I have been taking Besremi since Feb 2022. I was on Pegasys for about 6 months prior. I have found the interferons to be more effective and much easier to tolerate than hydroxyurea. I also had tried therapeutic phlebotomy, but ultimately the chronic iron deficiency symptoms were worse than the PV symptoms.

Efficacy - I achieved hematologic remission within a few months of starting on the interferons. I remained phlebotomy-free for over two years, erythrocytosis controlled on 150mcg dose. The thrombocytosis is well controlled. Being on Besremi has allowed me to let my iron levels rebuild, which makes me feel better in day-to-day function. In addition, in 18 months on interferons, my allele burden has reduced from 38% to 9%.

Besremi does have some side effects. I experience mild itching and occasional rashes. This is well controlled by taking Claritin. I also experience mild leukopenia since the Besremi suppresses all blood cell lines. Recently, I have seen some elevation in liver enzymes but not enough to warrant a reduction in dose. It is enough to preclude an increase in dose, however. My HCT is up above 45% for the first time since I started on the interferons. Therefore, I just had a therapeutic phlebotomy yo take the edge off the erythrocytosis.

Note that we all respond differently to Besremi and the other treatment options for PV. Other's experience may or may not be the same thing you experience. For myself, I would say that the Besremi is definitely the best treatment option I have used. The side effects are minimal compared to the benefits. Controlling symptoms and preventing progression are my two primary treatment goals. Besremi is helping me to achieve these endpoints.

It is unfortunate that Besremi is so expensive. I am fortunate to have good insurance and only have to pay $100/month with a $2000 annual cap. Not everyone is so fortunate and cost does play a role in making this decision. I would consider the Besremi to be worth the cost, even if I did have to pay more. We each have to make our own decisions about whether the benefits of Besremi justify the cost.

Wishing you success in whatever you decide.