Why Cellcept or Why Azathioprine/Immuran?
AnonymousMay 1, 2009 at 11:10 pm
Does anyone know why one person Dx with CIDP would be prescribed Cellcept and another person also Dx with CIDP would be prescribed Azathioprine/Immuran instead? Curious to know why my doctor may have decided what he did, but won’t see him for a little while to ask.
Surely it isn’t because Cellcept is so much easier to say and spell.;)
AnonymousMay 1, 2009 at 11:22 pm
Hi Joanne! It really depends on the CIDP you have. There are different kinds with different traits. Sometimes a doctor too may prefer a certain brand of drug because he likes the outcome better than other drugs. Other times it might be the patient itself where they couldn’t tolerate one drug and got switched. Cellcept what I know about it is used alot in Lupus patients but other things too. But I do know they use Cellcept alot for Kidney patients in Lupus. Immuran is good for Lupus too but used for CIDP. IVIG is also used.
Most doctor’s normally try the cheapest route first and if that fails then they go to the Chemo drugs.
Sometimes they give the pills first and then go to IV’s if the pills don’t work. Insurance companies too have a say so in alot of things also. Hope this helps! Ohh! One drug may be stronger too and that might be why the prescribe it to the patient. Also just depends on how bad the CIDP is progressing! Have learned one thing about CIDP. We may have simular symptoms but no two are alike. Each person’s body reacts different ways!
AnonymousMay 2, 2009 at 9:17 pm
Thanks for replying.
I’m interested in what appears to me to be a higher incidence of some kind of Lupus connection with some CIDP patients. Either they say they have it themselves along with CIDP or someone in their family has it (as in my case).
I read Norb’s recent comments with interest in regard to “molecular mimicry”. Wish I had paid better attention to biology in school, LOL. Of course I’m no scientist and could never figure all of that out on my own. But, I’d like to gather information from the scientists and researchers who [B][I]are[/I][/B] in the know.
I’m also concerned about the cancer connection to the immune suppressant drugs. I absolutely want to stay on top of that as much as possible too, so if it were to happen to me, I’d hope to catch it as early as I could. I wonder if/how antioxidants might play a role in mitigating that risk? I know scientists think drinking tea may help prevent some cancers:
More I need to check into.:)
Thanks again, Linda!
AnonymousMay 2, 2009 at 9:40 pm
[COLOR=black]Ah, the problems with generic versus trade names. Imuran (a trade name for azathioprine) isn’t too hard to say. But mycophenylate mofetil (CellCept’s generic name) is a bit of a mouthful. [/COLOR]
[COLOR=black]Both drugs work by inhibiting the purine synthesis pathway involved in the proliferation of T and B cells. In other words, they slow down the production of T and B cells. As to why one might choose one over the other, CellCelpt is more specific to lymphocytes and is associated with less bone marrow suppression and fewer opportunistic infections that is Imuran. However, at the Foundation’s Symposium in November, it seemed that several doctors had decided that CellCept was not as effective as they had first hoped. In my case, it seems that Imuran is more effective than CellCept was, although the comparisons are not completely fair.[/COLOR]
[COLOR=black]There is also a cost issue. Azathioprine costs about 50¢/50 mg tablet. A typical dose is 2 mg/kg/day, so if one were to weigh 75 kg, the cost would be $1.50 a day. CellCept costs about $7/1000 mg caplet. A typical dose is 2000 mg/day, so the cost is $14/day.[/COLOR]
AnonymousMay 2, 2009 at 9:51 pm
Thanks for that info, Mark.
I wish someone had taped and made an online podcast of that symposium; I would be very interested to watch that! Back in November, I didn’t even know CIDP existed. Not to mention that some CIDP patients are homebound (I virtually am now, I could use a wheelchair, but make due with my walker because my house is not very wheelchair accessible at all, plus the Dr. wants me regularly standing and walking if I can) and they wouldn’t have been able to attend in person. I probably would not have been able to go myself even if I did know about it.
May 4, 2009 at 9:26 am
Another note about Cell Cept, at the symposium it was suggested that Cell Cept causes central nervous system involvement. As Mark mentioned, its use for cidp was questioned.
Dawn Kevies mom
AnonymousMay 9, 2009 at 12:41 am
[COLOR=black]I think the central nervous system involvement was actually because there is a higher risk of PML (progressive multifocal leukoencephalopathy) when taking CellCept than when not. It turns out that the virus that causes PML infects a very large number of people—~85% of the population—but it remains latent unless the immune system is compromised. [/COLOR]
[COLOR=black]In CellCept’s case, isolated cases were reported. Between 1995 and 2008, Roche had reported 16 cases to the FDA, 10 confirmed and 6 suspected. In all of the cases, the individuals were transplant patients or patients with lupus. They were all taking other immunosuppressants in addition to CellCept. [/COLOR]
[COLOR=black]Between 2000 and 2008, there were over 186,000 kidney, heart, and liver transplants, with double transplants counting individually. Let’s guess that the number of actual transplant patient is 180,000. If half of these people took CellCept, the risk of PML is about 18 per 100,000. However, the risk is lower, because CellCept is prescribed for more than anti-rejection purposes. The number of people taking CellCept might be more like 110,000; which brings the risk down to 15 per 100,000. This is not an insubstantial risk, but it is by no means high.[/COLOR]
[COLOR=black]Yes, taking CellCept could lead to PML. However, if it helps, it means that you might not need, or could take less of, some other drugs that are known to have bad side effects. With this disease, you really do have to make the choice between the lesser of two evils.[/COLOR]
AnonymousMay 9, 2009 at 6:00 pm
Hi Joanne! I think the cancer rate when taking these meds are a bit on the slim side. Cancer is something I have seen hit many people without any problems at all and then suddenly develop cancer. Although our immune systems are much weaker than the average person our chances of getting cancer are about the same with the average person. Eating alot of fresh fruits and vegetables though are very important to us and even healthy people. Taking care of us and our lifestyles! We eat candy everyday all day long we can become obese and have risk for diabetes. So if we care for ourselves eating fresher foods and staying away from chemicals our chances of getting cancer get slimmer! But cancer too can run in family genes. We all just have to take care of ourselves the best we can with our illness! Eating right, sleeping right and getting what best kind of exercise that we can do. Each person is different. If you have Lupis in your family you might have Lupus causing your CIDP. That is what caused mine but I too have other autoimune disorders. So it could have been the combination that triggered mine too! Lupus can cause alot of things. I have seen some of the strangest things happen to my body with that disease. LOL! Sometimes it can make you feel like your going crazy. Especially when you tell the doctor what is happening and he looks at you in a funny way!
AnonymousOctober 12, 2009 at 6:53 am
I´m new on aziatioprina, started this month (oct 2009).
I didn´t know it was no the same as Imuran, my reumathologist told me,
Imuran is more expensive, but if is the one to take I would pay for it
instead of the aziatioprina.
I´m takin 2 x 50 mg a day, what about others here? wich dosage are having?
The other strange thing to me is that there are no side effect,
or maybe the side effects are masked by the cidp symptoms (pains, weakness and dizziness).
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