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Immunosuppressant Treatments for Autoimmune Disease

When are immunosuppressants commonly prescribed for autoimmune conditions, and how well do they work, according to research?

Immunosuppressants are medications that interfere with some aspect of your immune response.  Immunosuppressants belong to several drug classes, including corticosteroids, cytotoxic agents, antibodies, interferons, and anti-immunophilins.

These agents represent the first line of therapy for most autoimmune disorders; by reducing the production of inflammatory chemicals, blocking antibodies that attack your own tissues, or inhibiting the actions of hyper-stimulated immune cells, immunosuppressants effectively control many autoimmune-related symptoms.

According to a January 2012 review in International Journal of Rheumatology, the five-year survival of patients with systemic lupus erythematosus—the archetypical autoimmune disease—has improved dramatically due to the use of immunosuppressants; over 90% of lupus patients now survive for at least five years after diagnosis.  Similar trends in other autoimmune illnesses are attributed to immunosuppressant therapy.  However, not all patients respond to immunosuppressants, and these medications do have potentially serious side effects.

Have there been enough studies done to trust long-term use of immunosuppressants?

Immunosuppressants have been used to treat autoimmune diseases for decades, so their benefits are well-established.  Of equal importance, though, is what we’ve learned about the potential downsides of these drugs when they’re used for long periods.  For example, chronic use of corticosteroids increases your risk for atherosclerosis (hardening of the arteries), diabetes, and osteoporosis.  Methotrexate—a drug commonly used to treat rheumatoid and psoriatic arthritis—can suppress bone marrow and, in rare instances, trigger a fatal condition known as “methotrexate lung.”  All immunosuppressants increase your risk for serious infections, and many have been linked to a higher risk for cancer.

Will taking immunosuppressants reduce my need to take other medications for my symptoms and conditions?

Since immunosuppressants inhibit those immune activities that cause symptoms (i.e., inflammation and tissue destruction), it’s likely you’ll be able to reduce your use of nonsteroidal anti-inflammatories, narcotic painkillers, supplements, etc.  The flip side of the coin is that you may need additional medications to deal with the diabetes, infections, osteoporosis, and other side effects triggered by immunosuppressants.  This issue—the “morbidity” associated with immunosuppressants—is the driving force behind researchers’ efforts to develop less toxic treatments for autoimmune disorders.

If I plan to become pregnant anytime in the future, is immunosuppressant use safe?

Even the “safest” immunosuppressant drugs are classified as Pregnancy Category C, meaning it isn’t known if they cause problems for a developing fetus.  Many are classified as Pregnancy Category D (there is documented evidence of fetal harm) or Pregnancy Category X (the use of the medication during pregnancy is absolutely contraindicated due to inevitable fetal harm).  In a nutshell, no immunosuppressant should be considered safe during pregnancy, and at least one ovulation cycle (or more, if your doctor so advises) should be allowed before conceiving after discontinuing a Category X drug.

Questions for your doctor:

  • What benefits should I expect to see with any new immunosuppressant that’s prescribed for me, and how soon will I see some improvement?
  • What are the side effects, both short- and long-term, of my medication(s)?
  • If I decide to become pregnant, how will my medication(s) affect my chances of conceiving?
  • Do I need to discontinue my immunosuppressant before conceiving? If so, how long should I wait before I try to get pregnant?

Reference
M Postal, LTL Costallat, S Appenzeller. Biological therapy in systemic lupus erythematosus. Int J Rheum. 2012;2012:578641

 

About the Author
Steve Christensen, MD – “Doom” to his close friends – was trained at the University of Utah School of Medicine. Since his premature retirement from medicine in 2003, Dr. Christensen has expanded his knowledge of alternative medicine: he is a certified herbalist; he has dabbled at the edges of Ayurvedism, shared ideas with Chinese physicians, rubbed shoulders with Native American healers and contemplated the healing powers of channeled energy.

 

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Comments

  1. Sunny sharma says:

    I am suffering from alopecia totalis…what is treatment i can taken???
    Azithroprine gives result in alopecia totalty tretment????

  2. parvesh sharma says:

    I m suffering from ch. urticaria since 5 month should I use immunosuppressive drug for this ???

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