I would be one of those who tolerated the interferons well at age 68. Much better than HU. I did not have a problem getting PEG approved on my Medicare Part D plan. Besremi was a challenge the first time but subsequent approvals have gone smoothly. Even if the initial answer is a "No" that is not the end of the story. PEG is among the NCCN preferred treatments for ET. It is a denial that would be easily appealed.

Thx so much Steve. My oncologist is willing to go either way and it is a tough call for me. Interferon is not usually recommended at my age (75) but doc says other elder patients have tolerated it well and have reversed the mutation. But the side effect profile is shown to be worse for most people. And I believe insurance won't cover it until, like you, HU has been tried first. Also, it sounds as though you've had some integrative input? Good to know about Zyrtec and milk thistle! Some recommend Chinese medicines, but that is less appealing. 🤢 So glad to hear you are doing well! Pls keep me posted.

I am using interferon rather than HU to treat PV with thombocytosis. I was refractory to and intolerant of HU. I experienced toxicity even at very low doses. The interferons (Pegasys/Besremi) have been more effective and much easier to tolerate for me. Side effects on the IFNs have been easily tolerated/managed. Itching/rashes controlled by antihistamine (Zyrtec). Elevation in LFTs controlled by Milk Thistle Extract. Mild lymphopenia/borderline neutropenia which I can tolerate.

My only regret in switching to the IFNs is that I waited as long as I did. I wish I had just started on them in the beginning. Note, however, that we are all different in how we respond to these medication. My experience may be quite different than yours.

All the best moving forward,.