Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases

Author: Janey Willis. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Azathioprine (Imuran)
Mycophenolate mofetil (Cellcept)
Chemo Brain


Immunosuppressants are medications that suppress or prevent the immune response. (Also see What is Scleroderma?, Medical Overview, and Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases)

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; however, when used to treat scleroderma and some other autoimmine diseases the dosage is lower than when used in chemotherapy to treat cancer or organ transplant patients.

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. As with any drugs, immunosuppressants can have serious side effects and risks.

Case Report: Type B insulin resistance syndrome with Scleroderma successfully treated with multiple immune suppressants after eradication of Helicobacter pylori infection. The present case suggests H pylori infection–related pathological mechanism may contribute to type B insulin resistance syndrome and autoimmune disorders. BioMed Central, BMC Endocrine Disorders.

Advances in pathogenesis and treatment of systemic sclerosis. Immunosuppression is now established as a beneficial approach but balancing risk and benefit is vital, especially for powerful approaches such as autologous stem cell transplantation. PubMed, Clin Med, 2015 Dec;15 Suppl 6:s58-63. (Also see Stem Cell (Bone Marrow) Transplantation)

Assessment of Risks of Pulmonary Infection During 12 Months Following Immunosuppressive Treatment for Active Connective Tissue Diseases: A Large-scale Prospective Cohort Study. Physicians should be aware of the higher risks for corticosteroids of pulmonary infection than other immunosuppressants and assess these risk factors before immunosuppressive treatment. PubMed, J Rheumatol, 02/01/2015. (Also see Steroids)

Periodontitis treatment improves systemic lupus erythematosus response to immunosuppressive therapy. Periodontal disease treatment seems to have a beneficial effect in controlling disease activity in SLE patients under immunosuppressive therapy and therefore, management of this modifiable risk factor is recommended. PubMed, Clin Rheumatol, 2014 Jan 11. (Also see Systemic Lupus Erythematosus Treatments)

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.

Is immunosuppressive therapy the anchor treatment to achieve remission in systemic sclerosis (SSc)? Patients with rapidly progressing diffuse cutaneous SSc should be evaluated for hematopoietic stem cell transplantation. PubMed, Rheumatology, 2013 Oct 31. (Also see Stem Cell Transplantation)

Scleroderma Treatments and Clinical Trials ISN.

Azathioprine (Imuran)

Azathioprine (Imuran). Patient Education. American College of Rheumatology.

Prognosis and treatment of interstitial lung disease in systemic sclerosis (scleroderma). Azathioprine is an alternative immunosuppressive agent for systemic scleroderma (SSc) patients with early stage interstitial lung disease (ILD) who are not candidates for cyclophosphamide or who decline cyclophosphamide. Uptodate. JVarga, MD. 10/11/12.


Fewer Mycophenolate Adverse Events in Scleroderma Lung Study. Mycophenolate mofetil can be substituted for cyclophosphamide for the immunosuppressive treatment of scleroderma-related interstitial lung disease and might even be safer. Medscape, 11/02/2015. (Also see Pulmonary Fibrosis Treatments and Clinical Trials)

Systemic Sclerosis(SSc) Sera Impair Angiogenic Performance of Dermal Microvascular Endothelial Cells: Therapeutic Implications of Cyclophosphamide (CYC). In SSc, CYC treatment might boost angiogenesis and consequently improve peripheral microangiopathy. PLOS One, 06/15/2015. (Also see Raynaud's Treatments)

Low-dose pulse cyclophosphamide (CYC) in interstitial lung disease associated with systemic sclerosis (SSc-ILD): Efficacy of maintenance immunosuppression in responders and non-responders. The study supports the use of low-dose pulse CYC as induction therapy of recently deteriorated SSc-ILD. Moreover, it suggests that azathioprine should be administered to CYC-responsive patients but does not show any definite effect of micophenolic acid in unresponsive patients. ScienceDirect, 09/08/2014.

Cyclophosphamide Clinical Trials. ISN.

Scleroderma Lung Study II. ISN.

Results from the Scleroderma Lung Study I. This study showed that 1 year of oral cyclophosphamide (CYC) was effective in improving lung function, symptoms of shortness of breath, and quality of life but the effect on lung function and quality of life only lasted for another 6 months after CYC was stopped. UCLA.

Cyclophosphmide. Patient Education. Chemocare.


Cyclosporine (Neoral, Sandimmune, Gengraf).


Methotrexate Clinical Trials. ISN.

Methotrexate. Patient Education. American College of Rheumatology.

