Cellcept vs. Imuran

[Jules]

Hi everyone - I'm rapidly approaching the 3 month mark of taking ctx and my consultants have started making noises about a drug change. However, one is recommending Cellcept the other Imuran. Are there any major advantages/disadvantages of one over the other? Little confused as to which way to go - also, do you get to kick the Pred when you change to one of these . . . please tell me that's the case, some sleep would be lovely!!!!

[Sangye]

I don't think one is more advantageous than the other. Like all the meds it comes down to which one you tolerate best. Your docs should give you a thorough breakdown of the efficacy and risks for each one before deciding.

As far as pred goes, you'll probably have to stay on it while you transition and then taper once you stabilize. It's not good to change two variables at once. How much pred are you on now?

[Jules]

Just been reduced to 15mg . . . from looking at other threads, it looks like it can all go a bit pear-shaped from 10mg down - not looking forward to the change and possible side effects, as have managed to go back to work full time and am feeling ok on the ctx/pred + others mix!

[Sangye]

Don't extrapolate too much from others' experiences. Many people transition smoothly and taper off pred completely.

A lot of people get in trouble because their docs transition them onto milder drugs too soon (ie before remission has been induced) or their docs taper the pred too quickly after transitioning. (My original lousy doc did both of those at once!) Many people get stuck in a cycle where their doc starts using pred to knock down the Wegs activity instead of the proper immunosuppressant.

You're doing well right now, so there's no reason to think you will have problems as you transition.

[LisaMarie]

I hate both...both caused my liver enzymes to triple and made me sicker....so from my experience if you can avoid it do it...I here if you do rituxan you may be able to just stay on low dose pred to keep it at bay??? who knows...but i am willig to try it if it is truly low doses...i am currently on 10 mg of pred and holding my own as best as i can...but i do feel better joint wise......just my 2 cents

[LilyPony]

Many people get stuck in a cycle where their doc starts using pred to knock down the Wegs activity instead of the proper immunosuppressant.

Can you explain what this means... for a person who has yet to get proper treatment... Not doubting you, just very curious. The rheum I've seen so far have wanted me on pred plus bactrim. The one wanted me on pred I guess indefinitely until I was better, then taper. The other wanted me to taper the pred right then and see what happened (NOT good). Then I ran out of bactrim about a week ago, got busy and didn't refill it right away. I was thinking it wasn't particularly crucial but symptoms started sneaking up on my very quickly and wasn't until last night that it dawned on me I never picked it up (got it now). So I'd been thinking the pred was really doing something but seems more like pred/bactrim just put the wegs on hold until I messed it up. It really got me feeling like there was no way I'd ever get into a proper remission with the current plan ... then see your comment and kind of confirmed that thought.

[delorisdoe]

Interesting theory with the bactrim considering its actual role in wg. Bactrim s the only prescrption I have had for the last few years. Sometimes pred for mini flares. I always believed that the only thing bactrim does is prevent lung infections

[elsawind]

My husband was on Cellcept and after three months induced a bone marrow failure, so it was suspended. But of course, everybody reacts differently. No experience with Imuran.

[DEE]

Ive used both Cellcept gave me continual d and s and stomach cramps. Changed to Imuran and have had no problems since day one.
So I think it is very much an individual thing

[JanW]

Not to speak for Sangye, but what I see a lot around here is people on pretty significant doses of pred for many months if not years, when current recommendations suggest tapering within several months of dx (with the goal of tapering completely). This may be because they are not being treated with the right immuno, or the right dosage. Although I have moderate WG, with significant windpipe damage, the progression of my disease was not swift and my doc was willing to work with only the immunosuppressant for me (mtx) which actually worked (and which I am trying to transition off now). I've only been on pred once (as an experiment to see if we should increase the mtx; it worked to relieve joint pain and I did increase the mtx, which also worked). Although standard of care is that WGs start on both the pred and the immuno, many docs don't work quickly enough to reduce pred, seemed to be what the researchers at the symposium was saying. They also underplay pred symptoms and silent damage.