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Immunosuppressive drug therapy
W J McCune1, D K Vallance, J P Lynch
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0358.
Current Opinion in Rheumatology
|May 1, 1994
Summary
Immunosuppressive drugs like azathioprine and cyclophosphamide may offer a survival benefit for interstitial lung disease in rheumatic disorders when added to prednisone. However, more controlled studies are needed to confirm efficacy.
Area of Science:
- Rheumatology
- Pulmonology
- Pharmacology
Background:
- Interstitial lung disease (ILD) is a common complication of rheumatic disorders, including polymyositis-dermatomyositis, rheumatoid arthritis, systemic sclerosis, and mixed connective tissue disease.
- Current treatment strategies for chronic interstitial pneumonitis-fibrosis in these patients often involve immunosuppressive-cytotoxic agents.
Purpose of the Study:
- To review existing data on the efficacy of azathioprine, cyclophosphamide, chlorambucil, cyclosporine, and methotrexate in managing chronic interstitial pneumonitis-fibrosis associated with rheumatic diseases.
- To assess the comparative effectiveness of these agents against corticosteroid monotherapy.
Main Methods:
- Literature review of anecdotal successes and small, uncontrolled case series.
- Analysis of studies evaluating immunosuppressive agents in conjunction with or as alternatives to corticosteroids.
Main Results:
- Limited evidence suggests azathioprine or cyclophosphamide, when added to prednisone, may provide a slight long-term survival advantage in ILD.
- Cyclosporine use has shown less encouraging results.
- Data for chlorambucil and methotrexate are insufficient for drawing conclusions.
Conclusions:
- While current data are largely anecdotal and uncontrolled, azathioprine and cyclophosphamide show potential benefit in combination with prednisone for rheumatic ILD.
- Further rigorous, controlled clinical trials are essential to definitively establish the role and optimal use of these immunosuppressive agents in treating interstitial lung disease.