Is Chemotherapy a Treatment for Lupus?
Systemic lupus erythematosus, or SLE, is a chronic multisystem autoimmune disorder that may affect the joints, skin, and other organs in the body. Since there is no cure, treatment goals are for controlling symptoms. Nonsteroidal anti-inflammatory drugs, antimalarial drugs and corticosteroids are common types of medications for mild to moderate symptoms. SLE is not cancer, but when it becomes life threatening or aggressive, it may be treated with chemotherapy drugs, such as methotrexate, cyclophosphamide, azathioprine or leflunomide.
Methotrexate, sold under the brand names of Rheumatrex and Trexall, is a drug used to treat SLE by blocking the metabolism of cells. Possible side effects of methotrexate include stomach upset, mouth sores, headaches, rash, hair loss and low white blood cell counts. Potentially severe toxicity of the kidneys, bone marrow and liver require regular blood tests for monitoring. For long-term use, a liver biopsy may be recommended.
Serious interactions can occur when taking methotrexate with other medications. Be sure your doctor and pharmacist are aware of any prescription or nonprescription medication or supplement you take.
Cyclophosphamide, sold as Cytoxan and Neosar, is a group of drugs that slows or stops the rapidly dividing white blood cells, such as in a flare of SLE. MedlinePlus reports side effects are common and may include:
- Thinning or brittle hair
- Skin thickening
- Acne or blistering skin
- Poor appetite
- Shortness of breath
- Nausea and vomiting
Possible risks associated with cyclophosphamide include interference with the menstrual cycle in women and sperm production in men, kidney damage, and interactions with other prescription and nonprescription medications, especially aspirin.
Azathioprine, sold as Imuran or Azasan, is a chemotherapy drug used more for autoimmune disease treatment than for cancer. It inhibits the synthesis necessary for cell growth associated with autoimmune disorders, such as SLE.
Mild side effects of azathioprine may include hair loss, a rash or upset stomach and diarrhea. Notify your doctor if you experience fever, pain with urination, jaundice, unusual weakness, rapid heart rate, easy bleeding or flu-like symptoms. For difficulty breathing, hives, or swelling of your throat, lips or tongue, seek emergency help immediately.
Possible risks associated with taking azathioprine include a decrease in your body’s ability to fight infections, cancer and, if you are pregnant, harm to your unborn baby.
Leflunomide, sold as Arava, is similar to methotrexate and may be an alternative, if you are unable to take methotrexate. It can also be used in combination with methotrexate to treat lupus, if you have no preexisting liver disease, according to the Johns Hopkins Arthritis Center.
Possible side effects of leflunomide include:
- Liver toxicity
- Stomach upset
- Hair loss
- Chest pain
Risks of side effects associated with leflunomide may increase with kidney disease, liver disease, a weak immune system or any infection. Avoid taking leflunomide, if you are pregnant.
Mayo Clinic: How Is Lupus Treated? https://www.mayoclinic.com/health/lupus/DS00115/DSECTION=treatments-and-drugs
MedicineNet: Methotrexate https://www.medicinenet.com/methotrexate/article.htm
MedlinePlus: Cyclophosphamide https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682080.html
RXList: Azathioprine https://www.rxlist.com/imuran-drug-patient.htm#whatis
Johns Hopkins Arthritis Center: Leflunomide https://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_treat.html