Imuran vs. Rituximab?

[LisaT]

Does anyone know whether rituximab has better results or is used more for WG than imuran? I am on prednisone and imuran and tapering the prednisone. However when I went from 10 mg to 5 mg I started noticing my airway feels narrower again (I have subglottjc stenosis), so I've started taking 10 again some days. I will run this by my rheumatologist next week, but he told me to taper by 5 mg a week, then quit from 5 mg to nothing without further taper, which seems very drastic but that's another issue. The more I read, the more it sounds as though rituximab may be the more appropriate drug for me given my subglottic stenosis (I would really like to continue breathing) and the possibility that the 'thing' in my chest (I'm calling her Petunia) is being investigated as possibly fibrosing mediastinitis, a rare condition about which I'm still learning but is apparently responding well to rituximab in trials... Since some of this is rare, weird, relatively new stuff, it is entirely possible that my rheumatologist simply doesn't know this. I am following up with someone I'm in contact with through the Canadian branch of the vasculitis foundation to consult with a Wegener's specialist here, but thought others on this forum could also be a good source regarding the two drugs and whether they have the same or different effects on WG symptoms. Thanks in advance for any info or insight you can provide. It is SO GREAT to have a place to come to with these questions!

[Pete]

Going from 10 to 5 is a 50% reduction. It's probably a shock to your system overall. I have two taper experiences to share. Last year, I dropped 1 mg every two weeks from 10 and got to zero, but had a minor flare last fall. Had two doses of rtx in October in addition to returning to 60 mg pred. Have tapered slowly this time. Dropped 5 mg/2 weeks down to 20. Dropped 1 mg/2 weeks down to 10. Now dropping 1 mg/4 weeks. I'm currently at 5 mg (for another week). The plan (my rheumy and I set it up) is to get to the lowest pred dose where I can remain symptom free. Once symptoms show up, I'll go back to the previous dose and see if I can sustain it.

I'm also on 17.5 mg of mtx weekly. Was able to reduce from 20 mg/week about a month ago. Labs are still stable and I feel good.

Hope this info is helpful.

[LisaT]

Going from 10 to 5 is a 50% reduction. It's probably a shock to your system overall. I have two taper experiences to share. Last year, I dropped 1 mg every two weeks from 10 and got to zero, but had a minor flare last fall. Had two doses of rtx in October in addition to returning to 60 mg pred. Have tapered slowly this time. Dropped 5 mg/2 weeks down to 20. Dropped 1 mg/2 weeks down to 10. Now dropping 1 mg/4 weeks. I'm currently at 5 mg (for another week). The plan (my rheumy and I set it up) is to get to the lowest pred dose where I can remain symptom free. Once symptoms show up, I'll go back to the previous dose and see if I can sustain it.

I'm also on 17.5 mg of mtx weekly. Was able to reduce from 20 mg/week about a month ago. Labs are still stable and I feel good.

Hope this info is helpful.

I'm glad to hear your tapers are going well and you are feeling good, Pete. It's always helpful to hear success stories and experiences of others! Thanks...