Switching from Mycophenolate to Cyclosporine

[Steampunkpug]

Hi all.  What is the average time it takes Mycophenolate to start helping increase RBCs?  Limey has been on it for about a month, but his PCVs keep dropping. I'm wondering if I should switch to Cyclosporine.  If I do switch, do I have to wean him off the Mycophenolate?  Thanks

[Jo CIMDA]

Hi

Mycophenolate should start having effect after a couple of weeks but it might not reach it's full potential for much longer.

https://en.wikipedia.org/wiki/Mycophenolic_acid

However, due to its slow onset of action, initial aggressive disease may be managed with high dose steroids and other immunosuppressant's.

Is Limey on prednisolone as well as mycophenolate?   Prednisolone is really the preferred first line treatment for AIHA and Mycophenolate and Cyclosporin and other immunosuppressive drugs are most often used in combination with prednisolone.  The use of Prednisolone means that the slow onset of some of these drugs does not affect immediate control of the AI disease.

Cyclosporin may have better results than mycophenolate but if Limey isn't on prednisolone then I would ask why, and also if he is on prednisolone then perhaps the dose is wrong.  Sometimes if the dose of prednisolone is high for a prolonged period of time it will cause bone marrow depression and therefore the RBC's won't increase much above 30% until the dose is much lower; or if the dose of prednisolone is too low then  there will not be enough immunosuppression to control the disease and achieve remission.  Before you change to Cyclosporin I would evaluate Limey's whole drug regimen.


Some info about mycophenolate:

http://onlinelibrary.wiley.com/doi/10.1111/jsap.12107/abstract

https://www.drugs.com/pro/cellcept.html

Jo

[bellwoodbeardies]

Why don't they use Cyclosporine as well as Mycophenolate?  We used both these drugs as ours couldn't tolerate pred at all.  We are now at the fortunate stage of weaning off and our specialist said there is no known withdrawal protocol  for mycophenolate but we are erring on the side of caution (as she has been a particularly difficult case) and weaning off over 9 months. good luck x