1st dose of Besremi

[Cityreach]

Hi, I did my first dose of besremi tonight ( changed from peg due to shortage) was nervous with the change of how to use new pen type and forgot to check if there was any sign of a droplet on needle tip before I administered. I did the 1st pen use put it on the droplet icon, pressed the end it went back to 0, then adjusted to my dose of 60 and administered, pen went back to 0, I waited 10 seconds and removed needed, no liquid around injection site but can see puncture mark, now I am worried if I actually gave myself the medication, it's not like peg where you can see markings on syringe, I know the pen returned from 60 to 0 but because I didn't check for any droplet on needle before I injected and there was no liquid around injection site I worry if I did it right, I don't want to do again incase I did do it right, anyone know the chances that just because I didn't check for a droplet at the start and area was dry at end if it may have been administered ok, I know no one really knows the answer just wondered if anyone can say they don't check for droplet before administering and their injection site Is dry afterwards too, guess I could be over thinking it all too, I am not due next dose for 2 weeks now.

[Dane12]

Hi,If I understood well your question, in case you still have the pen, then you can check how much quantity is left in the pen by rotating the cap to the very end of the travel (hard stop).

Typically, the manufacturer adds an extra quantity of 50-60 ml to allow the priming of the pen several times.

If the pen used was of 250ml, and you used 60 ml and one prime (one push with the indicator on the droplet), then the quantity left in the pen should be around 230-240 ml.

Hopefully it helps.

[Cityreach in reply to Dane12]

Hi, I tried what you suggested and there is 1 turn/click left after the 250 marker on the used pen, I opened a new pen and there is 10 turn/clicks after the 250 marker, I am hoping both pens were the same which may mean I used some of the medication although it does not equate to 60 as I believe its 5 per click.I am annoyed with myself I missed that step on checking any droplets coming out before I administered

You are calling priming the needle as the one push, do you do that both times you use the pen that's if your dose allows 2 uses. I was told you only need to do it on the first use of the syringe but I feel it might make me feel better to prime each time and watch for the droplet to know it was coming out.

[Dane12 in reply to Cityreach]

You need to prime the pen only for the first use.

[Cityreach in reply to Dane12]

Thanks Dane

[Cityreach]

Thanks so much, I will give that a try

[AndW65]

Hi all, I was diagnosed with PV in 2018, I had my first dose of Besremi yesterday as well, (250mcg biweekly), having switched from Pegasys (180mcg weekly) after 2 years of taking it.

I take mine in the morning as I’ve never experienced the flu symptoms. My hematologist consulted with other specialists and used the conversion table for calculating the dose when switching from Pegasys.

It went well using the new pen type injection except they don’t seem to tell you that the needle shield can only be retracted once, so it’s best to leave it alone until you press it against your skin, even if you’re checking for the initial droplet. Luckily each pen comes with 2 needles so I was able to use the spare.

I found the experience completely painless compared to the standard Pegasys injection with no leakage or blood when retracting the needle. I usually use the area either side of the naval to administer injections and although these sites are relatively pain free I found I could still feel it slightly, however with the tiny needle in the new pen it was completely painless.

Just for clarity my previous treatment has included:

Pegasys Interferon 180mcg weekly

75mg Aspirin weekly

150 mg Allopurinol weekly (half a 300 mcg tablet)

Venesections as required, 5 to 6 x 450ml on average per year, (so far 5x for 2024)

New treatment will swap Pegasys for Besremi, with tablet dosing remaining the same.

Hope this helps

Wishing you all a very Merry Christmas

Best regards

Andy

[Jazzyb50 in reply to AndW65]

Andy, was the dose for Besremi the equivalent to Peg, or do you need to start low with Besremi and build up?

[AndW65 in reply to Jazzyb50]

Hi Jazzyb, apparently there’s a conversation table available for patients who have been on Pegasys and have had to switch over to Besremi due to the shortage. Initially I was supposed to start on a low dose and gradually increase until I reached an equivalent dose.

