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Forum Name: Neurology Topics

Question: plasmaphoresis vs. methotrexate vs imuran vs cyclosporin

 andim - Sat Mar 08, 2008 2:20 pm

I am 23 and have been taking cellcept/ low dose prednisone/ mestinon to control symptoms of my myasthenia gravis. On the last appointment with my neurologist he said it was necessary to change treatment options. I hate the idea of high dose prednisone, so my options are: methotrexate, imuran, cyclosporin or plasmaphoresis. I am obviously concerned about my future fertility first and foremost. I am a 3rd year medical student so I have a very busy schedule. I am wondering which option is the best ,taking into account the toxicities of the medications and their effects on my ability to focus and perform vs the time commitment for plasmaphoresis. My doctor favors plasmaphoresis. Has anyone tried plasmaphoresis? Is anyone taking Imuran- how is it? I know that cyclosoprin and methotrexate have fertility implications, how high of a dose does it take before oogenesis is affected- reversibly or irreversibly?
 John Kenyon, CNA - Mon Aug 11, 2008 11:14 pm

User avatar Hello -

While each of the medications in your short list carry significant teratogenic risks, plasmaphoresis would seem to be the least likely to carry any such risk, since it adds nothing and has been, in my experience (monitoring and observing its use on patients) one of the better treatments for MG, although there is a certain time committment involved. If future fertility and/or safety of a future fetus is your concern then immediate time scheduling would become more important. I still feel plasmaphoresis is the most effective therapy for MG (again, only based on my own first-hand observations), but if fertility is a future concern I don't know how much of a long-term risk any of the other drugs would pose. I would expect there is a database of information on this, and certainly any of them should be discontinued in favor of plasmaphoresis prior to pregnancy or even planning a pregnancy. As far as actual fertility is concerned, plasmaphoresis is still your safest bet. Perhaps consulting with a fertility specialist would be helpful in making your decision.

I hope this is helpful.


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