How do you manage the side effects of ropeginterferon alfa 2b for polycythemia vera patients?

Great question. Although ropeginterferon is better tolerated than other interferons, it is still associated with adverse events. If counts are controlled, I would recommend lowering the dose or spacing out the dosing interval, as that usually helps. For flu-like symptoms, I recommend pre-emptive management with acetaminophen or ibuprofen when they know they will have symptoms after the injection. I have not used metformin for this. I would also say that if a patient has actual muscle weakness and not just myalgias, that requires a workup, and if thought related to the interferon, likely requires dose interruption to ensure it's not related.