Medications for Scleroderma, Arthritis,
Autoimmune and Rheumatic Diseases |
| This page was written by Janey Willis and has not yet been medically edited. See Disclaimer. |
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| Immunosuppresants |
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| Overview of Immunosuppressants |
| Immunosuppressants are medications that suppress or prevent the immune response. Immunosuppressants are used to prevent rejection of a transplanted organ and to treat autoimmune diseases such as scleroderma, psoriasis, rheumatoid arthritis, and Crohn's disease. They are also referred to as immunodepressants. |
| Some immunosuppressants are chemotherapy drugs, but used at higher dosages than when used to treat autoimmune disease. |
| Immunosuppressants fall under a category of drugs referred to as DMARDs (Disease-Modifying Anti-Rheumatic Drugs). Immunosuppressants commonly used for scleroderma and rheumatic diseases include methotrexate, azathioprine (Imuran), cyclosporine, mycophenolate mofetil (Cellcept), and cyclophosphamide (Cytoxan). As with any drugs, immunosuppressants can have serious side effects and risks. |
| Immunosuppressants - clinical applications. There are now over 80 autoimmune diseases and several common allergic conditions in which immunosuppressants could play a role although they may not be life-saving. Australian Prescriber. |
| The Effects of Medications on Bone. Corticosteroids and cancer chemotherapeutic agents generally affect bone adversely and increase fracture. J Am Acad Orthop Surg, Vol 15, No 8, August 2007, 450-460. |
| Advances in immunosuppressive therapy. This represents the first evidence that immunosuppressive drugs are efficacious in rheumatic disease-associated interstitial fibrosis and provides a rationale for developing therapeutic regimens that optimize efficacy and safety. PubMed. Semin Respir Crit Care Med. 2007 Aug;28(4):398-417. (Also see: Pulmonary Fibrosis ) |
| Immune Status and Risk for Infection in Patients Receiving Chronic Immunosuppressive Therapy. Patients receiving chronic immunosuppressive therapy can develop severe lymphopenia that involves all subsets. Monitoring T-helper cell counts may be useful to estimate the risk for subsequent infections in such patients. J Rheumatol. 2005 August;32:1473-80. |
| Scleroderma Treatments and Clinical Trials ISN. |
| Azathioprine (Imuran) |
| Azathioprine (Imuran). Patient Education. American College of Rheumatology. |
| Twelve-month azathioprine as maintenance therapy in early diffuse systemic sclerosis patients treated for 1-year with low dose cyclophosphamide pulse therapy. This study suggests a role of AZA in maintaining the improvement induced by low dose pulse CYC in early dcSSc, making it possible a short duration of treatment at a low cumulative dose of the drug. These results, however, await confirmation in controlled studies. PubMed. Clin Exp Rheumatol. 2007 Jul-Aug;25(4):613-6. |
| A randomized unblinded trial of cyclophosphamide CYC) versus azathioprine (AZ) in the treatment of systemic sclerosis. After treatment there was a statistically significant improvement in the modified Rodnan skin score, attack frequency of Raynaud's phenomenon, and erythrocyte sedimentation rate (ESR) in the CYC-group, but not in the AZ-group. PubMed. Clin Rheumatol. 2006 Mar;25(2):205-12. Epub 2005 Oct 14. |
| Cyclophosphamide (Cytoxan) |
| Cyclophosphamide Clinical Trials. ISN. |
| Cyclophosphmide (Cytoxan). Patient Education. American College of Rheumatology. |
| Therapeutic Strategy Combining Intravenous Cyclophosphamide (CYC) Followed by Oral Azathioprine to Treat Worsening Interstitial Lung Disease Associated with Systemic Sclerosis: A Retrospective Multicenter Open-label Study. Intravenous CYC followed by oral maintenance immunosuppressive therapy for worsening ILD was well tolerated and was associated with stable or improved PFT in 70% and 51.8% of SSc patients at 6 months and 2 years, respectively. J Rheumatology First Release May 1 2008. (Also see: Pulmonary Fibrosis ) |
| Effects of 1-year treatment with cyclophosphamide on outcomes at 2 years in scleroderma lung disease. One year of CYC improved lung function, skin scores, dyspnea, and health status/disability, effects which either persisted or increased further for several months after stopping therapy. However, except for a sustained impact on dyspnea, all of these effects waned and were no longer apparent at 24 months. PubMed. Am J Respir Crit Care Med. 2007 Nov 15;176(10):1026-34. (Also see: Cytoxan and Pulmonary Involvement ) |
| High dose cyclophosphamide without stem cell rescue in scleroderma. High dose cyclophosphamide without stem rescue can lead to clinically significant improvement in skin score and measures of disease severity in patients with diffuse cutaneous scleroderma. PubMed. Ann Rheum Dis. 2007 Nov 1. (Also see: Diffuse Scleroderma and Clinical Trials ) |
