Onitoring and dose adjustments may be required for these patients. As previously described, the first study included seven newly diagnosed nmo patients with long-term combination of corticosteroids and azathioprine with positive results6. Himp was given first for five days, followed by oral prednisone (1 mg/kg/day) for two months daily. At week three, patients started azathioprine (2 mg/kg/day). Two months later, patients began prednisone tapering very slowly until they have achieved a dose of 10 mg/day and azathioprine doses of 75 to hundred mg/day. Another study observed that suspension of azathioprine was followed by increase in aqp-4 antibody levels and clinical attacks in some patients, together with the interruption of corticosteroid in two patients or the maintenance of low-dose corticosteroid treatment (5 mg/day)9. A retrospective study with 36 brazilian nmo patients analyzed those who used azathioprine alone or in combination with corticosteroids and provided similar findings of reduction in disability and relapse rates29. These results may indicate that combination therapy may be required in some patients. However, there are no multicenter controlled studies to provide class i efficacy evidence of this therapeutic regimen, and side effects may limit the use in some patients. viagra online canada pharmacy cheap viagra online generic viagra medicaresupplementspecialists.com/pfz-where-to-buy-viagra-online-lf/ http://medicaresupplementspecialists.com/pfz-sale-viagra-rp/ where can you buy viagra without a prescription buy viagra online viagra for sale cheap viagra online viagra without a doctor prescription
rituximab rituximab is a chimeric monoclonal antibody against the protein cd20, which is primarily found on the surface of b cells and it has the property to eliminate b cells selectively. Rituximab binds to the antigen on the cell surface, activating complement-dependent b cell cytotoxicity. It also binds to human fc receptors, mediating cell killing through an antibody-dependent cellular toxicity. Rituximab is used in the treatment of many lymphomas, leukemias, transplant rejection and some autoimmune disorders. Besides the clinical studies with rituximab, another evidence that b cells and aqp-4 antibody are closely related to nmo pathogenesis is a case report of a japanese nmo patient with hypogammaglobulinemia secondary to carbamazepine who reported no relapses during the lowered igg levels, but who had no attacks relapsed later when the hypogammaglobulinemia resolved in association with the normalization of cd19+ cells30. The first published open label study included eight patients in the usa, where rituximab was well tolerated, and positive response was observed in all patients with s.