When to stop neupogen / prednisone

Mayaus

10 Posts
Reply Posted on: May 31, 2014 at 5:21pm
Hi Dr Braverman,

When do you usually stop neupogen once patient is pregnant ? Does this depends upon test results, or do you have a standard protocol for this?
As for the prednisone, I understand it depends on testing results? I have been doing Ivig every three weeks but my cytokines are coming back more and more elevated after each treatment, so we keep increasing my prednisone dose, when I have a feeling I should soon prepare to wean off (10 weeks now). My Dr claims it can take a few Ivig infusions for the system to respond and levels to show improvment. Any thoughts? Thanks a lot!

Dr. Braverman

2026 Posts
RE: When to stop neupogen / prednisone Posted on: May 31, 2014 at 5:56pm
neupogen between 10-12 weeks. I would make adjustments in the dose based on testing. Im not sure which cytokines are being tracked that is important. Are they intracellular ratios or are they serum cytokines. So again without all of the correct parameters you cant determine IVIG dose, frequency or whether to increase or continue prednisone.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mayaus

10 Posts
Reply RE: When to stop neupogen / prednisone Posted on: May 31, 2014 at 6:42pm
Thanks so much Dr Braverman, I am talking about TNFILapha and TNFilbeta. The alpha is 42 after three ivig doses so this is what is concerning me.

Dr. Braverman

2026 Posts
RE: When to stop neupogen / prednisone Posted on: May 31, 2014 at 6:49pm
that is only looking at one ratio in one cell TNF/IL-10 in a CD4 T cell. Although high you cant draw conclusions from just one cell line. Look at my Diagnostic testing page and see what should be included in this analysis.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mayaus

10 Posts
Reply RE: When to stop neupogen / prednisone Posted on: May 31, 2014 at 8:09pm
Sorry, I shuold have posted the complete ifnormation

TH1:TH2 Intracellular Cytokine RatioTNF-a:IL-10 (CD3+/CD4+)Ratio 13.2 - 30.6 42.8 HighIFN-g:IL-10 (CD3+/CD4+)Ratio 5.8 - 20.5 23.5 High
This was the last test after two Ivig infusions three weeks apart from each other. Previous test TFNaIL was 34 ( and the previous one around 29 but this was before pregnancy).

Would you keep doing Ivig and increase prednisone?

Thanks so much

Dr. Braverman

2026 Posts
RE: When to stop neupogen / prednisone Posted on: May 31, 2014 at 8:17pm
Again, you dont have enough data to make such a difficult decision , these are only ratios in CD4 T cells and do not reflect serum cytokines , I would never make such a complex decision on so little data and really no one can.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.