From the Guidelines
The cytotoxic drug prescribed for a patient with lupus erythematosus would be azathioprine. Azathioprine is an immunosuppressive medication that works by inhibiting purine synthesis, which interferes with DNA production and reduces the proliferation of immune cells, particularly T and B lymphocytes. This mechanism helps control the autoimmune response in lupus by decreasing inflammation and tissue damage. Azathioprine is typically dosed at 1-3 mg/kg/day orally, often starting at a lower dose and gradually increasing while monitoring for side effects. Patients taking azathioprine need regular blood tests to monitor for potential bone marrow suppression, liver toxicity, and other adverse effects.
Key Points
- The other medications listed have different mechanisms:
- Humira (adalimumab) is a TNF inhibitor
- filgrastim is a granulocyte colony-stimulating factor
- Arava (leflunomide) is a pyrimidine synthesis inhibitor
- While these may be used for various autoimmune conditions, azathioprine is the cytotoxic agent commonly used in lupus management, as supported by the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1.
- Azathioprine is licensed for use in systemic lupus erythematosus, and there is evidence to indicate superiority for maintenance compared with cyclophosphamide, following induction in patients with lupus nephritis, as stated in the british association of dermatologists' guidelines for the safe and effective prescribing of azathioprine 2011 1.
From the FDA Drug Label
Azathioprine suppresses disease manifestations as well as underlying pathology in animal models of autoimmune disease The patient diagnosed with lupus erythematosus is prescribed the cytotoxic drug azathioprine 2.
- Key points:
- Azathioprine is used to suppress autoimmune diseases.
- It has been shown to be effective in animal models of autoimmune disease.
- The other options, humira, filgrastim, and arava, are not mentioned in the context of the provided drug labels as being used for lupus erythematosus treatment with azathioprine. Note that humira and arava are used for the treatment of rheumatoid arthritis, but the provided drug labels do not contain information about their use in lupus erythematosus treatment. Filgrastim is not mentioned in the provided drug labels.
From the Research
Cytotoxic Drug Options for Lupus Erythematosus
- The patient diagnosed with lupus erythematosus is prescribed a cytotoxic drug, and the options include humira, azathioprine, filgrastim, and arava.
- Based on the provided studies, azathioprine is a widely used cytotoxic drug for the management of systemic lupus erythematosus (SLE) 3.
- Azathioprine is effective for patients with skin lesions, pneumonitis, thrombocytopenia, or hemolytic anemia, and it may be used during pregnancy but not during lactation 3.
- A study comparing azathioprine with other immunosuppressant medications found that azathioprine had a high incidence of adverse events, including infections, gastrointestinal events, and hematological cytopenias 4.
- Another study found that mycophenolate mofetil was superior to azathioprine in maintaining a renal response to treatment and preventing relapse in patients with lupus nephritis 5.
- Humira is not mentioned in the provided studies as a cytotoxic drug for lupus erythematosus.
- Filgrastim is not mentioned in the provided studies as a cytotoxic drug for lupus erythematosus.
- Arava (leflunomide) is not mentioned in the provided studies as a cytotoxic drug for lupus erythematosus, but it is an immunosuppressant medication that may be used to treat SLE.