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Myasthenia Gravis

Cellcept and Prednisone

02/02/2005

Question:

On your patients who have had a good response to Cellcept how do you schedule the tapering of prednisone and what is a typical dose of prednisone that they end up on? Thank You.

Answer:

Cellcept (mycophenolate), like Imuran (azathioprine), is often used to reduce the total amount of steroid or to replace the steroid (prednisone) eventually. Steroids have many side effects that make their use uncomfortable. When a patient shows that they will require long term immunosuppression, it is not unreasonable to try and use another immunosuppressant, like Cellcept or Imuran. Cellcept and Imuran can often take 4-5 months before they begin having peak immunosuppressant effect. You will also need certain lab tests on a regular basis with either Imuran or Cellcept to check for adverse effects of these medications. Tapering of prednisone can vary from patient to patient. It can vary by the duration of treatment with prednisone, and the disease activity level. I have patients who need the addition of Imuran or Cellcept and I am still unable to taper the steroids. I have other patients who I am able to maintain on Imuran or Cellcept alone, without any prednisone. And then there are those patients in the middle, where I need a decreased amount of prednisone and the Cellcept/Imuran. When I do taper prednisone, I go slowly and try to have regular visits with the patient. I do not have a typical prednisone taper-- it depends on the current dose and the effect on disease at each decrement.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati

John G Quinlan, MD John G Quinlan, MD
Professor of Neurology
College of Medicine
University of Cincinnati