Pegasus to Besremi switch advice please

[Cityreach]

Hi I just wanted to ask people's thoughts on switching from peagsus to besremi. I am taking peg 45mcg weekly so classed as high user due to the wastage on only using half syringe. I have been asked to think about swopping due to shortage of pegasus. I always worry about any changes in dosage or changing meds. I have been given a couple weeks to think about making the change although quite possibly be asked to change back once the peg shortage is over. Is there anyone who can tell me the benefits of bes over peg and positives of swopping apart from it's more available also is there anyone who has made the recent change, was there any side effects during the change ,any feedback to help with decision would be much appreciated I know there are some very knowledgeable people here who will know more than me on the pros and cons of switching to besremiThankyou

[hunter5582]

I switched from Pegasys to Besremi by my own choice when it was first approved. I found no difference in either efficacy or adverse effects. Theoretically, Besremi may have fewer side effects due to its monopegylated formulation but the reality is that many of us find no difference.

It is important to follow the dosing conversion when making the switch. The attached slide is from Dr. ruben Mesa. It is the only dosing recommendation I am aware of.

Pegasys to besremi conversion

[Cityreach in reply to hunter5582]

Thanks Hunter for your reply, thats exactly the dosage they told me today for conversion with the 45mcg weekly I take of peg currently, hope you are keeping well yourself

[Cityreach in reply to hunter5582]

Hi Hunter, sorry I meant to ask your thoughts on switching from a 45mcg weekly peg to 125mcg monthy of besremi would you consider that is a big jump in dosage of a new medication in one go, I am thinking about side effects in an increased dose , although I manage the peg weekly ok, I know the benefit would be 1 injection instead of 4, and they are telling me not to fixate on dosage, or do you think low and slow still and go for 63mcg fortnightly at the start

[hunter5582 in reply to Cityreach]

The standard conversion (noted on the slide) from Pegasys 45mcg qweekly is Besremi 63mcg q14days. The jump to Besremi 125mcg q30days would seem to be a way to try to find a tolerable and effective dose while saving money by not wasting as much Besremi. Here in the USA Besremi only comes in 500mcg syringes. I believe there may be a 250mcg Besremi in the UK. Regardless, there will be significant waste involved. I regularly waste 325mcg of Besremi every two weeks, which makes my skin crawl given how much Besremi costs here in the States.

It is understandable that you would be concerned about such a significant dose increase and going to a monthly basis higher dose of Besremi both in terms of efficacy and tolerability. It is worth noting that Besremi has a half-life of 7 days compared to Pegasys half-life of 80 hours. Others staying on Pegasys are being told to double both their dose and dosing time. It sounds like you have been given an equivalent instruction for Besremi.

Suggest you address you concern directly with your care team and ask fo the rationale for the dosing instruction. Being told to not fixate on the dosage is not an adequate explanation. I would note that I am taking 175mcg q14days and tolerating it OK. You may well do fine on 125mcg q30days but deserve a more complete review of your dosage concerns.

Please let us know what you learn

[Cityreach in reply to hunter5582]

Thanks Hunter for your weather of knowledge and always taking the time to share it

[AndyT]

If you’re doing well on Pegasys have you discussed with your doctor the option of extending the dosage to 90mcg every two weeks, as that’s another recommended solution to avoid wastage? I’ve recently doubled my interval and dose, to avoid discarding half the dose each time, and it seems to be working fine.

Of course the above only works if there is some supply of Pegasys available to you. If you do switch to Besremi, NHS England have issued guidance on the equivalent dosage, which your doctor should be able to access.

[Cityreach in reply to AndyT]

Thanks Andy, that is an option to dicuss thankyou, did you notice any changes or additional side effects with the increased dose of pegasus

[AndyT in reply to Cityreach]

No - I have only returned to the higher dose of 90mcg once but had no increased side effects (just a bit of tiredness) compared to 45. I was fine when on 90 previously too.

[Cityreach in reply to AndyT]

Thanks Andy