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What are pros of hydroxyurea vs other methods of lowering platelets?

Blood Cancers & Disorders | Last Active: 4 days ago | Replies (35)
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@eferret

Over the last few years, studies have shown that reducing the allele burden for PV and ET patients is just as important as maintaining healthy blood counts. The traditional drugs prescribed for PV and ET, hydroxyurea and anagrelide are not very effective in reducing the allele burden over the long term. After 10 years or so on these medications, some patients progress to myelofibrosis which is a non-reversible scarring of the bone marrow and may require a transplant.
To reduce the risk of progressing to myelofibrosis, interferon drugs such as Pegasus and Besremi have been approved (so far for PV patients) to lower the allele burden as well as to control blood counts. A study released this month for ET patients called SURPASS-ET compared anagrelide to Besremi. It showed that Besremi is more effective than anagrelide in reducing allele burden and controlling blood counts. Hopefully Besremi will be approved for ET patients soon.
You can read about the SURPASS-ET study:
https://www.targetedonc.com/view/ropeginterferon-alfa-2b-succeeds-in-phase-3-essential-thrombocythemia-trial

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nohrt4me | @nohrt4me | 4 days ago

Yes, that tallies with what I hear. Because of my age (70), I am not much interested in the interferon-based drugs. But I do not understand the hold-up in approving these drugs for ET. (Actually HU is technically off-label for ET, but insurance pays because it's generic and cheap.)

Younger people would certainly seem to benefit from interferons, both because they slow disease progression and because they are safe for pregnant women.

In Europe, using interferon for ET patients under 40 is pretty standard. There is a risk of depression with these drugs, and I have talked to other older patients who went off Peg because of that side effect. I already have anxiety and depression, and don't want more.

However, I also hear that better dosing strategies might mitigate that side effect. So I try to keep up with new info.

In the US, of course, cost is a factor. If insurance won't pay, out of pocket costs run $6,000 per month for Peg.

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