SLE- Immunosuppressants DI Flashcards
Immunosuppressants used in SLE
MTX, AZA, MMF, CYC, CsA
Immunosuppressant indications in SLE
Organ-threatening SLE, mainly LN
Immunosuppressants are often used in combination with what?
Steroids
When to use immunosuppressants?
Poor symptom control after HCQ and steroids
CYC and CsA are used when?
Certain types of LN due to toxicity
MTX- where else is it used?
Concomitant RA or if arthritis is the main problem/complaint of SLE
MTX vs. AZA
MTX is more effective than AZA
MTX ADEs
Bone marrow suppression, GI toxicity, hepatotoxicity, nephrotoxicity, etc.
When to use AZA
Considered second-line after steroids for more moderate disease course
Safest immunosuppressant in pregnancy
AZA
AZA ADEs
Bone marrow suppression, N/V
MMF: when to use it
Proliferative LN, second-line for membranous LN
non-renal disease
When is MMF NOT effective in SLE?
Neuropsychiatric disease
MMF ADEs
GI effects (diarrhea, abdominal pain, constipation, anorexia, nausea)
MMF CIs
Hematological, CV, and teratogenicity risks- CI’ed in pregnancy!
CYC: when to use it
Organ-threatening disease, rescue therapy in non-responders
CYC: complications
Organ-threatening cardiopulmonary, renal, or neuropsychiatric disease
Warnings with CYC
Hematologic, cardiac, neurologic toxicity; can cause permanent infertility in both men and women
Hematologic complications with CYC: what can it do?
Neutropenia
Other complications with CYC
Hemorrhagic cystitis, bladder necrosis, cardio toxicity, CNS toxicity, malignancy development
CsA: when is it used?
Membranous LN
CsA ADE (the one that’s not as severe)
HTN- will make it worse in patients who already have HTN
CsA complications/cautions
Hematologic, nephrotoxic, neurotoxic side effects
