Medication Summary
The goals of pharmacotherapy are to induce remission, to reduce morbidity, and to prevent complications.
Antineoplastic agents
Class Summary
Has potent immunosuppressive properties.
Cyclophosphamide (Cytoxan)
Chemically related to nitrogen mustards. Transformed primarily in the liver to active alkylating metabolites. The mechanism of action of the active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. PO and IV administration appear to be equally efficacious, although controversy exists.
Corticosteroids
Class Summary
Used for immunosuppressive and anti-inflammatory effects.
Methylprednisolone (Solu-Medrol)
Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability. After 3 d, switch to PO prednisone.
Prednisone (Deltasone, Sterapred, Orasone)
Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.
Immunosuppressant agents
Class Summary
May be an effective substitution for cyclophosphamide.
Azathioprine (Imuran)
Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity. Protocol widely and successfully used in Europe is substitution of azathioprine for cyclophosphamide after 3-mo induction period.
