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Will Decrease In Omnacortil Dosage Cause Side Effects When Diagnosed With SLE?
Question: As i had mentioned earlier that my son was diagonised with SLE. As there was kidney involvement we had undergone the renal biopsy. The report revealed class 3 lupus. Last time when his urine report was normal his steroid was stepped down. He was on omnacortil 10mg daily initially in 2013when this was detected. It came down to 2.5 mg daily. Till then he was fine , then there were occasional + protien in his urine. We reported this to our doc but still he reduced the dose to 2.5 mg twice a week. Then the symptoms became more prominent and he started getting mild fever. We changed our rheumatologist and then we did the biopsy. Then we came accross another parameter which our earlier rheumatologist didnt suggest. Albumin to cretanine ratio. This was 3000+. Omnacortil was stepped upto 40 mg with mico phenolate 750 mg. the ratio came down to 525. Unfortunately we had to visit our old doc as our current was out of town. He suggested make the phenolate 1.5 g and step down omnacortil from 40 mg by 5mg every week. When it comes to 10mg get a urine report done. I am fearing that such a rapid step down can again cause symptoms.
Is this a correct way of stepping down. Last time it caused lupus nephritis. My son os 12 years old. Please advice
Is this a correct way of stepping down. Last time it caused lupus nephritis. My son os 12 years old. Please advice
Brief Answer:
Steroid Tapering
Detailed Answer:
Good evening
I have gone through your history. I tried contacting you previously also, but it is good to know you have gone through the right approach.
Well, you are right in being worried. In Lupus nephritis, we dont taper the steroid dose very fast. We dont want a relapse or we are brought back to the same old stage and again steroids will need to go up. The recommended tapering is 5 mg every 2 weeks after the disease is under control. If the disease is still active, there is no point tapering it as the other drugs take more time to act.
Secondly, Mycophenolate can be increased to 1.5 g to 2 gm daily(Max dose: 12-18 mg/kg). Once the dose has increased, we can come down on steroids as it will help in play a role in the steroid action.
Thirdly, You should discuss with your rheumatologist regarding options of cyclophosphamide as it is still the best line of treatment for Class III/IV lupus nephritis.
Hope the information was useful
Do let me know for more queries
REgards
Dr Naval
Steroid Tapering
Detailed Answer:
Good evening
I have gone through your history. I tried contacting you previously also, but it is good to know you have gone through the right approach.
Well, you are right in being worried. In Lupus nephritis, we dont taper the steroid dose very fast. We dont want a relapse or we are brought back to the same old stage and again steroids will need to go up. The recommended tapering is 5 mg every 2 weeks after the disease is under control. If the disease is still active, there is no point tapering it as the other drugs take more time to act.
Secondly, Mycophenolate can be increased to 1.5 g to 2 gm daily(Max dose: 12-18 mg/kg). Once the dose has increased, we can come down on steroids as it will help in play a role in the steroid action.
Thirdly, You should discuss with your rheumatologist regarding options of cyclophosphamide as it is still the best line of treatment for Class III/IV lupus nephritis.
Hope the information was useful
Do let me know for more queries
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for ur reply. I didn't understand the importance of health care magic initially. your reply is very satisfactory. Please pardon me for continuing this session as I would like to keep this conversation going. we did step down Omnacortil from 40 mg to 25 mg @5mg per week. mycophenolate is 1.5 g. I am continuing 25 mg currently. I will get urine ratio done tomorrow and vosit dr XXXXXXX XXXXXXX a visiting pediatric rheumatologist from XXXXXXX to XXXXXXX day after tomorrow. I will keep u posted of the updates.
Thanks once again
XXXX
Thanks once again
XXXX
Brief Answer:
Lupus Nephritis management
Detailed Answer:
Good evening XXXX
Oh dont worry about the conversation. You have full right to continue it as long as you wish.
