Sorry cellcept is causing problems. Sometimes starting with smaller doses and gradually increasing them may help.
My neuro (at Mayo Clinic) said that she had many folks on long-term prednisone at low doses (under 15 mg per day or alternate days). She said it all depends on whether or not there are other problems with the prednisone. My own was that I was being pushed into type 2 diabetes, and so she thought changing to Imuran would be better long term. I went into remission (and am there now for almost 4 years) so didn't have to make the switch.
Mom, who had an auto-immune disease, polymyalgia rheumatica, took about 10mg of prednisone per day from age 65 to when she died just before her 92nd birthday. She did get type 2 diabetes, but as she said, "life would have been unlivable without the prednisone." She did try to taper lower, but at about 7mg/day the pain would be almost unbearable to do anything. So, I was never really scared of taking prednisone long term as at the time, Mom was still alive and thriving. Her death was from heart failure, a sudden overnight peaceful stop after a regular active day, not related to the prednisone.
Good Luck

How did you know you were in remission? Did you symptoms resolve on the meds and you just tapered off and hoped for the best? That is what I did, but I had the flare of double vision and so I am back to square one it seems. Do you still see a neuro or just take it as it comes. I was so hoping that was happening to me, but it didn't. Did you have trial and errors of going off meds to see if you were in remission?

I didn't know if I was in MG remission at first . With high doses of prednisone, I no longer had any MG symptoms, so I was in what would be called remission with treatment.

I began tapering prednisone and none of the MG symptoms came back as I dropped lower. Eventually I tapered off of prednisone and after several months without a return of symptoms, my neuro said I am in drug free remission that might last for months, or maybe years or the rest of my life.

As I was tapering prednisone, my neuro wanted me to start Imuran (we had decided that would be better than prednisone long term for me). I asked her "if I start Imuran before I am off prednisone, I will not know if I am one of the 15% who do go into remission. Should I delay starting it?" She said it was up to me -- and if I could accept that MG could comeback and I would have to restart prednisone, I decided to try it. I was retired, and could get by with a restricted activity if needed, and I knew prednisone would likely work again.
Anyway, I tapered down to zero and MG symptoms have not come back now for nearly 4 years, so it was the right decision for me. However my neuro was less sure I should as 15% chance is not very high.

good luck Russ

Rhanson, We all hope your drug-free remission keeps going and never stops. It brings up an interesting discussion about the 15% number. How many people that are off prednisone, but still stay on Cellcept, etc. could possibly be in remission? In my case, I got a flare-up 3 months of being on Cellcept only, so that proves that I probably wasn't in remission anyways. Or, was I in remission for 3 months and didn't need the cellcept during that time. We will never know.

I am going to give zero prednisone another try most likely after I get this flare-up under control. My flare-up started 5 weeks after hip replacement surgery. My original symptoms appeared 5 weeks after my first hip replacement last year. I don't believe in coincidences.....lol

That is what happened to me. I was down to 2.5 mg of Prednisone and felt great. As I tapered, I never felt any different, just kept coming down. No Mestinon at all. Then I stopped and as I posted, the double vision happened. Now I am back on the Prednisone at 40 mg and Mestinon 3-4 x a day. I am going to cut back to 30 of prednisone and see how that goes. I did not take the Cellcept. I want to see how I respond to the tapering dose of Prednisone. Since reading your posts here, I realize that I must do a trial and error treatment with this and now that I am somewhat recovered, I am willing to start tapering down, but not too quickly. I thought perhaps if I had a flare, it would be hand weakness (that is how it started), I never imagined the double vision, so I have to keep that in mind as I am tapering. I started the Prednisone last May. I think now that I have sort of have an idea of how this stuff works or doesn't, I can try to slowly taper, but not go off the prednisone completely even at a tapering rate, even if I get back to 2.5 mg. Hopefully if I can reach that point again, I am going to see if I can just stick with that. I am not too keen on the Cellcept for long term use. I just take it one day at a time as they say.

40 to 30 is a pretty big jump. You might want to talk to your doctor about every other day dosing to minimize side effects. Basically, the avg. of the total dose for two days equals the daily dose. From 40 you could go to 50/20 then 50/10 then 50/0 then 40/0 etc. until 20/0 where you would slow the taper even more. When I did this, there were two weeks between each reduction.

I started at 10 mg, then tapered up weekly and now today I took 30 and hoping to taper down again. Again, trial and error. I guess I sort of panicked when I got the double vision; just didn't see that coming and for the most part, I don't really like the neuro I am going to, but what a hassle to get another referral, etc., only to probably be told the same thing from someone else, because doctors are all bound together by what the drug companies say anymore, not by their knowledge or instincts or experience. Like someone said to me, "medicine is an industry now."