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Can CellCept Be Taken In Place Of IVIG?
Question: I've moved and I am seeing a new neurologist. I have Myasthenia Gravis and he wants to change me from monthly IVIGs to Cellcept. I also take Mestinon and Prednisone. He says IVIGs should only be used for crisis and not for maintenance. Is he right?
Brief Answer:
Take cellcept and other previous drugs
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The second neurologist opinion is right.
Till now ivig is indicated for myasthenia crisis and not for maintenance therapy.
Immunomodulator drugs and other drugs being given should be continued.
Cellcept should be started.
Evaluation for thymus and thymectomy to be considered.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Take cellcept and other previous drugs
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
The second neurologist opinion is right.
Till now ivig is indicated for myasthenia crisis and not for maintenance therapy.
Immunomodulator drugs and other drugs being given should be continued.
Cellcept should be started.
Evaluation for thymus and thymectomy to be considered.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Can you provide references stating IVIG is only for crisis and that Cellcept(MMF) is effective. I could find none saying IVIG is to be used only for crisis. The only one I found for MMF effectiveness states an "... MMF trial was carried out on a large number of patients (MMF, 88; placebo, 88). The result showed no effect on primary and secondary endpoints.”
Source: XXXX
Source: XXXX
Brief Answer:
You can discuss treatment options with your neurologist based on recommend
Detailed Answer:
Hello,
There are controversies regarding use of IVIG in maintenance therapy.
For treatment the drugs are pyridlstigmine or neostigmine.
Then immunomodulator is used for disease remission. Most preferred is corticosteroid but due to its varied side effect on long term other steroid sparing drugs are used like azathioprine9most preferred) , cyclophosphamide and mycophenolate mofetil.
Below are various publication in support of this treatment approach.
You can read guidelines for treatment of MG.
Articles related to use of mycophenolate mofetil
XXXX
XXXX
XXXX
XXXX
Articles regarding IVIG
XXXX
Treatment guidelines articles
XXXX
XXXX
You can discuss treatment options with your neurologist based on recommend
Detailed Answer:
Hello,
There are controversies regarding use of IVIG in maintenance therapy.
For treatment the drugs are pyridlstigmine or neostigmine.
Then immunomodulator is used for disease remission. Most preferred is corticosteroid but due to its varied side effect on long term other steroid sparing drugs are used like azathioprine9most preferred) , cyclophosphamide and mycophenolate mofetil.
Below are various publication in support of this treatment approach.
You can read guidelines for treatment of MG.
Articles related to use of mycophenolate mofetil
XXXX
XXXX
XXXX
XXXX
Articles regarding IVIG
XXXX
Treatment guidelines articles
XXXX
XXXX
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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