Well, it is a bit too fast of a tapering schedule. Dont taper it any further and meet the rheumatologist tomorrow. From 25 mg to 10 mg you need to go a bit slow and then see which is the minimum dose he is good on.
Do discuss about Cyclophosphamide tomorrow with the rheumatologist as it helps bring the disease into remission earliest.
Do let me know for further queries
Regards
Dr naval
Lupus Nephritis management
Detailed Answer:
Good evening XXXX
Oh dont worry about the conversation. You have full right to continue it as long as you wish.
Well, it is a bit too fast of a tapering schedule. Dont taper it any further and meet the rheumatologist tomorrow. From 25 mg to 10 mg you need to go a bit slow and then see which is the minimum dose he is good on.
Do discuss about Cyclophosphamide tomorrow with the rheumatologist as it helps bring the disease into remission earliest.
Do let me know for further queries
Regards
Dr naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
sorry I just forgot to tell you he takes 2 other medicines. HCQS-200 and Losarton 50. Is that what u were referring to? HCQS-200 he has been taking since day 1 but Losarton was added about 20 days back.
Brief Answer:
HCQS is different
Detailed Answer:
Good evening
Well, HCQS is quite different. It is a very good drug for SLE but a mild one. It prevents SLE from progressing further, and is good for skin and joint problems, but got no rule in lupus nephritis.
Losartan was added to reduce the protein leakage from the kidneys. It does not stop the inflammation but definitely a good drug to reduce the protein leakage
Cyclophosphamide is a different drug which inhibits the inflammation. More like Mycophenolate but more potent and better results.
DO let me know for more queries
Regards
Dr Naval
HCQS is different
Detailed Answer:
Good evening
Well, HCQS is quite different. It is a very good drug for SLE but a mild one. It prevents SLE from progressing further, and is good for skin and joint problems, but got no rule in lupus nephritis.
Losartan was added to reduce the protein leakage from the kidneys. It does not stop the inflammation but definitely a good drug to reduce the protein leakage
Cyclophosphamide is a different drug which inhibits the inflammation. More like Mycophenolate but more potent and better results.
DO let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Raju A.T
We had been to our nephrologist in baroda. He too agreed that the step down was bit fast. Anyway todays report is no different than the last report. Hb count is 12.6 ESR 20
Protien createnine ratio is 700. Spot urine conc protien is 4.7 the figures for SGPT SGOT are within normal range. The reason for going to nephrologist is he being a nice gentlemen also did the kidney biopsy. My visit to pediatric rheumatologist is tomorrow.
I had also discussed cyclophosphamide with our nephro and he said that it being bit stronger in nature was given to my son via IV during hospitalization during biopsy. Later it was decided to go with mycophenolate and omnacortil. He said we will continue with 25 mg for another 2 weeks as u had also adviced. After that we can check the reports to decide the future course of action.
I will send you the snaps of report tomorrow.
Thank
XXXX
Protien createnine ratio is 700. Spot urine conc protien is 4.7 the figures for SGPT SGOT are within normal range. The reason for going to nephrologist is he being a nice gentlemen also did the kidney biopsy. My visit to pediatric rheumatologist is tomorrow.
I had also discussed cyclophosphamide with our nephro and he said that it being bit stronger in nature was given to my son via IV during hospitalization during biopsy. Later it was decided to go with mycophenolate and omnacortil. He said we will continue with 25 mg for another 2 weeks as u had also adviced. After that we can check the reports to decide the future course of action.
I will send you the snaps of report tomorrow.
Thank
XXXX
Brief Answer:
Further Course
Detailed Answer:
Good evening XXXX
Well, fair enough. He seems more sensible in tapering your medications.
As for protein leakage, dont worry about it. It will take time for the disease to go into remission for the protein leakage.
After 3-4 months of theraphy, you can consider repeating 24 hour urine protein. If the levels are going down, that is a positive sign. But if it continues to rise, we should consider switching to Cyclophosphamide
Yeah, do update me on what the pediatric rheumatologist says as well
Regards
Dr Naval
Further Course
Detailed Answer:
Good evening XXXX
Well, fair enough. He seems more sensible in tapering your medications.
