Lupus Site - a guide for lupus patients and their families

What are cytotoxics?

Cytotoxic or immunosuppressive drugs suppress immune function. �They can suppress any arm of the immune system, like T cells or B cells, they can suppress transplanted organ rejection, the making of antibodies, or the attack of certain cells, viruses or tumours. �The use of cytotoxic drugs is called chemotherapy.

Cytotoxics kill or inhibit the action of the immune system. �This can result in death of cells or the interruption of the synthesis of antibody. �Certain cells of the immune system manufacture antibodies, so if we turn off the manufacture of the antibodies, the damage done to the body, as a result of immune complexes, ceases.

What cytotoxics are used to treat lupus?

Cyclophosphamide (Cytoxan) - best used intravenously.

Chlorambucil (Leukeran) - much better tolerated than oral Cytoxan, long term use (more than 2 years) makes it a potent carcinogen. �

Azathioprine (Imuran) - has modest effects on serious lupus, but has the advantage of reducing steroid requirements. �

Methotrexate (Rheumatrex) - works within weeks, & is taken only once a week. �Decreases joint inflammation, but can make lupus patients more sensitive to ultraviolet light. �Has little effect on organ-threatening disease. Must be used carefully in patients with kidney impairment.

What symptoms of lupus can cytotoxics be used to treat?

Cytotoxics are very strong drugs, & usually only used to treat lupus when absolutely necessary. �They are used on patients who have major organ involvement, severe muscle inflammation, or intractable arthritis.

What are the side effects of cytotoxics?

Cyclophosphamide - hair loss, nausea, vomiting, possible infertility, can result in the cessation of bone marrow function, resulting in anaemia, & low levels of white blood cells & platelets.

Chlorambucil - occasional skin rashes, nausea, vomiting, diarrhoea, bone marrow suppression(as with cyclophosphamide), increased production of fibrous tissue in the lungs is a rare but serious problem.

Azathioprine - skin rashes, diarrhoea, nausea, vomiting(occasionally), occasionally results in cessation of bone marrow function (as with cyclophosphamide).

Methotrexate - nausea, vomiting, diarrhoea, anaemia, bone marrow suppression(as with cyclophosphamide), liver damage.