Can a 55-year-old male with rheumatoid arthritis, currently taking Mycophenolate Mofetil (Cellcept) 500mg tablets, be started on Prednisone 10mg for two months?

From the Guidelines

I strongly recommend starting prednisone 10 mg daily for two months in this 55-year-old male patient who is already taking mycophenolate mofetil (CellCept) 500 mg for rheumatoid arthritis, as this approach is supported by the 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1. The patient should take the prednisone once daily in the morning with food to minimize gastrointestinal side effects.

• While on prednisone, the patient should continue the CellCept as previously prescribed.
• It's essential to monitor for potential side effects of prednisone, including elevated blood glucose, increased blood pressure, mood changes, and sleep disturbances.
• The patient should also be aware of the risk of infection due to the combined immunosuppressive effects of both medications.
• Calcium and vitamin D supplementation should be considered to prevent bone loss during steroid therapy. Prednisone provides rapid anti-inflammatory effects that can help control rheumatoid arthritis symptoms while the slower-acting CellCept continues to work on modulating the immune response.
• After the two-month course, the prednisone should be tapered gradually rather than stopped abruptly to avoid adrenal insufficiency, as recommended by the EULAR guidelines for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update 1.

From the FDA Drug Label

The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT

• The recommended dosage of prednisone for a 55-year-old male taking Cellcept Tab (Mycophenolate Mofetil) 500Mg Tab for rheumatoid arthritis is not explicitly stated in the label.
• However, the label suggests that the initial dosage may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated.
• For rheumatoid arthritis, the dosage is not specified, but it is recommended that the dosage be individualized based on the disease and the patient's response.
• The label recommends administering prednisone in the morning prior to 9 am and adjusting the dosage as needed to achieve a satisfactory response.
• It is also recommended to gradually withdraw the drug if it is to be stopped after long-term therapy.
• The patient should be monitored closely and the dosage adjusted as needed to maintain an adequate clinical response 2.

From the Research

Treatment Overview

• The patient is taking Cellcept Tab (Mycophenolate Mofetil) 500Mg Tab for rheumatoid arthritis, and the doctor has prescribed prednisone 10 mg for two months.
• Mycophenolate mofetil is an immunosuppressive compound that inhibits the de novo pathway of purine biosynthesis and has anti-proliferative effects on lymphocytes 3.
• The use of mycophenolate mofetil in rheumatoid arthritis has been shown to reduce rheumatoid factor titres, immunoglobulin levels, and the total number of T cells in peripheral blood 3.

Potential Interactions and Side Effects

• There is no direct evidence on the interaction between mycophenolate mofetil and prednisone in the provided studies.
• Mycophenolate mofetil has been shown to be well tolerated, with the most frequent adverse events being gastrointestinal, such as nausea, vomiting, abdominal pain, and diarrhea 3.
• The use of glucocorticoids, such as prednisone, should be continued perioperatively, but elective procedures with high-risk surgical site infection should be postponed in patients under ≥20 mg/day prednisone or equivalent until the inflammatory process is controlled with the minimum effective dose 4.

Disease Management

• Mycophenolate mofetil is considered a useful alternative to standard immunosuppressants for the treatment of autoimmune rheumatic disorders, including rheumatoid arthritis 5.
• The perioperative management of patients with rheumatic disease under DMARDs or other immunomodulators is challenging, and a multidisciplinary approach is recommended 4.
• Mycophenolate mofetil has been used to treat interstitial lung disease related to rheumatic diseases, including rheumatoid arthritis, with a lower rate of side-effects compared to cyclophosphamide 6.