[akita]

@Hopeful, cititing the study in your link:
"We found a significant association between relapse risk and rapid CyA tapering: 60% compared to 7·6% in the ‘slow tapering group’ (P = 0·001)."
This is a big difference!

@MK921
I had this experience with doctors , and many other have it, that tapering of medicaments is forced or forbidden. Why that?

Tapering over a longer time period could also be favourable because of a reason which has not been mentioned in this thread: It is so with neuroleptics: The body-system gets adapted to the medicament and in case of tapering there occur reactions who would initially not having to do with your primary sickness, but instead with the adaptation and its tapering.

Therefore it is advised to reduce neuroleptics very slowly except when they have not been taken over a longer period than 14 days.

The same problem it is possibly with the immunsuppressive agents after stem cell transplantation. Cyclosporine is also such a medicament. A friend of mine had a heavy worsening of her Graft-Versus-Host-Disease after a fast taper of her immunosuppression, and also i have got a new sort of GVHD - a sclerodermiforme GVHD of the skin - last autumn after too fast tapering of Prograf.

I discussed this problem with my doctor who said to me: "Of course we try to reduce the immunosuppressive agent as fast as possible as it causes unwished side-effects. We know, that some patients will get bad side effects from the reduction, but we have to try the reduction at some time-point.. We cannot see in advance which patient would tolerate it an which not. To go sure that reduction would not cause side effects we would to let all patients stay on the immunsuppressive agents for their whole life..".

My personal opinion is: that this doctor never has tried to evaluate the different experiences with the reduction of immunosuppression in the different patients.Where is the statistics for that? It is so important regarding the consequences it has for the patient, reducing slowly (how slow) or fast oder never..

Kind regards,

Margarete