How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?

Susac's is a rare disease characterized by an occlusive retinal vasculopathy, eighth nerve disease including hearing loss and balance issues, and CNS disease with a predilection for involvement of the corpus callosum. I am not aware of any randomized controlled data to guide treatment for Susac's, but there is general consensus that immunosuppression as by IVIg and MMF is very helpful.

Knowing when to taper therapy is arguably an even more difficult question than what therapy to use. I would be guided in part by sustained evidence for no disease activity for a year (including retina, eighth nerve, and brain), how severely impaired the patient is from the initial attack, and how the medications are being tolerated. After that, it's a questio...