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How Do Drs Decide To Use Cytoxan Or Cellcept


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#1 Clementine

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Posted 28 March 2007 - 07:36 AM

Does anyone know how doctors decide to use Cellcept or Cytoxan? Does skin involvment and whether you have it or not matter?
Jen

#2 Clementine

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Posted 28 March 2007 - 04:24 PM

My question sounds confusing...what I meant to ask is why do doctors. choose Cellcept OVER Cytoxan and vice versa.
Jen

#3 Claudia-DR

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Posted 29 March 2007 - 02:45 AM

Hi Jennifer! You ask a very good question. The only thing I can tell you is that my Dr. chose Cellcept for me because the disease was progressing in my skin and not anywhere else (lungs, etc.).

Best,

Claudia

#4 peanut

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Posted 29 March 2007 - 04:33 AM

Hey Jen,
I don't know about Cellcept or how fast it works but I think Cytoxan is more immediate. In one article it called cytoxan, "a sledgehammer to your immune system". I imagine Cellcept to be slightly less abrasive and toxic.

peanut

You can deprive the body but the soul needs chocolate
my HMO makes me wear a helmet...

#5 janey

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Posted 29 March 2007 - 06:38 AM

Jennifer,
My rheumatologist originally choose cytoxan for me because of my pulmonary fibrosis and there was a level 3 study on it. It also had some evidence of being effective for polymyositis. Since I couldn't tolerate cytoxan, cellcept was the next choice because is had a small study showing fibrosis effectiveness, but nothing for poly. Of course I reminded him that I'm doing the IVIg infusions for poly and they are working great!

Big Hugs,
Janey

#6 Clementine

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Posted 29 March 2007 - 07:48 AM

Janey Lady,
What is a level 3 study? I remember my Dr. factoring in several things and telling me he wanted me on Cellcept, not Cytoxan, and one was my age...which does not make sense because I know people of all ages on Cellcept or Cytoxan. I do know my Dlco and TVC were/are really low (in 40s and 50s) and I have no skin involvement, so maybe my lungs could not tolerate the more aggressive treatment? I will have to ask him. He'll be thinking.."Why does she care now?"....xo
Jennifer

#7 janey

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Posted 29 March 2007 - 08:32 AM

Jennifer,
Now that I look at the numbers involved, the cytoxan trial was a phase 2 (20 - 300 people). There are actually 5 phases (levels) with Phase 0 being the animal and lab studies, but no human subjects. If you go to the on-line pedia and type in "Clinical Trials" you can get an complete explanation of each phase.

That's interesting that your doctor mentioned age as a factor for cellcept. I'd like to know his reasoning there. I don't have any skin involvement either, but I have read that Cellcept is very effective in slowing skin fibrosis. I hope it does the same for the lungs

Peanut - I think I can speak from experience that cytoxan is sledgehammer to your system. It shut down my immune system within 3 weeks of starting it! It was too much for me.

Big Hugs, Janey

#8 JJ-Knitter

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Posted 30 March 2007 - 06:10 AM

Hi Jen and Janey,

My doctors recently started me on CellCept. I have no skin thickening (lots of teleangiectasias), but both PH and ILD - "mild" in both cases. My last PFT's showed a substantial decline in FVC's down to the 50%'s. It was my impression from both the rheumatologist and pulmonologist that CellCept has the least toxicity and they had chosen it because it's level of aggression corelated with the level of progression; as in they didn't need to bring out the big guns, just get ahead of things and not have to try and play catch-up later. No need to risk a medication that could/would likely make me sicker than the CellCept risk. No mention of age concerns at all. I'm 60.

JJ

#9 Clementine

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Posted 30 March 2007 - 08:40 AM

Thanks for the information! I don't know why I feel the need to play detective and figure things out....I should have kept my day job...

JJ, I don't have skin involvement either. Maybe you have to be more aggressive if the skin is involved. Who knows....I sure don't.
xoJenxo