IMMUNOSUPPRESSIVE DRUGS USED FOR LUPUS
Although drugs that suppress the immune system (the human body’s natural defense system against infections and certain cancers) immunosuppressive drugs can be of great value in the treatment of SLE. Immunosuppressive drugs may help preserve kidney function, lessen the severity of symptoms and sometimes even put the disease into remission. These drugs also help reduce damage to vital organs.
CellCept (generic name mycophenolate mofetil): CellCept suppresses the immune system, which is overactive and misdirected in lupus. This medication is also used to prevent rejection of donated organs, kidney, liver, heart, and lung transplants. CellCept tends to be less toxic than Cytoxan, and less likely than Cytoxan to cause sterility. Its side effects include nausea and diarrhea. It may take several months for CellCept to become effective.
Methotrexate: Methotrexate is usually taken once a week orally. It may also be given by injection. It is generally well tolerated, but liver enzyme blood tests need to be monitored, as well as blood counts. Liver irritation and lung reactions can occur with methotrexate. It’s also commonly given for rheumatoid arthritis. It cannot be used during pregnancy.
Imuran (generic name azathioprine): Imuran is generally well tolerated, but blood count tests are needed to monitor the medication. White blood cell count can be reduced by the medication. There is an ongoing question whether Imuran increases the risk of developing lymphoma, but aside from nausea which occurs occasionally, Imuran is generally well tolerated. It helps in controlling lupus disease activity.
Cytoxan (generic name cyclophosphamide): Cytoxan is commonly given intravenously but can also be given orally. Though it is generally well tolerated, it can cause nausea, hair loss, a reduction of white blood cells, platelets, or red blood cells. Longer-term use of Cytoxan increases the risk of developing cancers, including leukemia and bladder cancer. Cytoxan may cause sterility, preventing patients from having children. It can also damage the developing fetus if a woman gets pregnant while taking the drug. Cytoxan can cause bleeding from the bladder, and large amounts of fluid help to prevent this side effect. Like the other immunosuppressive drugs, Cytoxan may predispose an individual to developing infections, particularly when given with higher doses of steroids. Cytoxan can be quite effective in controlling active kidney and lung disease and very active lupus in general.
Rituxan (generic name rituximab): Rituxan produces antibodies against B-lymphocyte white blood cells. These cells are responsible for making antibodies, including autoimmune antibodies such as anti-DNA antibodies that play a role in lupus. The medicine is given intravenously and although infections can occur, it is generally well tolerated.
Benlysta (generic name belimumab): Benlysta was recently approved for the treatment of systemic lupus. It is given intravenously once a month. It is an actually antibodies against B-lymphocyte white blood cells. It reduces these cells, which make antibodies, including autoimmune antibodies present in systemic lupus.
Prograf (generic name tacrolimus) and Neoral (generic name cyclosporine): Prograf and Neoral primarily affect T-lymphocyte white blood cells. T-cells activate the immune system and cause the manufacture of chemical messengers called cytokines that can initiate and increase inflammation and tissue damage in people with lupus. These medications are also used to prevent organ rejection in kidney, heart, liver, and other organ transplant recipients. These drugs can elevate blood pressure and reduce kidney function.
Robert S. Katz, M.D.
Although drugs that suppress the immune system (the human body’s natural defense system against infections and certain cancers) immunosuppressive drugs can be of great value in the treatment of SLE. Immunosuppressive drugs may help preserve kidney function, lessen the severity of symptoms and sometimes even put the disease into remission. These drugs also help reduce damage to vital organs.
CellCept (generic name mycophenolate mofetil): CellCept suppresses the immune system, which is overactive and misdirected in lupus. This medication is also used to prevent rejection of donated organs, kidney, liver, heart, and lung transplants. CellCept tends to be less toxic than Cytoxan, and less likely than Cytoxan to cause sterility. Its side effects include nausea and diarrhea. It may take several months for CellCept to become effective.
Methotrexate: Methotrexate is usually taken once a week orally. It may also be given by injection. It is generally well tolerated, but liver enzyme blood tests need to be monitored, as well as blood counts. Liver irritation and lung reactions can occur with methotrexate. It’s also commonly given for rheumatoid arthritis. It cannot be used during pregnancy.
Imuran (generic name azathioprine): Imuran is generally well tolerated, but blood count tests are needed to monitor the medication. White blood cell count can be reduced by the medication. There is an ongoing question whether Imuran increases the risk of developing lymphoma, but aside from nausea which occurs occasionally, Imuran is generally well tolerated. It helps in controlling lupus disease activity.
Cytoxan (generic name cyclophosphamide): Cytoxan is commonly given intravenously but can also be given orally. Though it is generally well tolerated, it can cause nausea, hair loss, a reduction of white blood cells, platelets, or red blood cells. Longer-term use of Cytoxan increases the risk of developing cancers, including leukemia and bladder cancer. Cytoxan may cause sterility, preventing patients from having children. It can also damage the developing fetus if a woman gets pregnant while taking the drug. Cytoxan can cause bleeding from the bladder, and large amounts of fluid help to prevent this side effect. Like the other immunosuppressive drugs, Cytoxan may predispose an individual to developing infections, particularly when given with higher doses of steroids. Cytoxan can be quite effective in controlling active kidney and lung disease and very active lupus in general.
Rituxan (generic name rituximab): Rituxan produces antibodies against B-lymphocyte white blood cells. These cells are responsible for making antibodies, including autoimmune antibodies such as anti-DNA antibodies that play a role in lupus. The medicine is given intravenously and although infections can occur, it is generally well tolerated.
Benlysta (generic name belimumab): Benlysta was recently approved for the treatment of systemic lupus. It is given intravenously once a month. It is an actually antibodies against B-lymphocyte white blood cells. It reduces these cells, which make antibodies, including autoimmune antibodies present in systemic lupus.
Prograf (generic name tacrolimus) and Neoral (generic name cyclosporine): Prograf and Neoral primarily affect T-lymphocyte white blood cells. T-cells activate the immune system and cause the manufacture of chemical messengers called cytokines that can initiate and increase inflammation and tissue damage in people with lupus. These medications are also used to prevent organ rejection in kidney, heart, liver, and other organ transplant recipients. These drugs can elevate blood pressure and reduce kidney function.
Robert S. Katz, M.D.
