**4.4 Management of Recurrent relapse**

Despite an initial good response to therapy, about 30–50% of patients will suffer a relapse, within the next two years [1–5, 18–20]. The use of secondary agents such as methotrexate (or others such as azathioprine in patients, who are intolerant to methotrexate) should be considered in patients with recurrent relapse or failure. Various clinical trials have shown that Methotrexate (7.5–15 mg once a week) reduces the relapse rate and overall duration of exposure to corticosteroids [20].
