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.