Systemic Lupus Erythematosus - Lifestyle Changes

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Immunosuppressant Drugs

Drugs known as immunosuppressants are often used, either alone or with corticosteroids, for very active SLE. Immunosuppressants are particularly recommended when kidney or neurologic involvement or acute blood vessel inflammation is present. These drugs suppress the immune system by damaging cells that grow rapidly, including those that produce antibodies. About a third of patients with SLE take immunosuppressants at some point in the course of the disease.

Specific Immunosuppressants. The most common immunosuppressants are:

• Cyclophosphamide (Cytoxan, generic) used to be considered the gold standard of treatment for lupus kidney disease (lupus nephritis). Cyclophosphamide is given intravenously and is sometimes used in combination with corticosteroids or other drugs. It has been used for lupus since the 1970s. Side effects are very severe and include nausea, vomiting, hair loss, infertility, and infections.
• Mycophenolate mofetil (CellCept, generic) and mycophenolate acid (Myfortic) are now becoming the new standard. Many recent studies have shown that mycophenolate works better than cyclophosphamide and causes far fewer severe side effects (diarrhea is the main side effect). Unlike cyclophosphamide, it is taken by mouth. Most doctors now recommend mycophenalate mofetil as a first-line treatment for newly diagnosed patients with mild or moderate lupus kidney disease. It may not be appropriate for patients with kidney failure or rapidly progressing kidney disease. Mycophenolate should not be used during pregnancy as it can cause miscarriage and birth defects.
• Azathioprine (Imuran, generic) has fewer side effects but is less effective than other immunosuppressants.
• Cyclosporine (Sandimmune, generic) has been used for years, mostly for kidney complications associated with SLE. High blood pressure is common, however, with this drug.

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The most frequent side effects of immunosuppressants include:

• Stomach and intestinal problems
• Skin rash
• Mouth sores
• Hair loss

Serious side effects of immunosuppressants include:

• Low blood cell counts
• Anemia
• Menstrual irregularity
• Early menopause
• Ovarian failure
• Infertility
• Herpes zoster (shingles)
• Liver and bladder toxicity
• Increased risk of cancer
• Kidney damage

In general, immunosuppressants should not be used alone unless corticosteroids are ineffective or inappropriate.

Review Date: 02/18/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).