How long for liver counts to stabilize?

[mother2britton]

My specialist recently put me on a Pegasus "Holiday" due to liver ALT 224 and AST 91. We are going to do some labs of course and when/if things return to normal I can return to PEG. I was on bi-weekly 90mcg and that dose kept my CBC all within normal limits with my platelets at 350 to 380. Its going to be disappointing watching my platelets clime again after taking so long to get them under control. So my question is, has anyone had to discontinue PEG for their liver and how long did it take for your liver counts to return to WNL? Thanks and stay well.

[Steve_Essex]

I cant answer the specific question for how long.. but I do know supplements like milk thistle have been linked to helping liver recovery and repair.. might be worth trying to support the recovery process.

[mother2britton in reply to Steve_Essex]

Thanks for the reply, I have been trying milk thistle for about six weeks now. 500 mg daily. I will keep trying though. Thanks

[hunter5582]

My experience when my LFTs were 3x/ULN on 150mcg Besremi was that there was no need to take a IFN Holiday. I was prescribed 500mg qd Silymarin (milk thistle extract), which restored my LFTs WNL within a matter of several weeks. My reaction cannot be used to predict yours however. We are all different.

I know you are taking milk thistle extract. Not sure which formulation. Note that it does matter. Note also that milk thistle extract works for some of us but not for all.

One thing to consider is whether you need your PLT < 450. There is no evidence that there is a clinical benefit for all people with ET in making PLT normal. The goal needs to be individualized to your case. Perhaps a change in goal and a lower dose of PEG would be appropriate. This is something you would need to discuss with a MPN Specialist who knows your case.

The broader answer to your question is that it is not uncommon to temporarily discontinue a cancer treatment medication when adverse effects occur. Rechallenge with the medication can be done when appropriate. Sometimes, second time is the charm. An MPN Specialist would be the best one to explain this.

Do please let us know how you get on.

[Mustang50]

Hi interested in reading this although sorry this is happening to you, I also have been on peg and the same thing happening, blood counts are great except for liver function, at the min they have lowered peg dose from 45ml every week to every 2weeks now every 3weeks having bloods taken next week to see how things are going, do hope you get some answers and manage to settle the liver best wishes!

[Solyesh]

very similar experience - after about 3 months on Peg and good CBC readings my liver function readings shot up - my MPN specialist suggested a Peg holiday to see if they’d return to near normal - I was off Peg for about 6 weeks (had been on 180mcg/every two weeks). The readings dropped to near normal and we restarted Peg, this time at half the previous dose (so 90mcg / every two weeks). I also started milk thistle during the interval (also Silymarin to Hunter’s post) - my body was able to handle the Peg at that dose and the CBC numbers again started to normalize. So it took 6 weeks off and another two months for the liver readings (on milk thistle and lowered dose) to get back WNL.

[AndyT]

How many consecutive abnormal LFT results have you had? I’ve been on Pegasys for 8+ years and have had occasional abnormal LFTs but they have always resolved by my next 4-month blood test.

No issues since I’ve been on a maintenance dose of 45mcg every 4 weeks, so maybe discuss with your haematologist reducing the dose and/or frequency rather than stopping Peg completely and see if that helps?

[ainslie]

you have good answers already, Hunter covered it well, is there some reason you need platelets at 350-380, most experts won’t treat platelets at double that or more unless symptomatic or other related health issues. Maybe slightly more platelets and less Peg might be fine, worth discussing with a MPN expert if you can

[JT_Marlin]

i feel your pain - ive been on Peg 90 for a few years now - works excellent to bring my platelet numbers way down with minimal side effect except for elevated liver enzymes. I also like to enjoy wine and take a statin. Ive found milk thistle capsules to be incredibly effective at lowering enzymes - mine end up right around 40.

[mother2britton]

Yes, great answers thank you. My LFT's have been bouncing around for the last year in the 2x maybe 3x upper limits. My specialist and I had agreed that under 600 platelets for me would be acceptable. We adjusted my dose from 90mcg weekly to 90mcg bi-weekly in November to start working towards this goal and hoping my LFT's would decrease. Instead December, January and February they jumped from AST 53 and ALT 111 to to AST 91 and ALT 224 with the bi-weekly adjustment. I started Silymarin 500mg by Pure encapsulations sometime in January as well. I see why he (and me) is worried and we are running the appropriate liver tests to be safe. But (little history here) we were very aggressive in getting my platelets under control do to an M.I. around 2 years ago when my platelets were in the 980 range. My heart cath was unremarkable and my cardiologist claims my veins and arteries were like a 25 year old's. I had a few cardiac episodes when my platelets were in the 800"s that I administered sublingual nitro to relive the pain. I haven't had any problems since we got my platelets under control. So it was a race to get my platelets down and now a race to get ALT AST down. I am trying to get an appointment with my specialist again and talk about raising platelets slowly with dose adjustment, I would like to see maybe 45mcg bi weekly or even monthly at least this way if my ALT and AST continue to clime coming off 45 will not be as big and fast of a platelet climb. My plan will be, they came down slow lets let them up slow. I hope he understands my concerns, I DO NOT want another heart cath, life flight or worse. Thank you for the responses it made me rethink things and get another appointment. Stay Well.

[Luthorville]

When my Besremi dose climbed to 400 my ALT climbed to 80. They cut my dose to 350 and my ALT declined to 39 in 2 months. Obviously I wasn't that high at 80. It seems everything is finding the right balance.