Why Is Chemotherapy Used for Lupus?
What is Lupus?
Systemic lupus erythematosus, also known as lupus, is a disease of the immune system. The immune system protects the body from infection. In lupus, however, the immune system turns against the body, leading to tissue damage and illness. Thus, lupus is called an autoimmune disease.
Men and women of any age can be affected by the disease. People from Africa, Asia, and Native America are more likely than Caucasians to develop lupus. One in 2,000 people in the U.S. may develop this disease. Also, one in 250 women of childbearing age may develop lupus. The possible reason is female hormones, which may influence the risk of having this disease.
Lupus patients may experience fever, weight loss, tiredness, anemia, low platelet count, and low white blood cell count, skin problems, hair loss, mouth sores, arthritis, kidney problems, depression, confusion, stroke, inflammation of the covering of the heart and lungs, and, although rarely, brain problems including seizures.
The exact cause of lupus is not yet known, but the factors that may influence one's risk of getting it are environmental chemicals, viruses, and the person's genetic make up.
More women than men are affected by lupus. Among women, those of childbearing age have higher chances of getting lupus; hence, female hormones are thought to play a role. Lupus may affect more than one family member, which suggests that lupus can be inherited. Ten percent of lupus patients have close relatives also suffering from this condition.
Chemotherapy as a Treatment for Lupus
Chemotherapy is usually associated with cancer treatment. However, it is also used to treat lupus in its aggressive forms. Mostly patients with lupus are not given chemotherapy as the first option. It is only given after other methods are not effective or have failed. Actress Selena Gomez received chemotherapy after having been diagnosed with lupus. This treatment option came as a shock to everyone, since chemotherapy is known as a treatment for cancer, and lupus is not a form of cancer. This treatment course goes on for several months. Below are the major chemotherapy medications used in the treatment of lupus.
CellCept
CellCept is the brand name of mycophenolate mofetil. It was originally developed for organ transplant patients. It helps the body not reject the new organ but adapt to it. But since CellCept lowers the immune system and lupus is an autoimmune disease, the drug began to be used for lupus.
Depending on the severity of the condition, the lupus patient will receive the dose in combination with a steroid. The most common side effect is infection. Since this may become life threatening, you should notify your doctor if you feel any signs of infection. The side effects experienced by people taking CellCept are nausea, vomiting, gases, diarrhea, headaches, stomach upset, loss of appetite, anxiety, insomnia, tremors, swelling of the hands and feet, numbness, and tingling. Women about to undergo this treatment should have a negative pregnancy test result, and after the medication is ceased the patient should avoid getting pregnant for six weeks.
Once the patient is on CellCept, the doctor will monitor the her condition by doing regular blood tests to see to it that the treatment does not damage the body further. It may take several months for the treatment to result in any big beneficial changes in the patient's health.
It is suggested that people taking CellCept are at an increased risk for cancer. However, the doctor will judge the benefits against the risk before starting the treatment. People on the medication should avoid sun exposure and wear sunscreen.
CellCept works by targeting a protein in the body. This protein is important in cellular DNA formation, being responsible for certain chemical reactions. By targeting this enzyme, immune system function is impaired. CellCept may be given twice daily, with the doses amounting to 2000-3000 mg per day. Drugs that may interact with CellCept include azathioprine (Imuran), acyclovir (Zovirax), cholestercholestyramine (Questran), gancyclovir (Cytovene), theophylline (Theo-Dur), trimethoprim/sulfamethoxazole (Bactrim),*antacids containing magnesium or aluminum hydroxide (such as Maalox, Rolaids, or Mylanta), probenecid (Benemid), oral contraceptives, phenytoin (Dilantin), and aspirin as well as other salicylates.
It should be noted that an alert was issued by FDA a few years ago regarding a link between CellCept and multifocal leukoencephalopathy, a rare, usually fatal neurological disease.
Methotrexate
This is another major chemo treatment given to lupus patients. If the patient does not respond to a hydroxychloroquine and prednisone regimen, the doctor may resort to this. Methotrexate is used to treat lymphoma, osteosarcioma, leukemia, lupus and rheumatoid arthritis.
Methotrexate is used to reduce joint pain and swelling from polyarthritis in lupus patients. Meanwhile, it is mildly effective for severe lupus symptoms involving the kidneys and other organs.
Methotrexate interferes with the production folic acid, which is required for cell-building. Hence, methotrexate hinders the growth of cells. This includes the cells of the immune system. Improvement can be seen in 3-6 weeks, and the drug is taken for three months for its complete benefits. Since the folic acid production is interfered with, the doctor may recommend folate supplements.
Inform your doctor and let him know about all the prescriptions, over-the-counter medications, and other supplements that you are taking. Methotrexate is a very strong drug and can have strong, even dangerous drug interactions. Methotrexate should not be taken antibiotics containing trimethoprim-sulfamethoxazole. Other drugs that should not be taken alongside methotrexate are acitretin (Soriatrane), leflunomide (Arava), asparaginase (Elspar), retinoids, penicillins, and drugs that can cause kidney or liver problems.
Methotrexate is taken orally by lupus patients, in doses much lower than those received by cancer patients. Methotrexate may not be taken every day, and the doctor will put you on a strict regimen which should be followed. This medication is usually taken in tablet form once or twice in a week.
It is important to follow the doctor’s directions. Otherwise, methotrexate can be lethal. Some side effects of this medication are temporary hair loss, vomiting, nausea, boils, acne, rash, itching, and pale skin. Women should have a negative pregnancy test before starting this medication, and should not be breastfeeding. After stopping the medication, women have to take measures against getting pregnant, while men have to do the same to avoid getting female partners pregnant.
