Many patients – particularly those who are newly diagnosed – wonder what the treatment options are. The following is a summary based on recent scientific articles.
The most frequently used initial treatment for the newly diagnosed is High Pulse IV Steroid Treatment with Solu-Medrol (methylprednisolone sodium succinate). Patients are generally given between 3 and 7 days of IV treatment. Treatment usually consists of receiving two infusions per day, for a total of 1000 mg (1 gram) of Solu-Medrol each day. Thereafter, patients are given oral prednisone and taper down the dosage over time. Most commonly, patients start with 60 mg per day at the conclusion of the IV treatment, and they taper the dosage slowly down over many months. In some patients, it will take up to a year to completely wean off steroids. Other patients, in whom symptoms re-emerge, require a maintenance dose of between 2 and 10 mg per day of prednisone indefinitely. More recently, physicians have found success in using so-called steroid-sparing agents as a form of ongoing maintenance for HE/SREAT. There are a number of different medications used for ongoing treatment. Research indicates that the most commonly used alternatives for maintenance are Imuran, Cellcept, or Methotrexate. A future post will focus on and discuss these maintenance therapies.
For those who do not respond sufficiently well to steroid therapy, there is the option of Intravenous Immunoglobulin treatment (IVIG). In this treatment protocol, the patient’s own antibodies are replaced with an infusion of antibodies from donors. Treatment is usually given as an outpatient, although the first session is often done inpatient to monitor for side effects. Typically, a patient will begin by receiving twice weekly infusions (intraveonusly), with each infusion taking 3 to 4 hours. Over time, treatment will go from the initial twice weekly treatments for the first month, to treatments once a week each month, and then ultimately to infusions given once each month. The goal is for the patient to, over time, go as long as possible between infusions. It should be noted that many insurance companies balk at this treatment because it is quite expensive. But research shows (see Case Studies link above) that IVIG can be a very effective way to treat patients who do not respond sufficiently well to steroid treatment.
The other treatment that has been found effective for many patients is Plasmapheresis, sometimes called Plasma Exchange or Plasma Transfer. In Plasmapheresis, a patient’s blood is filtered through a machine that separates the plasma from actual blood cells. The patient’s plasma may then be replaced with saline, albumin, or donor plasma. The reconstituted solution is then returned to the patient.
These are the most commonly used treatment options as of the date of this posting (October 2012). Future posts will discuss some of the maintenance therapies currently being used with good results.