Immunosuppressive Drugs

Immunosuppressive drugs constitute a heterogeneous group of compounds, each with a unique mode of action and toxicity profile. The long-term use of immunosuppressive drugs is associated with an increased risk of infection, a reduced response to vaccinations, and other individual drug-related side effects. Cyclophosphamide is a cytostatic drug for remission induction in severe systemic lupus erythematosus (SLE) and necrotizing vasculitis. Azathioprine can be effective as a glucocorticoid-sparing cytostatic agent in remission maintenance therapy, particularly in SLE and necrotizing vasculitis. Mycophenolate mofetil is increasingly being used as an alternative to cyclophosphamide for remission induction in lupus nephritis, for remission maintenance in SLE and necrotizing vasculitis, and for management of systemic sclerosis lung and skin involvement and myositis-related interstitial lung disease. The calcineurin inhibitors cyclosporine and tacrolimus can be effective in various rheumatic conditions but are less commonly used due to side effects and paucity of long-term data from controlled trials. Voclosporin is a new and safer calcineurin inhibitor and analogue of cyclosporine used in combination with background immunosuppressive regimen for the treatment of lupus nephritis.