Change to interferon alpha

[hansyhand]

Hi all, I've just had a call from the hospital pharmacy and apparently I'm being transferred to interferon alpha... I was on Pegasus. I'm just wondering if anyone can explain the difference? My haematologist didn't mention anything, it's the pharmacist who's told me and I've now got to travel to Doncaster to collect whereas Pegasus used to be couriered out to me. Alpha doesn't qualify for home delivery?

(To be honest, I'm not bothered about collection...felt a bit cheeky having it delivered since COVID but I'm just wondering why the difference/ what the difference is with the meds).

Thanks in advance 😁

[hunter5582]

Pegasys = PEGylated interferon alpha 2a. Besremi = ropeginterferon alpha 2b. They are both Pegylated interferons. The formulation is different but they are very similar. Beremi is different in that is a monopegylated form of interferon that has a longer half life. It can be dosed every other week instead of weekly.

I have used both. I did not experience any difference other than the frequency of dosing.

PEG and BES have both been effective and easy to tolerate. The IFNs have effectively managed blood cell counts and reduced JAK2 VAF from 38% to 10%. Side effects have been minimal. Much easier to tolerate that hydroxyurea or phlebotomies.

Wishing you all the best.

[hansyhand in reply to hunter5582]

Thank you - that's reassuring 😊

[Kelly2 in reply to hunter5582]

Hi.thank you for the information. What about hypothyroidism and interferon? Any problems?

[hunter5582 in reply to Kelly2]

I have not experienced any thyroid issues,

[Kelly2 in reply to hunter5582]

What I meant is is it suitable for me? I have hypothyroidism. I had read somewhere that interferon needs caushiousness with hypothyroidism.

[hunter5582 in reply to Kelly2]

There is a caution if you have an endocrine disorder. This does not mean you cannot take it but does mean you need to be closely monitored.

[EPguy in reply to Kelly2]

IFN is closely associated with thyroid disorders. Normally these can be treated and allow continuing IFN therapy. But care is indicated and your Dr should be consulted and well informed on this risk.

From the Bes label:

--

5.2 Endocrine Toxicity

Endocrine toxicity has occurred in patients receiving interferon alfa products, including BESREMi. These toxicities may include worsening hypothyroidism and hyperthyroidism. Autoimmune thyroiditis and hyperglycemia, including new onset type 1 diabetes, have been reported in patients receiving interferon alfa-2b products. Eight cases of hyperthyroidism (4.5%), seven cases of hypothyroidism (3.9%) and five cases (2.8%) of autoimmune thyroiditis/thyroiditis occurred in the development program of BESREMi"

So over 11% suffered a thyroid event with hypothyroidism being ~4% which is "common" by the Euro definition.

-and a critical note on related autoimmune risk:

"Do not use BESREMi in patients with active serious or untreated endocrine disorders associated with autoimmune disease"

This is part of a broader serious risk potential of IFN with autoimmunity in general. Do you know whether your hypothyroidism is of the autoimmune sort?

--

accessdata.fda.gov/drugsatf...

[Kelly2 in reply to EPguy]

Hi. Thank you for looking at it. I don't know about the autoimmune. I will have to check that before anything else. I am very disappointed 😢

[EPguy in reply to Kelly2]

No need for disappointment too fast. I see you've been on PEG a long time. That is a good start. Both Bes and PEG are IFN-a2, so there should not be any specific added risk with Bes. But if the thyroid condition started recently your Dr should be advised.

Thyroid conditions are common and often of the non-A-I sort. Such members here are often doing fine on IFN with standard thyroid meds. But existing A-I, or emergent while on IFN, is a something you want your MPN Dr to consider while on any IFN.

You can see my posts why I try to watch out for other members on this topic.

[Kelly2 in reply to EPguy]

Hi! Actually I've never had interferon. Only hydroxyurea. That's why I am scared!

[EPguy in reply to Kelly2]

So sorry for the confusion with the OP, my mistake. You should ask Dr whether your Thyroid condition is of the autoimmune sort and ask for tests if this is not known. From posts here, it seems most are not and these members seem to do fine on IFN with standard thyroid treatments if needed. You should also ask your Dr how much experience they have with IFN, many have not much.

I also went to Bes from HU and with the smaller dose I wanted it likely would have gone well.

[Kelly2 in reply to EPguy]

Thank you so much for your time. You are helping me in what to watch and ask. Bless you and thank you again.

[EPguy]

All IFN's for MPNs have been the alpha type, while there are other Greek letters not used for MPNs. Sometimes "Interferon Alpha" can refer to the old types without pegylation. These required frequent dosing. But these should no longer be available. As Hunter says, you're likely going to Besremi, you can know it's Bes if it starts at every two weeks dosing.

I've posed details on this whole area over the years, here are the main three for those interested.

--

"Interferon types, Old and New, what are the options?"

healthunlocked.com/mpnvoice...

what-are-the-options

--

"What and Why is IFN Pegylation?"

healthunlocked.com/mpnvoice...

--

"Interferon Alpha 2-a (PEG) vs 2-b,(Bes) exactly what's the diff?"

healthunlocked.com/mpnvoice...

[hansyhand in reply to EPguy]

Thank you 😊

[light]

Hi there, just to suggest to ask pharmacist when you pick up your meds, then you will get more info about which type of Interferon it is and the difference between. Wishing you best.

[AnitaJ]

Hi, Interestingly I had a phone call with a consultant on Friday and she has decided to give me one injection of Peg. Interferon to see how I go. I said that I did not think that I would be put on it as I was seen as lower risk than some and was put on a break. However, whilst my bloods are within the normal range, though the platelet count is rising, I explained that I was getting symptoms and for once I was listened to and she agreed to prescribe one injection and then review in 6 weeks. Apparently the hospital is getting about one third of their normal quota of P.I. The plan is to see if I can manage the occasional injection. Prior to the "break" I was seen to have a "complete response" to Peg. Interferon and felt pretty good on it. I hope that the next six weeks help me to continue with the support I received on Friday, as the previous consultant was fairly dismissive. Hunter5582 's response is, as usual, very informative. This is such a good place to find information.