dosing

[alice]

Hi folks,

So I've done 4 weekly shots of procrit (40K IU) and my Hgb continues to fall-- 8.5 this week. Doc didn't mention cutting back my riba-- I'm on 1200 but WBD should have me at 800. I expected some increase in Hgb by now.

Obvious solution is to cut riba and I--- gulp-- started that today even without waiting for doc to suggest it. Can't tell you how much this pained me, not with 2 failed tx under my belt already. I'm debating whether to increase Procrit... thoughts? Experiences? FYI-- past experience shows me that Procrit has a potential for *&*&ing up my menstrual cycle so I have it 2-3 times/month with a rip-roaring migraine every time. No good solution here so I'm looking for maximizing success rate. Oh, also what's best scheduling for B12 shots while on procrit?

Still doing 2 shots/week Neupogen, platelets low @ 60/70. 40 weeks, 3 days left.

thanks,
shalice

[inquiring mind]

I hate that you are in this situation I know you already kind of know my thoughts on this but:

Given that you did a lead in with an extra high dose of riba AND

you were UND even before starting telaprevir AND

you have a low body weight AND

Procrit can really mess you up;

I would dose reduce the riba even further. I'm guessing you dose reduced to 1000. We weigh about the same and my doctor's nurse told me 800 would still  be a weight appropriate dose. I am currently on 600. If I were you I would reduce to 800 or even 600, at least for the weekend. Reducing for a couple days doesn't mean you can't take it back up after you talk to your doc. It might keep you from dropping further until you can talk to your doctor, and an extra shot of procrit might just make you miserable for the weekend. I hope you are feeling ok.

 

Anna

[Trinity]

My God woman, you're a human pin cushion!  I wouldn't increase the Procrit, I'd wait and see how the riba reduction goes.  8.5 is sustainable for now and you will see the hgb increase once that riba reduction kicks in.   You're little like me, we have no business doing 1200 mg but as relapsers we tend to be desperado's.  I really think you can get by with a 1000 or even 800.  You were UND at 4 without the Incivek and it's hard for those of us who have failed SOC to wrap our head around the concept that more isn't always better but when there's a DAA added to the mix it's true.   The stats show in all the studies there was only a slight difference in SVR rates for those who were on reduced riba.

This is all just my opinion Shar - You've been around the bush more times than me so you know what you can handle and what you can't.  I know all too well a girl has to do what a girl has to do. 

Trin

[DougV]

Shalice,

Dunno what to tell you.  After 4 weeks you would have hoped to see some impact.  Not real sure what a good Procrit/B12 schedule would be.  I like three times weekly and of course folic acid and maybe iron. 

Not sure I would inrease frequency of Procrit, not with that interesting blend of side effects, but dang dose reduction scares the heck out of me.  This is of course why I have made the arrangements I have.

You seem to be experiencing a reaction similar to the one I did last time and as you know Procrit simply did not work.  I don't think you will be willing to go to far on the reduction route, you might consider a backup infusion plan. 

Please do not forget the bright side of this.  With the low hgb the bruising from the low platelets doesn't show. 

Off to do #11.

Doug

[banarep]

I know this is starting to sound like a broken record,  but after two failed attempts at treatment - first one a failed to clear, second one either a failed to clear or a relapse (depending on how you look at it)    my third attempt, my riba was reduced from 1200 to 600 and I weighed 170 pounds and here I sit SVR and healthier than I have been in 30 years. 

these new meds are changing the landscape when it comes to all the dosing thoughts and ideas. 

what my study doc told me was that after the telaprevir is done, the reduction does not seem to hurt the chance of SVR.

If you need to reduce riba and still get to stay on treatment, especially with the new drugs,,,,,you got to do it.

[greyrocker]

Sharon, this is so tough on you, I worry about the long-term effects.... If it was me, I would dose reduce to 1000 right away (you did, right?) and see where my HGB went, then go to 800 if needed. If you don't start to feel better quickly, you might not bother waiting and just go to 800. I don't think doing more procrit is the answer for you, and I would be more concerned about what it could do to you down the road.

I really think that banarep's experience is a good, legitimate yardstick for you. Like you, he had treated twice before unsuccessfully, but the telaprevir was the game-changer. I don't think that you need to worry as much about reducing ribavirin now as we did before with the old SOC. I have read a few reports  (sorry, no references right now) that seemed to support this approach in the Clinical Care Options site.

Hang in there kid.... 

greyrocker

[alice]

Thank you all. I really appreciate having you guys to bounce ideas around. I did my Procrit shot a few days early and have committed to 800 mg/day. Got the b12 shot and taking folic acid. Blood draw as usual on Tuesday.

How long should it take to see effects of decreasing riba? As you all understand, I am concerned about cutting doses, lowering tx effectiveness, taking more Procrit, and what will happen if the procrit really isn't working... Too much to think about sometimes. Thanks for listening to me.

On the upside, i can hang at 8.5. We just got back from a very sedentary camping trip. We saw a big black bear on the drive home. I'm glad to be back in bed with my heating pad, tho! 

sharon

[greyrocker]

Good for you! Seeing as you've gone down 400mg, you should feel the change within a few days, maybe even sooner.

Keep us posted, alice shalice sharon! 

GR

[banarep]

just let us know girl, we are concerned and very hopeful that this is it for you.

[snapplecandy]

what my study doc told me was that after the telaprevir is done, the reduction does not seem to hurt the chance of SVR.

If you need to reduce riba and still get to stay on treatment, especially with the new drugs,,,,,you got to do it.

Banarep, big question is where in the timeline does dose reduction hurt the chances of SVR? You mentioned study doc said AFTER telaprevir is done, there doesnt seem to be effect on SVR. What about before telaprevir is done with early-onset anemia with triple therapy? Combo studies show there is a difference if dose reduction occurs before 8 weeks.

Hang in there Alice. I just went to 1000 3 days ago and wondering when I will see a difference in how I feel. Im at 9.0 and heading in your direction. I dont know how you do it at 8.5. Im getting a few good hours in the morning. On the upside, day after shot is getting better. Go figure

[alice]

Banarep, big question is where in the timeline does dose reduction hurt the chances of SVR? You mentioned study doc said AFTER telaprevir is done, there doesnt seem to be effect on SVR. What about before telaprevir is done with early-onset anemia with triple therapy? Combo studies show there is a difference if dose reduction occurs before 8 weeks.

oh dear... where is this study?

[inquiring mind]

I think they were using this as a reference, please correct if wrong:

http://www.natap.org/2011/EASL/EASL_41.htm

[alice]

WOW! Hgb up to 10.1 in one week! It's been a week since a procrit shot so i'll do that now and try easing back up to 1200/day. To be honest, I forgot to cut my riba dose a couple of times (I am SO accustomed to tossing back 3 riba pills it's a habit) so getting back to where I was won't take long. Only a few more weeks of incivek and then the anemia should get a little better. 
 thanks everybody!
alice

[snapplecandy]

This is great Alice! How are you feeling? better?

[greyrocker]

Good to hear, Sharon. Are you sure you don't want to split it in the middle and go up to 1000 instead of 1200? Think about it, although I'm sure you have. Anyway, over 10 is great when you've been below, right? 

GR