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Amy, I think it often goes like this with the multiple medications: patients are started on prednisone because it’s fast, effective, and inexpensive. But over time and/or at high doses it can cause a lot of other problems, like bone density loss, glaucoma, high blood pressure, and the bane of my existence, increased appetite. People on long term prednisone might be prescribed calcium and vitamin D supplements to try to offset some of the effects of the prednisone, or bactrim to prevent lung infections like mentioned in another post in this thread.
To try to reduce the predisone dose, they add “steroid sparing drugs” – immunosuppressants that work well with prednisone to produce the same effect but at lower prednisone doses. This is where cellcept (mycophenolate), azathioprine, or methotrexate get added in to the mix. Taking the two together lets them use less prednisone for the same result.
If the oral medications aren’t enough, a patient might be put on IV immunosupressants like Soliris or Rituxan, or on IVIG which isn’t a suppressant but something that kind of modifies the behavior of the immune system for a few weeks at a time.
I don’t know how far along that spectrum it usually takes to keep just ocular MG under control. I suspect it’s pretty variable but my guess is it’s more likely to be controlled with just the pills compared to generalized MG. But that’s just a guess.