Good article. We always worry when we have to reduce. I reduced several times in the 48 wks from 3 pills twice a day to 2 and worried. It does bring the HGB up though. Thanks.

Yes I have seen a lot of anxiety about that so thought this would be good to post!

Good article thanks Kramer

Yep.
It's interesting to see this info was extracted from the clinicals, numbers were already posted.

The one thing I noticed in the study is:
People always ask about ribavirin dose reductiondoes it matter? The second question we ask is, Should the dose be increased after the anemia is recovered?
1. The dose reduction data suggest it doesnt make any difference, and 2. that ribavirin does not need to be increased.

The package insert for telaprevir calls for physicians to use the labeled ribavirin dose-modification guidelines to manage anemia.

http://www.gene.com/gene/products/information/pegasys/pdf/pi.pdf

From pg 5-pg 8
2.4 Dose reductions pg 8

Adult Patients
Once COPEGUS has been withheld due to a laboratory abnormality or clinical adverse reaction, an attempt may be made to restart COPEGUS at 600 mg daily and further increase the dose to 800 mg daily. However, it is not recommended that COPEGUS be increased to the ORIGINAL dose ( 1000 mg or 1200 mg).

Although it's great that the data already presented leans toward not mattering and not needing to increase riba after reduction. In light of the facts, staying within protocol is still suggested.

The problem is once we step out of mfg dosing protocol, liablilty immediately shifts to the Physician, RN, PA, LPN or NP.
They (MD, etc) then would be completely responsible for any problems or liability and the mfg is then completely released of any liability to patient if need be.

Until I see a revision from Vertex on paper, I would continue to follow Vertex suggestion to refer to Gennentech's Peg/Copeg for their redux protocol.
Just a different point of view!
Thanks ImKramer!
You continue to keep us well informed!

Thank you Mike! :)

I had interferon and RIBA reduced during treatment and I always wondered if it affected my ability to clear the virus. Will never know and there are so many factors that affect how you will respond to treatment.

I was one of those who's HGB tanked within a week of starting tx. I started at 1000 mgs of Riba, could not be given rescue drugs because of having had Cancer, and doc was very leary he said of giving me a transfysion because my immune system was acting very strange before tx.

He reduced me to 400 mg riba for 4 weeks, my numbers came back up to between 11 and 12, so I went to 600 mgs. Doc said that 600 seems to be the magic number. Sounds like this article is spot on. Thank you Kramer for posting it.
Course...how the hell do I know what works....I got taken off.......

Actually Kelly, the article suggests no additional increase of riba once reduced is necessary.
We both were reduced, then raised.
They also find that redux of 200 and 400 mg pr day needed no increase either. So, the study claims it was unnecessary for your Dr to have raised your riba dose once reduced to 400.

I'm glad we were raised. I want all the extra percentage points of SVR I can get!

It also states This study gives us some degree of confidence that we can reduce ribavirin.
Unfortunately, Some degree of confidence is not enough confidence for me.



It also states This study gives us some degree of confidence that we can reduce ribavirin.

I take 1000mg a day of Riba. I have not had a reduction of Riba or Peg since day one.So far so good.