New evidence on the early treatment of low-risk PV patients (using IFN)

[Joey1025]

I saw this article: Final results from the Low PV study now published in the NEJM Evidence

fondazionefrom.it/fondazion...

"The results of the randomized, controlled phase II trial Low PV clearly demonstrated that the addition of ropeginterferon alfa-2b not only reduces the number of required phlebotomies but also brings additional significant benefit to the patient by better controlling the target hematocrit, stabilizing the disease and improving patients' quality of life."

It seems in this new clinical trial it was further demonstrated that using IFN (Besremi in this trial) early in the treatment of low-risk PV patients could be highly beneficial (if I understand correctly, low-risk PV patients usually are not treated with medication or PHL?).

Good news!

[Nrl303]

Hi, yes many benefits to go the interferon route when diagnosed.

I came across this article as well. Although, sample size is small, It still gives me hope. There have been reports that interferon can as you know achieve remission & sometimes reverse the disease in patients

pubmed.ncbi.nlm.nih.gov/199...

[hunter5582]

Low-risk PV patients are usually treated with aspirin and therapeutic phlebotomy. The goal is to keep HCT < 45% for males or HCT < 42/43% for females. Keeping the erythrocytosis under control is what reduces the risk of thrombosis.

The aspirin + phlebotomy approach can help control the risks of the disease but do not treat the underlying cause nor do anything to prevent progression. Symptoms like pruritis are not treated with this approach. In addition, chronic phlebotomy-induced iron deficiency can have significant adverse effects even when there is no anemia.

One of the issues with using phlebotomy is that by its nature, HCT will rise and fall. Hence the need for repeated phlebotomies. It is thought that there is benefit to continently keeping HCT at a stable target. While the significance is still in debate, the IFNs also have the possibility of reducing allele burden, possibly to the point of molecular remission. There is evidence that the IFNs have to potential to reduce the risk of the PV progressing.

There is also risks associated with the use of IFNs. We each have to do an individualized risk/benefit analysis to determine the best choice. Knowing what I know now and having experienced being on both Pegasys and Besremi, my only regret is that I waited as long as I did to initiate treatment with IFNs. It is the right choice for me.

Wishing you success in finding the right choice for yourself.

[Joey1025 in reply to hunter5582]

Thank you for providing such a detailed explanation. Very helpful.