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What Are Indicators to Raise or Lower Interferon Dosage?

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Published on February 4, 2020

Key Takeaways

  • The main indicators for raising or lowering the interferon dose have to do with symptoms of progression.
  • If you are experiencing symptoms like spleen growth, itchiness, night sweats, LDH levels increasing, that’s usually an indication to increase the interferon alfa-2a (Pegasys)  dosage.
  • Some people who are on interferon experience dose-dependent depression. Your doctor might need to lower the interferon dose until you feel better.

Myeloproliferative neoplasm expert Dr. Catriona Jamieson, from UC San Diego Moores Cancer Center, answers a question submitted by an MPN patient on what factors doctors look at when raising or lowering interferon dosage. Dr. Jamieson also discusses how some patients experience dose-dependent depression and what to do about it. Watch now to hear an MPN expert perspective.

This is an MPN Research Foundation program produced by Patient Power. We thank Celgene for their financial support through grants to the MPN Research Foundation. These organizations have no editorial control, and the program is produced solely by Patient Power.

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Transcript | What Are Indicators to Raise or Lower Interferon Dosage?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:         

Linda wrote in, "What are the indicators to you of the need to raise or lower interferon dosage?" Because we have a lot of people who are on interferons. So, how do you know what dose is right?

Dr. Jamieson:             

You know, I think that's such a great question, and actually at the last NCCN panel meeting, we debated interferon really rigorously, because there are different types of interferon now. Most people are on peginterferon alfa-2a (Pegasys) and actually tolerate it very well. And I think that the main indicators for raising or lowering the dose really have to do with symptoms of progression. So, if people are having their spleens grow, they're getting itchy skin, having their night sweats come back, having their lactate dehydrogenase or LDH levels in other words go up.

That's usually an indicator that we want to adjust the dose upwards, so we're going to want to go up on the Pegasys dose. And that's just a weekly dose. The range is all the way from 45 up to 180 micrograms under the skin weekly. And it's really a patient-specific dose, and 45 is the absolutely lowest—not normally therapeutic. Usually people range in dosing from 90 to 180 micrograms, and it's symptomatic.

It's also normalizations of counts, and now we're getting a bit greedier. We're starting to look for molecular responses in addition to a reduction in actual fibrosis in the marrow. So, there's a suggestion that if we start early enough in low to intermediate risk myelofibrosis, we may be able to make incursions on that scarring in the bone marrow and actually reduce it.

And then the question is can we also reduce the variant allele fraction, orJAK2 mutation burden, or calreticulin mutation burden. Why couldn't we look at that before? Well, because we didn't have next-generation sequencing panels that could be done on the blood. And now in many centers, we have those panels of 150 some odd genes, but we can actually measure the level of the mutation. And that has changed everything, because we can do the peripheral blood test and say, "Oh, okay. Your JAK2 mutilation fraction or variant allele fraction, VAF, is 60 percent. If you go on Pegasys, can we lower that? 

Andrew Schorr:         

So, you see why this woman is a scientist and getting in a lab. And many of the doctors we feature who are MPN experts spend time in the lab, and then maybe it's one day a week, two days a week. And they travel a lot. They see you in clinic. And you want that bridge between science and what you're getting, or through these NCCN guidelines to inform your local doctor if you're not near one of these research centers. 

Dr. Jamieson:               

I did want to mention one more thing about interferon, and that's this insidious depression that some people get that appears to be dose dependent. 

Andrew Schorr:         

You mean just feeling sad? 

Dr. Jamieson:             

Just plain sad, sadness, depression, all the symptoms of depression. It's a known side effect of interferon, and we have to remember that, because it's dose dependent. So, what I do is sometimes I have to lower the dose, because of this incipient depression. And we lower the dose, and then after a few weeks people feel better.

Andrew Schorr:         

But not going on antidepressants. 

Dr. Jamieson:               

They can just for the shorter period of time to get over that, but generally they get better with just lowering the dose. And they—usually it's people that have had a preexisting history of depression in the past. But I have had that happen, where it was quite profound. And we've had to lower the dose and then see if they get better, and they generally do.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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