Medical Health Encyclopedia

Angiotensin II Receptor Antagonists. Angiotensin II receptor antagonists (losartan, candesartan cilexetil, and valsartan) have benefits similar to ACE inhibitors and may have fewer or less severe side effects, including coughing. They may also have positive effects on blood vessels. Small studies showing improvement in Raynaud's phenomenon warrant further research.

Immunosuppressive Agents

One major approach to scleroderma is to use agents and other therapies to suppress the immune system and therefore reduce the activity of the harmful processes leading to scleroderma. Such treatments are being used effectively in other autoimmune diseases. Their use in scleroderma varies depending on the location and severity of the disease process.

An important 2002 study employed an approach called high-dose immunosuppressive therapy, which uses radiation, powerful immunosuppressant drugs, and other therapies to severely suppress the immune system. This is a very toxic treatment, but improvements in skin and other indicators of scleroderma were more significant than those reported with other therapies. More research is warranted.

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Cyclophosphamide (Cytoxan) is the most important immunosuppressant currently used for scleroderma. A small study found that patients with scleroderma-related lung disease respond better to intravenous cyclophosphamide than those without such lung disease. When used with stem cell transplantation, high doses of cyclophosphamide are proving to be safe for patients with systemic sclerosis.

Other drugs used to suppress the immune system may be useful in specific cases. They include D-penicillamine (which may useful for skin symptoms), methotrexate (Rheumatrex), corticosteroids, cyclosporine (Sandimmune, Neoral), and chlorambucil (Leukeran). All of these agents have potentially severe side effects.