What to do? Only 3 drugs to choose from.

So, here I am in Japan and my wife's ITP isn't responding to anything and hovering around the 5,000 mark. The doctor said we will have to choose a new medication by Thursday but he only provides us with three options. Rituxan, Imuran, or Promacta. Rituxan isn't covered by insurance here, but I can always rob some convenience stores, and I have heard that ITPers are responding to 25% of the usual dosage. Imuran just sucks. Promacta sounds like a lifelong commitment. This is just my take on things but I have to choose a drug. Help me by letting me know what you would choose. I really appreciate it.

P.S. I told the doctor that my wife and I still wanted to have a child so what medicine would he recommend to stay in line with that goal. His answer..."I don't know." That is how bad Japanese doctors are, but I have no choice but to deal with these morons.

I can only give you my experience with rituxan, as that is the only one of the 3 I have taken. I did ask several doctors if rituxan had any effect on long tem fertility and was told no by everyone I asked as I was concerned with that as well.

Dog:

Of the three, Promacta has the best chance of getting her counts up the fastest (if she responds). Rituxan can take a few weeks, and Imuran also takes a good bit of time. You might want to consider Promacta for now, that does not mean it's a life-time commitment. Remissions can and do occur and new treatments are being developed all the time. She could use Promacta until something else becomes available or feasible (such as Rituxan) in the future. If the goal for now is to get counts up, Promacta may be the best choice. Some people also have luck with N-Plate.

What Sandi said.

You didn't say what they have already tried. I'm assuming Prednisone, Dexamethasone, and/or IVIG?
They didn't offer common immune-system suppressants like Cyclosporine or Cellcept?
If they are only offering three other choices (which seems really odd), I'd choose Promacta (for the reasons Sandi gave. Make sure your insurance covers it though, it isn't cheap.

I agree it doesn't make sense to only have 3 drugs available. Unfortunately it is very difficult to communicate with the doctors. They take my inquisitive demeanor as disrespect here. Usually Japanese patients ask no questions. As a doctor, you can do whatever the hell you want to them.

I also like Promacta and I am pretty sure insurance covers it. I just read from the drug description that becoming pregnant is ill advised while on Promacta, yet it is a drug that you usually don't discontinue. Rituxan, on the other hand, asks that people wait one year after treatment to attempt conception. Of course, who knows if remission would last that long.

Dog:

I know things seem bleak now as far as having a family goes, but it might not always be this way. This change, and you never know what might be around the corner. Many people have had unexpected remissions when they didn't think it would ever happen. Hang in there.