The Drug-Induced Repiratory Disease Website. List of over a hundred medications that can cause lung disease or symptoms and also shows the associated patterns. Pneumotox. (Also see Pulmonary Involvement)

Inadequate response or intolerability to oral methotrexate (MTX): Is it optimal to switch to subcutaneous (SC) methotrexate prior to considering therapy with biologics? SC MTX can prove to be more efficacious in patients refractory to oral MTX therapy or in patients experiencing severe gastrointestinal adverse effects. PubMed, Rheumatol Int, 03/02/2016. (Also see Treatments for Rheumatoid Arthritis)

Eosinophilic fasciitis (EF): clinical characteristics and response to methotrexate (MTX). MTX represents an effective treatment option for EF although the rarity of this disease would make a double-blind controlled trial study difficult to perform. PubMed, Int J Rheum Dis, 2015 Jan;18(1):91-8.

Three decades of low-dose methotrexate in rheumatoid arthritis: Can we predict toxicity? A summary of current data on low-dose MTX-associated toxicity, its prevention and predictors, keeping in mind practical RA clinical care. PubMed, Immunol Res, 2014 Nov 13. (Also see Medications for Rheumatoid Arthritis)

Methotrexate (MTX) in systemic lupus erythematosus (SLE). The use of MTX is associated with significant reductions in SLE Disease Activity Index and the average dose of corticosteroids in adult patients with SLE. PubMed, Lupus, 2014 Jan 7. (Also see Systemic Lupus Erythematosus Treatments)

Methotrexate vs Azathioprine in Second-line Therapy of Sarcoidosis. Comparing the effect of second-line therapy in sarcoidosis shows that both methotrexate and azathioprine have significant steroid-sparing potency, a similar positive effect on lung function, and comparable side effects, except for a higher infection rate in the azathioprine group. CHEST Journal, September 2013.

Mycophenolate mofetil (Cellcept)

Mycophenolate Mofetil (Cellcept). CellCept lowers your body's immune system. Genentech.

Safety and effectiveness of mycophenolate in systemic sclerosis. A systematic review. Mycophenolate-associated gastrointestinal adverse events are common in SSc, but not severe enough to preclude its use and it may be effective in improving or stabilizing interstitial lung disease and skin involvement. PubMed, PLoS One, 2015 May 1;10(5):e0124205.

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.

Go to IVIG
Most Recent Donors

Winn Schillberg
Reading Voices of Scleroderma Books: Diana Kramer.
Sharing Scleroderma Awareness Bracelets: Deb Martin, Brenda Miller, Vickie Risner.
Thanks to UNITED WAY donors of Central New Mexico and Snohomish County!

In Loving Memory

Patricia Ann Black: Marilyn Currier, Shelley Ensz, Richard Howitt, Gerald and Pat Ivanejko, Juno Beach Condo Association, Keith and Rosalyn Miller, and Elaine Wible.
Gayle Hedlin: Daniel and Joann Pepper and Nancy Smithberg.
Janet Paulmenn: Anonymous, Mary Jo Austin, Shelley Blaser, Susan Book, Dennis and Pat Clayton, Grace Cunha, Cindy Dorio, Michael and Patricia Donahue, Shelley Ensz, Nancy Falkenhagen, Jo Frowde, Alice Gigl, Margaret Hollywood, Karen Khalaf and Family, Susan Kvarantan, Bradley Lawrence, Jillyan Little, Donna Madge, Michele Maxson, Barry and Judith McCabe, John Moffett, My Tribute Foundation, Joan-Marie Permison, John Roberts, Margaret Roof, Maryellen Ryan, Mayalin and Kiralee Murphy, Nancy Settle-Murphy, and Bruce and Elizabeth Winter.


SCLERO.ORG is the world leader for trustworthy research, support, education and awareness for scleroderma and related illnesses, such as pulmonary hypertension. We are a service of the nonprofit International Scleroderma Network (ISN), which is a 501(c)(3) U.S.-based public charitable foundation, established in 2002. Meet Our Team, or Volunteer. Donations may also be mailed to:

International Scleroderma Network (ISN)
7455 France Ave So #266
Edina, MN 55435-4702 USA

Email [email protected] to request our Welcome email, or to report bad links or to update this page content.

TOLL FREE HOTLINE 800-564-7099
Free to U.S. and Canadian Callers. Ask for our Free Info Packet by mail or email!
Scleroderma, Pulmonary Arterial Hypertension, and related illnesses.
Privacy Policy.

The most important thing in the world to know about scleroderma is!
Donate Now
Copyright 1998-2016, International Scleroderma Network. AKA Scleroderma from A to Z and SCLERO.ORG. All Rights Reserved.