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Thread: Tapering Cytoxan

  1. #21
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    The latest information mentioned on these pages was suggesting that Imuran is the best option.
    Jack

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    Imuran or methotrexate are the most popular choices; if you look at the thread I started about new research on immunosuppression, you can see that concerns are being raised about cellcept. Essentially it doesn't appear to be as effective at maintaining remission as imuran, and, in fact, people on cellcept seem to flare more seriously. There are plenty of people on mtx, though...I don't know if this is gaining in popularity...it's the drug I started out on and it got me (and is keeping me so far) in remission. Haven't had to go the ctx or rtx route so far.

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    Both imuran and mtx are harder on the liver than cellcept. Those with liver issues with might not be able to tolerate them. Also, both imuran and mtx are chemo drugs and cellcept isn't. If someone has a history of having taken chemo in the past (eg cancer treatment), it may be unwise to use more chemo drugs. The doses are much lower but it is given every day, sometimes for years at a time. So depending on a patient's history, cellcept might be the best option.

    There is a blood test they have to do to make sure you can use imuran. It looks for an enzyme called TPMT that allows the body to metabolize imuran. Some people have a genetic mutation and don't make the enzyme, so the imuran would accumulate and damage the liver. (Even if someone's TPMT test is fine they can still have a terrible reaction to imuran, like Elephant did.) So some people can't even try imuran, if they don't make TPMT.

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    I remember having the TPMT test done. They don't do it here in Canada so we had to send it to the Mayo Clinic in Rochester. I had lots of it and was able to take Imuran.

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    I wish I could take the Imuran but the hospital pharmacist really thought I has a allergic reaction to it...many theories but to be on the safe side I wanted to be switched. My local Rhuemy was not convinced but I had to go on what the pharmacist thought. Many docs involved in my case when I was hospitalized....they had to rule out many things before they came up with this diagnosis of allergic reaction.

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    Sorry for raising this again....

    It appears that there are different practices when switching from ctx to aza or mtx? Is there any benefit to doing the "tapering" that is mentioned in this thread?

    if it is a straight switch how do they determine the dosage -- ie Holly is currently on 75mg of ctx, would they make it 75mg of aza? Her Neph mentioned 50mg of aza and bump it up if necessary -- does that sound like the right thing to do?

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    Hey Daggar, Holly and I seem to be on a similar time scale - made the switch from ctx to aza this week. I went from 50mg ctx to 100mg aza. . . without any side effects so far. . .fingers crossed it carries on that way!! Now they are hell bent on getting me down to 5mg of pred within a month. Keeping everything crossed Holly's (and everyone elses) switch goes as smoothly!

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    Hello Jules, sound like you're doing well. We have are fingers, arms, legs, eyes and whatever other body part that can be crossed for you -- may be difficult to keep that up for any extended time without being labelled a pretzel but hope your progress continues!

    I was wondering about the lower dose of aza-50mg from the current ctx-75mg that Holly's docs were looking at. I just got an email from one and their concern is a possible liver issue with the switch and considering all WG markers are dormant and have been for quite some time they feel that the lower dose would be wiser for now. I'm not sure if that makes sense? They will be giving her one more iv of methylpred and holding her oral dose at 10mg while she makes the switch.

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    Quote Originally Posted by Daggar View Post
    Hello Jules, sound like you're doing well. We have are fingers, arms, legs, eyes and whatever other body part that can be crossed for you -- may be difficult to keep that up for any extended time without being labelled a pretzel but hope your progress continues!

    I was wondering about the lower dose of aza-50mg from the current ctx-75mg that Holly's docs were looking at. I just got an email from one and their concern is a possible liver issue with the switch and considering all WG markers are dormant and have been for quite some time they feel that the lower dose would be wiser for now. I'm not sure if that makes sense? They will be giving her one more iv of methylpred and holding her oral dose at 10mg while she makes the switch.
    They switched me and started me at the same low dosages mentioned cause they didn't have the results back on the enzyme test but didn't want to leave me without any protection while waiting. My WBC was low from the CTX and wasn't holding the inflammation markers down anymore. My rheumy said that at the low dosage liver problems would be minor if they showed up.

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    drz - How long have you been doing the low dose Imuran and has it kept the WG in-check?

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