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Adverse Event Management

Adverse Event Management. Short Cases. Case 1. 68 yo WF with HCV geno-1b cirrhosis, prior partial non-responder to PEG/RBV stopped after 24 weeks with HCV still detectable. Required both PEG and RBV dose reductions. PMH Psoriasis treated topically w/ good control

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Adverse Event Management

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  1. Adverse Event Management Short Cases

  2. Case 1 • 68 yo WF with HCV geno-1b cirrhosis, prior partial non-responder to PEG/RBV stopped after 24 weeks with HCV still detectable. Required both PEG and RBV dose reductions. • PMH • Psoriasis treated topically w/ good control • Mild depression – not treated • No cardiovascular disease; otherwise healthy • Exam: • 5’2”, 62kg, • Spleen tip; psoriatic patches on elbows (mod)

  3. Case 1 • LABS • AST 78, ALT 45, AP 123, TB 1.2, INR 1.0, Alb 3.7 • WBC 3.2K, Hgb 11.7, Plts 121K • U/S: cirrhotic appearance, no mass. (AFP 22) • HCV RNA: 765,000 IU/mL • Treatment: • Boceprevir 800 mg TID w/ PEG + 1000 mg RBV • Week 2: WBC 2.8K, Hgb 9.8, Plts 100K (RBV to 600) • Week 4: WBC 2.6K, Hgb 8.9, Plts 96K (marked fatigue) • What to do?

  4. Case 1 • Course: • RBV reduced to 400 mg and Procrit 40,000 ordered • Week 4 HCV RNA: 57,000 IU/mL • Boceprevir initiation delayed 2 weeks • Hgb increased to 10.8; RBV increased to 600 mg • Boceprevir started at week 6 • Week 8: WBC 1.9, Hgb 9.4, Plts 86K • Week 10: WBC 1.7, Hgb 8.9, Plts 78K; PEG reduced 135; RBV reduced to 400 mg; HCV RNA: <43 IU/mL • VERY fatigued, SOB, more depressed….continue???

  5. Case 1 • Course: • Week 12: WBC 2.1, Hgb 8.7, Plts 81K; • HCV RNA: undetectable • Patient decides to quit therapy…”never felt so bad!”

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