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Can I Continue Prednisone And Wear Off Both Azathioprine And Methotrexate For Pemphigus?

Posted on Mon, 24 Mar 2014

Question: I suffer from pemphigus since September 2010. Started treatment in XXXXXXX 2011, Have been treated with prednisone and methotrexate. It has not beenvery successful. Azathioprine was added last November. At the middle of January \I have had no new outbreaks, I was feeling absolutely terrible.No energy , no muscle strength, My head was in a fog.I felr like a zombie. That week my bloodtest came back with very bad results. My liver has been effected, my A1Clevel is ar 7.6 ( used to be 5.6) and my thyroid has also been effected. I was immediately taken of the methotrexate and azathioprene. I am now on 17.5 mg prednisone. I saw a panel of dermatologists and their consensus is that I start taking Cellcept. My question is , as I have no outbreaks at the moment should I leave it for now and see what happens.

Answered by Dr. Dr. Rahul Kumar (2 hours later)

Brief Answer: don't stop both Detailed Answer: Hello, Cellcept is usually used as a steroid sparing agent. Although it has side effects like diarrhoea and electrolyte imbalance, but it is much safer than long term steroids. I would try to reduce the dose of steroid gradually and maintain cellcept at same dose. Once steroid is stopped I shall start reducing cellcept. You cannot stop both drugs together, else there will be a rebound flare up. Let me know if you have any other doubts. Thank you.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Rahul Kumar (3 hours later)

I don't think you answered my question. I am not planning to stop both. I am not taken both at the moment. I am taken 17.5mg prednisone only.. I have no outbreak at the moment. I am very reluctant to take a new drug after the bad experience I have just had. ( and I still feel very unwell ). My question is , as I have no outbreaks at the moment I am hoping to slowly reduce the prednisone , and not take any additional drug. Is this a reasonable plan.? Can I wait with the cellcept until ( if or when ) I experience a new flareup? Thank you

Answered by Dr. Dr. Rahul Kumar (20 hours later)

Brief Answer: reduce it slowly Detailed Answer: Hello Yes you can reduce prednisolone. Reduce it by 5 mg every 3 weeks. once it has reached 5 mg continue it for 2 months and then stop. Although cellcept is a steroid sparing agent but it has side effects too. It is better to avoid it now. You must be knowing pemphigus can only be controlled and cannot be cured. We always aim to maintain remission with minimum drug or drug free remission. So please go ahead with slow reduction in steroids. Let me know if you have any other doubts. Thank you

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Raju A.T