Another side effect of the treatment is infection, and patients should watch out for signs and symptoms and inform the doctor if there are any.
Cytoxan
Another chemotherapy for lupus patients is cyclophosphamide or Cytoxan. It is used to treat leukemia, breast cancer, eye cancer, ovarian cancer, neurobalstoma, rheumatoid arthritis, and in cases of severe lupus with severe kidney inflammation and other lupus complications that threaten other major organs. For lupus, it is usually given in the form of shots, in combination with other medications, and at lower doses than those for cancer patients.
Dosage may vary from person to person. Cytoxan is usually given in shots, but it can also be taken in tablet form. Sometimes, it is also given intravenously.
The drug may take months to show improvement. Initially, the doctor gives the medication once in six months, and then every 2-3 months. It is given for two years.
Side effects include bruising, and wounds may not heal easily. Hence, the patient is advised not to take part in any activities where there are chances of injuries. Another side effect is the risk of developing an infection. Hence, one should report any signs and symptoms to the doctor right away.
Other side effects of Cytoxan are hair loss, loss of menstrual periods, loss of appetite, diarrhea, vomiting, skin rash, feeling unwell, stomach pain, weakness, changes in skin color and nail texture, and pale skin.
A number of byproducts result as the body processes Cytoxan. One of these byproducts may irritate the bladder and cause scarring or bleeding. Thus, blood in urine is one common side effect. To avoid this, patients on Cytoxan should drink 8 glasses of water a day. If the drug is being taken intravenously, the doctor should give Mesna in order to prevent bladder issues.
Cytoxan may increase the risk of cancer, since along with immune cells, it may target the normal cells of the body. It may cause leukemia and bladder cancer, in particular. There have been reports of patients developing these forms of cancer due to prolonged use of Cytoxan. The doctor should perform blood tests and urine tests in patients taking Cytoxan regularly.
Cytoxan may interact with certain drugs. These are the gout medication allopurinol (Aloprim, Zyloprim), warfarin (Coumadin), thiazide diuretics such as hydrochlorothiazide, phenobarbital (Solfoton), and some psychiatric medications.
Pregnant or breastfeeding women should not take this medication.
Azathioprine (Imuran)
Imuran is an immunosuppressive drug. It reduces joint damage and disability in lupus, and also decreases the need for steroids.
Imuran works by preventing certain immune cells that are involved in immune response from spreading. However, it may take 6 to 12 weeks for the drug to work, since it is a slow onset drug. Side effects include nausea, vomiting, stomach pain, and diarrhea. Liver test abnormalities, hepatitis, pancreatitis, and allergic reaction are less common side effects. Prolonged use of Imuran may increase the risk of developing cancer.
The doctor should perform routine blood tests. Also, the patient should look for any signs and symptoms such as easy bruising, bleeding, fever, rashes, and infections, and inform the doctor immediately. If you are pregnant or breastfeeding, you should avoid this medication.
Imuran should not be combined with the following drugs: the gout medication allopurinol (Zyloprim), warfarin, ACE inhibitors, which are used for high blood pressure, olsalazine, mesalamine, and sulfasalazine.
How chemotherapy helps fight lupus
Overactive immune systems and inflammation are controlled by immunosuppressive medications. When steroids fail to bring lupus under control or high doses of steroids cannot be tolerated by the person then immunosuppressive drugs are prescribed by the doctor.
Since these drugs have side effects, the patient is monitored by the doctor. These drugs suppress the immune system and reduce its ability to fight infections; hence, a person taking any of these medications should call her doctor in case of any signs or symptoms of infection such as redness, tenderness, pain, or swelling. These drugs may also increase the risk of developing cancer.
Many immunosuppressive medications are used by organ transplant recipients to prevent their bodies from rejecting the organs. However, these drugs are also used for certain autoimmune diseases.
Immunosuppressive drugs interfere with DNA synthesis. DNA contains the entire genetic information blueprint, thus by interfering with its synthesis it down regulates the attack of immune system. When the cells are unable to divide properly they die. Hence immunosuppressive drugs are used. Serious lupus complications involving the kidneys, cardiovascular system, brain, and lungs can be controlled by these drugs. Sometimes, immunosuppressive drugs are combined with steroids.
Cytoxan and CellCept reduce the activity of the immune system. Methotrexate, which is mostly used when the patient does not respond to hydroxychloroquine or prednisone, has a powerful suppressing effect on the immune system and is also used for other diseases such as arthritis and psoriasis.
Bottom line
In the past four decades, the number of lupus cases has almost tripled. Chemotherapy was initially used only for cancer, but began to be used for autoimmune disorders as well. It was in 1971 that chemotherapy was first used in a controlled trial to treat lupus. Today, chemotherapy is used to treat illnesses such as rheumatoid arthritis, lupus, Crohn’s disease, polymyositis vasculitis, psoriatic arthritis, and scleroderma.
Chemotherapy is used to treat cancer and severe cases of lupus by reducing or suppressing immune system activity, inflammation, and symptoms. The FDA has not approved the use of CellCept, Methotrexate, and Cytoxan for lupus, since their therapeutic value in the treatment of lupus has not been proven in clinical trials. Nevertheless, many rheumatologists consider these drugs effective and use them to treat lupus in severe cases where complications involving major organs call for the aggressive treatment. It should always be borne in mind, however, that they may carry significant side effects and therefore, their use requires strict compliance by the patient and monitoring by the doctor.
