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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.

Does an Autoimmune Disorder Affect My Covid-19 Risks? Patients with conditions like lupus and rheumatoid arthritis, who may take immune suppressing drugs, do not appear to be at greatly increased risk from coronavirus. New York Times, 11/18/2020.

Current immunosuppressive and antifibrotic therapies of systemic sclerosis (SSc) and emerging therapeutic strategies. A better understanding of SSc pathophysiology has enabled the identification of numerous new therapeutic targets. PubMed, Expert Rev Clin Pharmacol, 10/02/2020. (Also see Stem Cell (Bone Marrow) Transplantation)

Characterizing Disease Manifestations and Treatment Patterns Among Adults with Systemic Sclerosis (SSc): A Retrospective Analysis of a US Healthcare Claims Population. One-third of patients with SSc in the healthcare claims population received immunomodulating therapy during the first year after diagnosis. PubMed, Rheumatol Ther, 11/16/2019.

Scientists Are Teaching the Body to Accept New Organs. Patients receiving new kidneys and livers must take damaging anti–rejection drugs for the rest of their lives, but now researchers hope to train the immune system instead of just tamping it down. New York Times, 01/22/2019. (Also see Dendritic Cells)

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.

Scleroderma Treatments and Clinical Trials ISN.

Azathioprine (Imuran)

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

Azathioprine (AZA) Maintenance Therapy to Prevent Relapses in Autoimmune Pancreatitis (AIP). AZA is an effective and safe treatment to prevent AIP relapses. PubMed, Clin Transl Gastroenterol, 2017 Apr 27;8(4):e90. (Also see Pancreatitis, Autoimmune)


Treatment of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis (AAV): Is There Still a Role for Cyclophosphamide (CYC)? With the emergence of newer agents with more favorable safety profiles, CYC is no longer the cornerstone of management of AAV. PubMed, Rheum Dis Clin North Am, 2019 Aug;45(3):379-398. (Also see Vasculitis)

Long–term effects of immunosuppressive therapy on lung function in scleroderma patients. Cyclophosphamide does not appear to result in clinically significant improvement of pulmonary function but fulfilled criteria of stable disease. PubMed, Clin Rheumatol, 2018 Nov;37(11):3043-3050. (Also see Treatments for Pulmonary Fibrosis)

Case Report: Successful treatment of cerebral large vessel vasculitis in systemic lupus erythematosus with intravenous pulse cyclophosphamide. Here, we present a rare case of cerebral large vessel vasculitis treated successfully with a clear visual presentation. PubMed, Lupus. (Also see Vasculitis and Symptoms and Complications of Lupus)

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. (Also see Raynaud's Treatments)

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)

Effect of Methotrexate Use on the Development of Type 2 Diabetes in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Rheumatoid arthritis patients on methotrexate treatment had a lower risk of developing type 2 diabetes compared to rheumatoid arthritis patients not exposed to methotrexate. PubMed, PLoS One, 2020 Jul 6;15(7):e0235637. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Comparative Persistence of Methotrexate (MTX) and Tumor Necrosis Factor Inhibitors (TNFi) in Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. Concomitant use of MTX with a TNFi, however, is associated with improved TNFi persistence in all 3 diseases. PubMed, J Rheumatol, 2020 Jun 1;47(6):826-834. (Also see Treatments for Rheumatoid Arthritis, Psoriasis and Psoriatic Arthritis and Ankylosing Spondylitis)

Type 2 Polarized T Cell Phenotype is Associated with Methotrexate (MTX) Non-response in Patients with Rheumatoid Arthritis (RA). MTX-non-responsive RA patients exhibit a bias towards type 2-polarized T cell inflammatory responses. PubMed, Arthritis Rheumatol, 02/10/2020. (Also see Diagnosis of Rheumatoid Arthritis and B Cells and T Cells)

Predictors of disease activity and structural progression after treatment with adalimumab plus methotrexate or continued methotrexate monotherapy in patients with early rheumatoid arthritis. Findings suggested a relationship between the addition of adalimumab at 6 months after methotrexate failure and improved outcomes. PubMed, Ann Rheum Dis, 08/03/2018. (Also see Treatments for Rheumatoid Arthritis)

Comparing ultraviolet light A photo(chemo)therapy with Methotrexate (MTX) protocol in childhood localized scleroderma: Evidence from systematic review and meta–analysis approach. Our study supports the combination of MTX and glucocorticoids in patients with a high risk of complication and UVA1 could represent a therapeutic option in patients with limited scleroderma. Seminars in Arthritis and Rheumatism, 03/30/2018. (Also see Morphea Scleroderma Treatments)

Thymidylate synthase (TYMS) polymorphisms and responsiveness to or toxicity of methotrexate (MTX) in rheumatoid arthritis (RA). This meta–analysis demonstrates that the TYMS 2R/3R and 6 bp I/D polymorphisms may not be associated with non–responsiveness to or toxicity of MTX therapy in RA patients. PubMed, Z Rheumatol, 01/29/2018. (Also see Medications for Rheumatoid Arthritis)

Eosinophilic Fasciitis (EF): an Updated Review on Diagnosis and Treatment. Methotrexate has emerged as the leading corticosteroid–sparing agent for EF. PubMed, Curr Rheumatol Rep, 2017 Nov 4;19(12):74. (Also see Eosinophilic Fasciitis)

Mycophenolate mofetil (Cellcept)

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

A Real–World Experience of Mycophenolate Mofetil (MMF) for Systemic Sclerosis (SSc): A Retrospective Multicenter Observational Study. This real-world based study supports the role of MMF in the stabilization of lung function and the improvement in skin thickness with an acceptable safety profile in patients with SSc. PubMed, Arch Rheumatol, 2020 Jan 13;35(3):366-375.

Mycophenolate mofetil (MMF) for systemic sclerosis (SSC): drug exposure exhibits considerable inter–individual variation–a prospective, observational study. MMF–treated SSc patients exhibit considerable inter–individual variation in drug exposure. PubMed, Arthritis Res Ther, 2020 Oct 6;22(1):230.

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.

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