Immunosuppressive Therapy in Autoimmune Disease: A Review

The 1991 document reviews immunosuppressive therapies for autoimmune diseases, detailing the use of various drugs and techniques, their effectiveness, and associated risks. It discusses hormonal drugs like prednisolone, cytotoxic drugs such as methotrexate and cyclophosphamide, anti-T-lymphocyte activation drugs, and immune modulation techniques like intravenous immunoglobulin and plasmapheresis. Azathioprine is noted for its steroid-sparing effects in conditions like lupus and rheumatoid arthritis, while hydroxychloroquine is beneficial for reducing flare-ups in SLE. Cyclophosphamide is effective in severe cases like lupus nephritis, and methotrexate has a rapid benefit in inflammatory diseases. Cyclosporin's selective T-cell inhibition is effective in various diseases but has nephrotoxicity concerns. The document also mentions the potential of future therapies to be more specific, targeting immune cells involved in the disease, but recognizes that this may be overly optimistic. Side effects such as marrow suppression, infection risk, and malignancy are significant concerns, emphasizing the need for careful drug management.