Lupus Erythematosus is an incurable autoimmune medical condition that can be managed with permanent treatment. Cytotoxic drugs may be used in advanced cases of systemic lupus, to stop the development of the rapid growing cells that are produced by a defective immune system.
The cytotoxic drugs, also known as antimetabolites, are actually immunosuppressant medication that will damage the cells produced by the immune system that cause the symptoms of lupus. There are three drugs that are commonly used in the management of systemic lupus:
- Cyclophosphamide, marketed as Cytoxan, which is most frequently prescribed
- Azathioprine, found as Imuran
- Methotrexate, or Myotrex
These drugs may also be used in patients with arthritis, after organ transplants to prevent the rejection of the new organ and may also be utilized in cancer treatment.
Cytotoxic Drugs for Lupus Erythematosus
The cytotoxic drugs are only recommended in certain patients with lupus. Typically, patients with systemic lupus that have affected organs should start this type of treatment. If there are life threatening conditions caused by lupus (vascular damage, neurological symptoms), these drugs are recommended. Patients that don't respond to corticosteroid treatment may also get cytotoxic treatment. In some patients, the cytotoxic drugs are used in conjunction with corticosteroids, alternating a day of corticosteroids with a day of cyclophosphamides.
Side Effects of Cytotoxic Drugs
While the cytotoxic drugs can do a good job suppressing the immune system and keeping the patient's condition stable, there may be a series of side effects, especially if the drugs are used as a standalone treatment and for a longer period of time. The side effects may vary according to the type of drugs prescribed, but most commonly include:
- Hair loss; however, the hair may grow back. Some patients even reported getting curly or wavy hair as a result of cytotoxic treatment.
- Secondary infections and diseases, which are due to the fact that the immune system is suppressed and cannot react to infections agents or foreign bodies that cause diseases. The most common infections in patients under cytotoxic treatment include pneumonia, urinary tract diseases or blood infestations.
Other symptoms of treating lupus erythematosus with cytotoxic drugs include:
- Liver toxicity
- Bladder injury
- Nausea and vomiting
- Cancer development, in rare cases
The cytotoxic drugs shouldn't be used in pregnant women, as these may lead to miscarriage or birth defects.
There are also a series of newly developed immune system suppressants such as cyclosporine (Neoral) and mycophenolate mofetil (Cellcept), which are still being studied in the use of lupus erythematosus and may cause fewer and less severe side effects.
Administration and Treatment Monitoring
The treatment with immunosuppressants should be prescribed only by doctors that have experience with similar cases and administration of cytotoxic medication. While under treatment, the patient should be monitored constantly and if possible, the dose should be reduced. This can be done when the patient's condition is stable or she seems to be in a remission phase. The treatment may also be replaced with less aggressive drugs if the patient shows signs of improvement.