Reply To: cellcept/ cyclosporin/immunosuppressants questions

March 5, 2012 at 2:03 am

Hello Lori,

There is a host of immunosuppressants that could be taken. Probably the four most common for CIDP are CellCept (mycophenolate mofetil), Imuran (azathioprine), Cytoxan (cyclophosphamide), and Rituxan (rituximab). The first two work mostly but not exclusively by interrupting T-cells. Cytoxan seems to work by suppressing bone marrow and also by interrupting T-cells. Rituxan works by interrupting B-cells. CellCept and Imuran are most often taken by mouth. Depending on dose, Cytoxan can be administered orally or by IV. Rituxan is administered by IV. Cyclosporin has also been used.

What works for one person may not work for another, so you just have to try them. Many doctors hoped CellCept would be the most effective, but that has not proven to be the case. If it does work though, it carries the fewest severe side effects. Imuran is often considered more effective than CellCept, but it carries more serious side effects. Cytoxan is riskier still, but might be more effective. Rituxan seems to have less risk overall, but it is relatively new, so the long-term effects are not known.

I have to take some exception to what Dawn said. All immunosuppressants carry a cancer risk, it is just a matter of degree. As an indication of risk, CellCept and Rituximab are not listed as carcinogens by IARC (International Agency for Research on Cancer), while Imuran and Cytoxan are listed as known human carcinogens. Dr. Lewis’s comment about CellCept’s CNS involvement concerns the very small risk of developing progressive multifocal leukoencephalopathy (PML). Nearly everybody has the virus that cause PML, but CellCept suppress the immune response to it in some people, leading to PML. PML is a demyelinatiing disease of the CNS, similar to MS, but much more rapidly progressive. CellCept is a commonly prescribed anti-rejection drug, but fewer than 30 cases of PML have been reported. The risk of PML is small.

Discuss these with your doctor. I think all of these carry what is called a “Black Box Warning”, which means that your doctor must have experience in using them before prescribing them. This warning is also an indication that these are riskier than average drugs.