| Revimmune Uses An Approved Drug In A New Patent-Pending Method To Eliminate Autoimmunity. Revimmune uses an ultra-high intensity, short-course of an intravenous formulation of an approved drug (cyclophosphamide), in a new patent-pending method to "reboot" a patient's immune system, thereby eliminating the autoimmunity. Medical News Today. 03/03/07. (Also see: Clinical Trials and Autoimmunity ) |
| Combination of intravenous pulses of cyclophosphamide and methylprednizolone in patients with systemic sclerosis and interstitial lung disease. The results suggest that the employed combination is safe and effective, mainly in stabilizing the respiratory function of the patients. This goal is more realistic when treatment is given before significant functional compromise has ensued. PubMed. Rheumatol Int. 2007 Feb;27(4):357-61. (Also see: Pulmonary Fibrosis and Cyclophosphamide for Scleroderma Lung Disease ) |
| Cyclosporine |
| Cyclosporine (Neoral, Sandimmune, Gengraf). Patient Education. American College of Rheumatology. |
| Successful treatment with cyclosporine in a case of progressive interstitial pneumonia associated with systemic sclerosis. Prednisolone and cyclophosphamide were given to the patient, but clinical symptoms and chest radiographic findings worsened. After cyclophosphamide was replaced with cyclosporine, his symptoms, chest radiographic findings and pulmonary function improved and stabilized. PubMed. Nihon Kokyuki Gakkai Zasshi. 2003 Jul;41(7):480-5. (Also see: Pneumonia: Other) |
| Methotrexate |
| Methotrexate Clinical Trials. ISN. |
| Methotrexate. Patient Education. American College of Rheumatology. |
| A Novel Predictor of Clinical Response to Methotrexate (MTX) in Patients with Rheumatoid Arthritis (RA): A Pilot Study of in Vitro T Cell Cytokine Suppression. An in vitro tumor necrosis factor-a suppression assay may help predict clinical response to MTX in RA. Nigil Haroon. J Rheumatol First Release May 1 2008. (Also see: Rheumatoid Arthritis ) |
| Tolerability of methotrexate (MTX) and leflunomide (LEF) combination therapy for inflammatory arthritis in routine clinical practice: results of a four-centre study. The contrasting modes of action of MTX and LEF make them attractive candidates for use in combination with the potential to provide additive or synergistic actions, perhaps without the need for expensive biologic agents. A. Kaul. Rheumatology Advance Access. July 15, 2008. (Also see: Arthritis and DMARDs ) |
| Therapy with Immunosuppressive Drugs and Biological Agents and Use of Contraception in Patients with Rheumatic Disease. The increasing use of combination therapies containing Methotrexate necessitates ensuring that advice regarding birth control is followed in order to avoid pregnancies exposed to potentially fetotoxic drugs. J Rheumatol 2007 June;34:1266-9. (Also see: Scleroderma and Pregnancy ) |
| Rheumatoid arthritis could be prevented if the timing is right: Methotrexate shown to delay and prevent RA progression. Patients diagnosed with undifferentiated rheumatoid arthritis could have their disease outlook changed if treatment is given at the right time. Innovations Report. 06/22/06. (Also see: Rheumatoid Arthritis) |
| Placebo controlled trial of methotrexate in systemic sclerosis. Clinical improvement following treatment was observed in 33.33% of the patient in MTX group but none in placebo group, but this difference was not statistically significant. PubMed. Mymensingh Med J. 2005 Jan;14(1):71-4. |
| Mycophenolate mofetil (Cellcept) |
| Mycophenolate Mofetil (Cellcept). Patient Education. American College of Rheumatology. |
| Cases of progressive multifocal leukoencephalopathy (PML), sometimes fatal, have been reported in patients treated with mycophenolate mofetil (MMF). PML is a rare, progressive, demyelinating disease of the central nervous system (CNS) that usually leads to death or severe disability. Novartis global safety database has no cases of PML. Roche has reported ten confirmed and seven possible cases of PML with MMF. The ten confirmed cases were six solid organ transplant patients and four systemic lupus erythematosus (SLE) patients. The seven possible cases were four solid organ transplant patients and two SLE patients. The seventh possible case was an HIV positive patient. U.S. Food and Drug Administration. 07/01/08. (Also see: FDA warnings ) |
| Effect of Mycophenolate Mofetil (MMF) on Pulmonary Function in Scleroderma-Associated Interstitial Lung Disease (SSc-ILD). These retrospective data suggest MMF improves vital capacity (VC) in patients with SSc-ILD. (PubMed) Chest. 2007 Dec 10. (Also see: Pulmonary Fibrosis ) |
| FDA Alert for CellCept (mycophenolate mofetil). Roche and FDA notified healthcare providers that use of CellCept (mycophenolate mofetil) is associated with increased risk of first trimester pregnancy loss and increased risk of congenital malformations. In addition, CellCept reduces blood levels of the hormones in an oral contraceptive pill and could theoretically reduce its effectiveness. FDA Medwatch. October 2007. (Also see: FDA Warnings ) |