As for protein leakage, dont worry about it. It will take time for the disease to go into remission for the protein leakage.
After 3-4 months of theraphy, you can consider repeating 24 hour urine protein. If the levels are going down, that is a positive sign. But if it continues to rise, we should consider switching to Cyclophosphamide
Yeah, do update me on what the pediatric rheumatologist says as well
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Visited ped rheumatologist. As per her she too feels that steroid needs to be tapered to 20 from 25 but make the mycophenolate to 2g. keep this for 10 days then make it 17.5, till 10 days, then 15 again after 10days. I have discussed this with our nephro in baroda. He feels that we will make mycophenolate to 2, but will not reduce to 25 till another 2 week. He is of the opinion that let the protien-createnine ratio come to 300-400 in 2 weeks time. By that time mycophenolate will also be active as per 2 mg. we can start tapering down then.
Brief Answer:
Further Course
Detailed Answer:
Good evening XXXX
Sorry for late reply. Was stuck in hospital duties
Well, I will go with what the nephrologist says. If the pediatric rheumatologist is comfortable in increasing the dose of Mycophenolate to 2 gms, it is a good thing as that is the full dose. MEanwhile go slow on steroids as they still are the best drugs for lupus nephritis
As for the remission, it will take long. More than a year at times for the proteinuria to go into remission. SO you can monitor 24 hour urine protein every 3 months as that will give us a fair idea if the leakage has increased or not. Urine protein creat ratio is sensitive but still not superior to 24 hour urine protein.
I hope the information has been useful
Feel free to contact me anytime for further queries
Regards
Dr Naval
Further Course
Detailed Answer:
Good evening XXXX
Sorry for late reply. Was stuck in hospital duties
Well, I will go with what the nephrologist says. If the pediatric rheumatologist is comfortable in increasing the dose of Mycophenolate to 2 gms, it is a good thing as that is the full dose. MEanwhile go slow on steroids as they still are the best drugs for lupus nephritis
As for the remission, it will take long. More than a year at times for the proteinuria to go into remission. SO you can monitor 24 hour urine protein every 3 months as that will give us a fair idea if the leakage has increased or not. Urine protein creat ratio is sensitive but still not superior to 24 hour urine protein.
I hope the information has been useful
Feel free to contact me anytime for further queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr Naval
I will not be able to thank u enough for the way you supported us. I just want to ask you that should I accept this conversation or keep it open? In case I accept it will I ne able reach you again?
Do let me know.
Thanks anyway.
XXXX
I will not be able to thank u enough for the way you supported us. I just want to ask you that should I accept this conversation or keep it open? In case I accept it will I ne able reach you again?
Do let me know.
Thanks anyway.
XXXX
Brief Answer:
Future Course
Detailed Answer:
Good evening XXXX
I think you have to accept it or else it closes itself after 5-7 days. But you can approach me whenever you want, you have to mention my name and the moderator will direct the question for me or the direct questioning. Whichever works out cheaper for you
Just to add: Make sure you do DsDna and Complement C3 C4 as well for your son, now and a few months later as they are good supporting markers for disease flare /remission in lupus nephritis
Do let me know for more queries
Good luck to you. My prayers are with your son. I am sure he will come out fine
Regards
Dr Naval
Future Course
Detailed Answer:
Good evening XXXX
I think you have to accept it or else it closes itself after 5-7 days. But you can approach me whenever you want, you have to mention my name and the moderator will direct the question for me or the direct questioning. Whichever works out cheaper for you
Just to add: Make sure you do DsDna and Complement C3 C4 as well for your son, now and a few months later as they are good supporting markers for disease flare /remission in lupus nephritis
Do let me know for more queries
Good luck to you. My prayers are with your son. I am sure he will come out fine
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Raju A.T
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