Corticosteroids are a very effective treatment, but unfortunately their side-effects can become a problem. So, other medications are often used alongside Corticosteroids. These are known as steroid-sparing drugs or adjuvant drugs (adjuvant means ‘helping’).
Most steroid-sparing drugs help the Corticosteroids to suppress the immune system. This means the dose of corticosteroid can be lowered, which helps reduce the side-effects of the corticosteroid.
These steroid-sparing drugs are started at the same time or after the Corticosteroids. Steroid-sparing drugs are generally slower to start working and so it is important to get treatment underway with Corticosteroids which work quicker.
Common steroid-sparing (adjuvant) drugs used in PV are:
Azathioprine (Imuran)
- Azathioprine is the most commonly used steroid-sparing drug for PV.
- It takes six to eight weeks to start working (known as ‘slow onset’).
- It works by suppressing the immune system.
- It is usually taken orally (by mouth) once a day.
- Some people lack an enzyme in the body (called thiopurine methyltransferase or TPMT) which deals with azathioprine. This means they are much more likely to get side-effects from azathioprine. Because of this possibility, your doctor may test your TPMT activity by a blood test before starting you on azathioprine.
- Patients on azathioprine are carefully monitored for side-effects (see ‘Side-effects of azathioprine’). This involves blood tests and liver tests done every one to two weeks to start with. Once the test results are stable they are done every two to three months.
Cyclophosphamide (Cytoxan, Endoxana)
- Cyclophosphamide is a commonly used steroid-sparing drug.
- It works by suppressing the immune system.
- It is usually taken orally (by mouth) once a day.
- It can also be given intravenously (into a vein through a drip) to patients who have more severe PV or if Other Treatments have not worked well. Intravenous cyclophosphamide is usually given along with intravenous Corticosteroids. The intravenous treatment is usually given on three days of every month and this would be done at the hospital.
- Patients on cyclophosphamide are carefully monitored for side-effects (see‘ Side-effects of cyclophosphamide’). This involves blood and basic urine tests. These tests are done every one to two weeks to start with. Once the test results are stable they are done every two to three months.
Mycophenolate mofetil (CellCept)
- Mycophenolate mofetil is a relatively new steroid-sparing drug.
- It works by suppressing the immune system.
- It is taken orally (by mouth) twice a day.
- Patients on Mycophenolate mofetil are carefully monitored for side-effects (see ‘Side-effects of Mycophenolate mofetil’). This involves blood tests done every one to two weeks to start with. Once the test results are stable, they are done less frequently.
Ciclosporin (Neoral)
- Ciclosporin is sometimes used as a steroid-sparing drug in PV.
- It works by suppressing the immune system.
- Ciclosporin is taken orally (by mouth) twice a day.
- Patients on cyclosporin are carefully monitored for side-effects (see ‘Side-effects of ciclosporin’). This involves blood tests (a blood count, kidney and liver tests) and blood pressure measurement. These tests are done every one to two weeks to start with. Once the test results are stable they are done less frequently.
Gold
- Gold is sometimes used as a steroid-sparing drug in PV.
- It is not known exactly how gold works.
- Gold is usually given by intramuscular injection (into a muscle) once a week to start with. If it seems to be working, it is given once a month after this.
- Patients on gold are carefully monitored for side-effects (see ‘Side-effects of gold’). This involves blood tests (a blood count) and urine tests before every injection.
Methotrexate
- Methotrexate is sometimes used as a steroid-sparing drug in PV.
- It works by suppressing the immune system.
- It is taken usually taken orally (by mouth) once a week, but it is occasionally given by intramuscular injection (into a muscle).
- Patients on methotrexate are carefully monitored for side-effects (see‘ Side-effects of methotrexate’). This involves blood tests (a blood count and liver tests). These tests are done every one to two weeks to start with while the dose is being established. Once the dose is stable they are done every two to three months.
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