| 2nd Phase III CellCept Failure Sends Aspreva Shares Down. The 370-patient, 24-week, randomized, open-label study failed to prove that CellCept was superior to intravenous cyclophosphamide (IVC), a cancer drug used off-label in lupus nephritis and widely considered to be the current standard of care. BioWorld Today. 06/28/07. (Also see: Lupus ) |
| Mycophenolate Mofetil and Intravenous Dexamethasone in the Treatment of Persistent Lupus Myelitis. Subsequent therapy with mycophenolate mofetil and continuous intravenous infusions of dexamethasone resulted in reduction of the lesion's size, disappearance of magnetic resonance imaging enhancement, and a complete recovery. J Rheumatol 2007;34:588-91 (Also see: Lupus ) |
| Mycophenolate Mofetil (Cellcept) as First-Line Treatment Improves Clinically-Evident Early Scleroderma Lung Disease. Our preliminary data suggest that in patients with recent, clinically apparent dSSc-related alveolitis, early treatment with Cellcept and small doses of corticosteroids may represent an effective, well-tolerated and safe alternative therapy. S. C. Liossis. SAT0210 EULAR 2006. (Also see: Pulmonary Fibrosis ) |
| Mycophenolate mofetil (Cellcept) is safe, well tolerated, and preserves lung function in patients with connective tissue disease-related (CTD) Interstitial lung disease (ILD). Glucocorticoids and immunomodulatory agents are regarded as mainstays of therapy for CTD-related ILD; however, apart from those studies that have evaluated certain medications for patients with scleroderma, few studies have been performed. PubMed. Chest. 2006 Jul;130(1):30-6. (Also see: Pulmonary Fibrosis ) |
| Warnings and Risks associated with Immunosuppressants |
| Pregnancy and rheumatic diseases. Infertility is rarely due to the disease but can be associated with cyclophosphamide therapy. Most rheumatic diseases that are well controlled prior to pregnancy do not deteriorate in pregnancy, providing that the patient continues with appropriate disease-modifying therapy. Rheumatology 2007 46(11):1634-1640. (Also see: Scleroderma and pregnancy ) |
| Therapy with Immunosuppressive Drugs and Biological Agents and Use of Contraception in Patients with Rheumatic Disease. The increasing use of combination therapies containing Methotrexate necessitates ensuring that advice regarding birth control is followed in order to avoid pregnancies exposed to potentially fetotoxic drugs. J Rheumatol 2007 June;34:1266-9. (Also see: Scleroderma and Pregnancy ) |
| Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. In this large cohort of RA patients, the most heightened risk of serious infections was seen with the use of glucocorticoid agents and immunosuppressive DMARDs. Rheumatology. Volume 46, Number 7 Pp. 1157-1160. (Also see: RA ) |
| Patients with Rheumatoid Arthritis Undergoing Surgery: How Should We Deal with Antirheumatic Treatment? Continuation of methotrexate (MTX) appears to be safe in the perioperative period. To avoid the antiplatelet effect during surgery, NSAIDs other than aspirin should be withheld for a duration of 4 to 5 times the drug half-life. (Science Direct) Seminars in Arthritis and Rheumatism Vol 36, Issue 5, April 2007, Pages 278-286. (Also see: RA ) |
| Immune Status and Risk for Infection in Patients Receiving Chronic Immunosuppressive Therapy. Patients receiving chronic immunosuppressive therapy can develop severe lymphopenia that involves all subsets. Monitoring T-helper cell counts may be useful to estimate the risk for subsequent infections in such patients. J Rheumatol. 2005 August;32:1473-80. |
| Brain abscesses caused by Abiotrophia defectiva: complication of immunosuppressive therapy in a patient with connective-tissue disease. We report the case of a patient who developed brain abscesses caused by Abiotrophia defectiva. The patient was treated with prednisone and cyclophosphamide for connective-tissue disease (Lupus-Sjogren's overlap syndrome). PubMed. Scand J Infect Dis. 2004;36(6-7):497-9. (Also see: Lupus, Sjogren's Syndrome, Overlap Syndrome, and Brain Involvement) |
| Infections in systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis/dermatomyositis. In SLE, scleroderma, and PM/DM, infections are important causes of morbidity and mortality. Thus, patients with these diseases, especially when receiving high doses of corticosteroids and immunosuppressive therapy, need to be monitored closely for these infections. PubMed. Rheum Dis Clin North Am 2003 Feb;29(1):163-84. |
| Chemo Brain |
| Some immunosuppressants are chemotherapy drugs, but used at higher dosages than when used to treat autoimmune disease. |
| Chemobrain: When cancer treatment disrupts your thinking and memory, Dealing with thinking and memory problems caused by cancer or cancer treatment can be frustrating. Find out more about chemobrain and how to cope. MayoClinic. |
| Scientists Find 'Chemo Brain' No Figment Of The Imagination. People with 'chemo brain' often can't focus, remember things or multitask the way they did before chemotherapy. ScienceDaily. 10/08/06. |
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