During the past two decades, the immunosuppressive drugs have been widely used in the treatment of patients with lupus nephritis. Complications that arise from these therapies stem from their immunosuppressive or pharmacologic effects, or both. Uncontrolled studies reporting good results in treating patients with various combinations of corticosteroids and azathioprine and, especially, cyclophosphamide cannot be confirmed by the few clinical trials that are available so far. Part of the problem of inconclusiveness has to do with timing treatment to different phases of the disease and the vast heterogeneity of lupus nephritis. Although these immunosuppressive agents may have favorable effects on the overall activity of lupus, their long-term effects are in question and could be attributed to lower prednisone dosage and better medical management of hypertension, hyperlipidemia, infection, and other metabolic consequences of the disease.
Types of Immunosuppressive Medications
Imuran is an anti-inflammatory immunosuppressive that can decrease joint damage and disability in people with lupus, and other conditions. Moreover, Imuran has proven to significantly improve lupus affecting the liver and kidneys. Imuran is “steroid-sparing,” which basically means that it may allow for a reduction of the amount of steroid being taken. Since the side effects of steroids generally increase with the dosage, this medication generally promotes a reduction in steroid side effects as well.
Mycophenolate mofetil (Cellcept)
Cellcept is an immunosuppressant used especially for lupus patients with signs of kidney disease. It works by targeting an enzyme in the body that is important in the formation of DNA in cells. In doing so, Cellcept impairs your immune system function. Most commonly, Cellcept is given twice a day for a total dose of about 2000-3000 milligrams per day, but this dosage may sometimes be reduced. Like Imuran, Cellcept is steroid-sparing, so it may allow you and your doctor to reduce your dosage of steroid medications and therefore reduce their side effects.
Cyclosporine (Neoral, Sandimmune, Gengraf)
Cyclosporine is a more potent immunosuppressive medication that works by blocking the function of cells in your immune system called T-lymphocytes. Just like other immunosuppressives, it was originally used to prevent the immune systems of patients with transplanted kidneys from rejecting the transplanted organs. It is now also prescribed for people who suffer from inflammation of the kidney caused by lupus. However, cyclosporine can be toxic to the kidneys, so use of this medication is usually reserved for cases in which a person’s lupus does not respond to other immunosuppressive medications. Cyclosporine is also prescribed for people with severe psoriasis, a skin condition that can also cause pain and swelling of the joints, and it can be helpful in reducing some of the pain, swelling, and stiffness associated with lupus arthritis.
All immunosuppressant drugs are available only by a prescription from your doctor. They come as tablets, capsules, liquids, and injections. Naturally, your doctor will decide the best drug forms and treatment regimen for you and they may sometimes use a combination of drugs. The goal of immunosuppressant therapy is to find the treatment plan that will suppress your immune system while having least harmful side effects. If you take immunosuppressant drugs, you must take them exactly as prescribed. In case you have an autoimmune disorder, a regimen change can cause a flare-up of your condition. If you’re an organ recipient, even the slightest change from the medication regimen can trigger an organ rejection. No matter why you’re being treated, if you miss a dose, be sure to call your doctor right away.
An estimated 1.5 million Americans have some form of lupus and five million cases of lupus have been reported around the world. Lupus is more common in African-Americans, Hispanics/Latinos, Asians, Native Americans, Native Hawaiians, and other Pacific Islanders. Women are also more susceptible to it than men, and 90 percent of patients diagnosed are women. If you notice any lupus symptoms, make sure to speak to your doctor as soon as possible in order to come up with the best treatment possible for you!