Hydroxy to Pegasys switch

[intothewoods]

Hello - couldn’t find this on a search and wonder if you can help.

Here’s the context: Partner is 33, ET triple negative with acquired Von willebrand on 1.5mg hydroxy a day after heart attack and platelets approaching 2m. All under control now after a lot of time adjusting the dose.

We’re thinking of trying for a second child sometime in the next 12 months so would look to do a long wash out of hydroxy and then move onto interferon.

My question is - Has anyone made the switch this way? How was it managed?

I’m hoping we won’t be back to square one with getting counts under control.

Sorry this is so long!

[fee13]

From what I believe (& I could be wrong) the hydroxy will bring his platelets down faster. They may want to get them below 1 million at least as quick as possible. Some have combined both medications when starting interferon as it can take a 6 odd months to work. This would include a lower dose of interferon for a couple of weeks & usually upping the dose over a period of a month or so. So it could be a lengthy transitional period.

[intothewoods in reply to fee13]

Thank you. Platelets are currently in a normal range so I’m hoping it won’t send them back up!

[SuET2017]

Hi

I am ET triple neg and was on hydroxy and had acquired VW. Due to side effects of hydroxy I am now on pegasys (for about 6 months now) with very mild and more than tolerable side effects and my platelets came down from over 1200 to within normal levels within 4 weeks of starting pegasys. For me it’s been great.

[intothewoods in reply to SuET2017]

Thank you! It’s brilliant you’ve had a better response to interferon.

How did the doctor manage the changeover? Did you have a gap or did you take both at the same time in smaller doses for a while?

[SuET2017 in reply to intothewoods]

I did have a break, but only because I was so unwell from side effects. And then I tried the non pegalated interferon, again with side effects. Then had a break. And no I didn’t take them both at the same time, though my platelet count went up when “on a break”.

[Mazcd Partner MPNVoice]

Hi, this information on our website might help

mpnvoice.org.uk/living-with...

[intothewoods in reply to Mazcd]

Thank you!

[charl17]

I have proliferative phase PMF. I was off of Hydrea for 10 weeks before starting Pegasys. It took a month to get my platelets back under control. Whites and reds took much longer. With your partner's ET the issue is probably high platelets. Pregnancy may not be wise before your partner has been off of Hydrea for several months. This might be the factor which delays pregnancy rather than the time it takes Pegasys to work.

[intothewoods in reply to charl17]

Thank you!

[hunter5582]

HU is highly teratogenic. It is very important for couples to wait at least 6 months for a woman and one year for a man post-discontinuing HU to have a child. You should also have been advised to use condoms to protect the partner while on HU as it passes into semen and vaginal secretions. Since HU is also a carcinogen and a mutagen, protecting the partner is important. Women of child-bearing age (not on HU) are advised to not even handle the HU bottle without gloves. I recently saw a reference to the same warning for men, though I have not seen that confirmed.

HU does work for lowering platelet levels for high-risk patients. For many people the benefits outweigh the potential adverse effects, but not for anyone who want to have a child. Hopefully your partner can work with the hematologist to switch over to Pegasys and see how it works.

All the best.

[intothewoods in reply to hunter5582]

Thank you! Our haematologist said it takes 3 months for it to leave his system and then it’s safe to conceive. Do you have any links to data we can show her about the 12 months you mentioned?

[hunter5582 in reply to intothewoods]

This is from the monograph re. hydroxyurea on the ePocrates on-line application. ePocrates is a professional level drug information service

Pregnancy

-

Individuals of Reproductive Potential

obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and for at least 6mo after D/C in female pts and for at least 12mo after D/C in male pts

Here is a link to the monograph.

online.epocrates.com/drugs/...

You can usually look up one drug for free without a membership.

If you have any trouble, you can go to the base website and sign up for the free-level membership online.epocrates.com/ . This is a terrific service and offers professional drug monographs, patient education leaflets, and drug interaction check.

Please do be careful. While HU can be very beneficial for some, there are serious potential adverse effects .this is a toxic medication.

Hope that helps

[intothewoods in reply to hunter5582]

So helpful. Thank you so much.