Christine,
I'll be 54 next week. The thinking by many of the MS neuros on the Consortium is that it is acceptable to give women at or near menopause steroids to treat a flare but not to give more than two or three grams a year if possible. At the same time they try to support the bones by giving Fosamax, calcium, D, magnesium.

I've been watching for some written guidelines to come out on this protocol but have not yet seen it. When it is weritten or I come across it, I'll try to post here with the citing.

There are other meds now coming into favor for treating flares that do not have a bone wasting component. CellCept is one of those. It came to us from the transplant arena as an antirejection drug and is taken orally twice a day for 6 months to a year. Main side effect appears to be loosing of stool for the first few weeks (for some that's a real plus). In the old BT, xo had several articles posted on the validity of that therapy. My current neuro is now using it in most of his female menopausal patients rather than depending on steroids.

How does cell-cept work o the flare, with steroids I feel great, lots more energy etc.. I could become a steroid junkie, does cell-cept give the same benefits? Can it be used with Novantrone?? I kow I need to check with my nuero, but just asking basic questions.

Here is a dated article on CellCept when it was approved to help people with Lupus. At the time this article was written, it had just started Phase III trials in MS for inflammation reduction.


Drug Offers Help for People With Lupus
October 25, 2003
By THE ASSOCIATED PRESS
Filed at 10:40 a.m. ET

ORLANDO, Fla. (AP) -- A drug used to prevent organ rejection in transplant patients works as well as chemotherapy for treating kidney failure from lupus but with fewer side effects, a study shows.
Side effects from chemotherapy, including hair loss, anemia, loss of appetite and nausea, sometimes prevent some patients from completing their treatment.

``Having an alternative that provides fewer side effects is a very important thing for patients,´´ said Sandra C. Raymond, president and chief executive officer of the Lupus Foundation of America Inc. She noted there haven´t been any new drugs for lupus in 30 years.

The research compared the effectiveness of oral doses of CellCept, which suppresses the immune system, with chemotherapy, the standard treatment for patients with lupus nephritis, a serious complication of lupus.

``Our study shows tremendous promise,´´ said the lead researcher, Dr. Ellen Ginzler of the SUNY Downstate Medical Center in New York. ``It can be an alternative standard of care.´´
The research was to be released Saturday at the American College of Rheumatology's annual meeting in Orlando.

Lupus is an inflammatory disease that affects between 500,000 and 1.5 million people in the United States, primarily women between ages 18 and 45. About half of lupus patients get lupus nephritis, which in its most serious form can cause kidney failure.

The 130 study participants received either CellCept or intravenous doses of cyclophosphamide.

In the CellCept group, there were 14 complete and 21 partial remissions compared to four complete and 14 partial remissions in the chemotherapy group.

Fifty-two of the 66 patients on CellCept completed the six months of treatment, while only 38 of the 64 patients on chemotherapy finished their treatment.
Severe infections also were less common in the patients taking CellCept, according to the research sponsored by the Food and Drug Administration.

Martha Emerson, a 52-year-old homemaker in suburban Orlando, began taking CellCept four months ago after chemotherapy and other treatments failed. The only side effects she has had are mouth sores and difficulty getting to sleep.

``It´s not a miracle drug, but it´s a very big help,´´ she said.

I am not at home with my files and will not be for a couple of weeks, but you should talk this over with your neuro.

Hi Christine,

I am wannabe. I wannabe better but for right now that's not one of my wannabe options. So I guess I wannabe a movie star.

Was the steroid decadron? I have heard good things about it from someone in my MS support group.

Good luck with the copaxone. It takes a while to work but it seems to be standing the test of time as a solid treatment option.

Wannabe; we all want to be well!!! I remember the old me and have hope for the future. I try so hard to think what can I do not what I can't!!! Anyway I love these steroids; Dexamethson. what a difference they make. I know they are not the best for me as the sdie effects are probably harmful over use as I am sure Cheri can attest to with her weatlh of knowledge, but for now they are helping. thanks for the info on Copaxone, I have had 3 weeks and know to be patient, if it could stop the progression and attacks that weakned me so.

Cherie you mentioned Cell-cept and I am really interested in that, would that be instead of Novantrone?
Hoep you all have a great day and God's richest blessings!!! Hugs, Christine

Cherie, I hope to meet you sometime.

Cell Cept is generally used in place of steroids to reduce inflammation. Talk to your doc about it.

If you check out this site http://www.news-medical.net/?id=18900 You'll see how effective Novantrone and Copaxone is proving to be over time.

Christine,

Here is some information I found on cell-cept. It looks like there's not a lot of data yet on its effects on MS beyond the preliminary except that it is worth continuing investigations into its effectiveness in MS. It's used on its own as well as with other therapies. Doesn't look like it's ever been tested in combination with novantrone but since they are both immune suppressants, I wouldn't think they could be taken together.

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Lupus. 2005;14 Suppl 1:s42-5. Links
Mycophenolate mofetil and neurological diseases.Vermersch P, Stojkovic T, de Seze J.
Department of Neurology, Hopital Roger Salengro, Lille, France. pvermersch@chru-lille.fr

We describe experience with the use of mycophenolate mofetil (MMF) in neurological diseases. Although only small series of patients or case reports were described, MMF is promising in immune-mediated neuromuscular disorders. MMF has been used for the treatment of polymyositis, chronic inflammatory demyelinating polyradiculoneuropathy, and multifocal motor neuropathy. These studies showed that MMF is well tolerated and may be useful in some patients. MMF can be effective alone but mainly as an adjuvant therapy by reducing steroid requirements or the frequency of infusions of IVIg. MMF has also been tested alone as a single drug treatment or in combination with immunomodulatory drugs in multiple sclerosis in open surveillance trials or in phase II studies. None of these studies have been designed to demonstrate a clinical efficacy but preliminary results are very promising.

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Clin Neuropharmacol. 2004 Mar-Apr;27(2):80-3. Links
Mycophenolate mofetil in multiple sclerosis.Frohman EM, Brannon K, Racke MK, Hawker K.
Department of Neurology, University of Texas, Southwestern Medical Center at Dallas, USA. elliot.frohman@utsouthwestern.edu

OBJECTIVE: To describe experience with the use of mycophenolate mofetil (MMF) in the treatment of multiple sclerosis (MS). BACKGROUND: MMF is a potent immunosuppressant that is a selective inhibitor of inosine 5'-monophosphate dehydrogenase type II, the enzyme responsible for the de novo synthesis of the purine nucleotide guanine within activated T and B lymphocytes and macrophages. METHODS: A retrospective review of experience in treating 79 MS patients with MMF (61 with secondary progressive, 14 with relapsing-remitting, and 4 with primary progressive MS) in the authors' MS center. RESULTS: In most cases, MMF was added as adjunctive therapy in patients already being treated with either interferon-beta (n = 44) or glatiramer acetate (n = 20). Fifteen patients not able to use interferon or glatiramer acetate were treated with MMF monotherapy. Seventy percent of the patients continued MMF therapy. Eight patients discontinued therapy because of side effects, 7 patients continued to exhibit evidence of disease progression, 4 were denied insurance coverage, 2 were lost to follow-up, and 1 patient had an elevation of hepatic transaminases that resolved on discontinuation of MMF. One patient discontinued MMF therapy secondary to cytomegalovirus diarrhea. CONCLUSION: MMF was well tolerated by the majority of patients treated. While these clinical observations were uncontrolled, the clinical course of MS was either unchanged or subjectively improved in many of the treated patients. A randomized controlled trial of MMF in MS, either as monotherapy or in conjunction with interferon or glatiramer acetate, appears warranted.