I actually first heard of the conversation table here on this site as someone posted it. When I went for my appointment I was informed that due to the quantity of Pegasys and my tolerance to it, I had been on I would be starting at 250mcg, which is nearly what I had worked it out to using the conversion table posted on this site (252). Up to now I feel no different and have not experienced any issues.

Best regards

Andy

[Jazzyb50 in reply to AndW65]

Thanks for your reply and the conversion table Andy. Good to hear you don't feel any different!Jane

[AndW65 in reply to Jazzyb50]

this was the conversion table posted on this site.

Conversion table

[Jazzyb50]

Hope you've managed to do it correctly Cityreach, it sounds very complicated! I will be switching to Besremi when my Peg runs out. I'm feeling very apprehensive about it after 6 years on Peg. Let us know how you get on.

[Ginestragiallo61]

HI I too have been using Besremi for two years with excellent results. And I too was initially anxious about the injection, but it is easy once you understand the mechanism. Before setting your dose, however, try to push the syringe a little on the drop symbol, you will see a drop on the top of the needle. Set the dose and proceed with the injection. You will only see a small dot where the gel enters, but no liquid on the skin. be confident, everything will be fine. my best wishes for your health and happy holidays.

[Jazzyb50 in reply to Ginestragiallo61]

Good to hear about your excellent results on Besremi. I'm screenshotting all the advice in preparation! Wishing you all the best 😊

[Cityreach in reply to Ginestragiallo61]

Thankyou have a lovely Christmas and new year

[Ovidess]

I'd love to read more about the availability of the new Besremi pen. I use a needle and have to dispose of most of this medicine, which is a terrible waste of vital medicine and a needless drain on Medicare and our insurers. (I don't feel sorry for insurers, but when there's waste we all pay more.) Can someone tell me what sort of dose sizes are available with the pen? Is it in use in the USA?

[RoundTheWorld in reply to Ovidess]

(uk) 250mcg (and 500mcg pen is also available I think)

[Cityreach in reply to Ovidess]

HiI am in UK just using the Besremi pen for the first time this week. It's a 250mcg pen, I will only use 120 mcg over 2 uses out of that so again the rest 130mcg has to be thrown away, I do agree it's such a waste the same with pegasus I would have to throw half of that away too that's why I have been moved to besremi I was told they are trying to move the people who have to waste the peg to save it for people who use the whole syringe, although they say it's still wastage but there is no shortage of besremi, that's what I was told

[EPguy in reply to Cityreach]

That is still much less wasteful than the US style 500mcg syringe. 1st, it's only 250mcg, and 2nd it gets reused. For example a US pt on 75 mcg using the official procedure throws away over 425mcg with every use. The 250 UK pen is equiv to a 125 syringe with regard to wastage.

Still it is a shame to throw away any of such a costly med.

[Cityreach in reply to EPguy]

Wow that is alot of wastage especially where you pay for your medicines

[EPguy in reply to Cityreach]

In the US most or all pay zero when not on medicare. After age 65 (usually) medicare costs $2000/year, so there is no personal financial incentive care other than the aggravating waste. Rux, which I 'm now on, doesn't have this issue since it's a pill.

[EPguy]

The US FDA rejected the Besremi application that used the pen. Implication was that while it was usable the instructions and/or procedure were too complex for too many pts to use. That is how the US ended up with the basic and extra wasteful syringe. So you've got company on the confusion.

[Cityreach in reply to EPguy]

I got mixed up on the first injection too, I do think maybe first injection of any new drug the first injection should be done supervised at clinic, although I had a call out of the blue yesterday from a nurse at Guys who asked how I got with first dose and sent me a video she said the company have a video how to use and sent video to me, there is still wastage with the pen too you would think the drugs are made with more options of dosage to save wastage...but then they have no incentive to do that they probably don't care it gets wasted, all about the money

[Ovidess in reply to EPguy]

There was a trial regarding that pen application that I applied for but did not get in on. It took place in several US cities, so obviously it could come here eventually...

[EPguy in reply to Ovidess]

Quite interesting, I assume that was after 2021; that's when the pen was rejected. Maybe they made some design changes too. Problem with IFN for MPN is the huge variations in dosing. Maybe insulin has similar large diffs, they seem to have solved the pen design there.