Intermittent cyclophosphamide for the treatment of autoimmune thrombocytopenia in systemic lupus erythematosus

Article Abstract:

Systemic lupus erythematosus (SLE) is a complex and highly variable autoimmune disorder. From 7 to 26 percent of SLE patients develop thrombocytopenia, a decrease in blood platelets which may result in uncontrolled bleeding. Corticosteroids are often the first line of treatment against autoimmune or inflammatory disorders, but the disease in many SLE patients either does not respond to corticosteroids or would require unacceptably high doses. In general, the next therapeutic step would be the removal of the spleen. This surgery, splenectomy, is not always effective, and cases that are unresponsive to splenectomy might require treatment with cytotoxic drugs. One cytotoxic drug which can have beneficial effects is cyclophosphamide. Intermittent pulses of cyclophosphamide have been shown to be superior to daily doses in the treatment of kidney inflammation in SLE patients. A study of seven patients with thrombocytopenia was conducted to determine if similar advantages could be observed in this complication. The patients received cyclophosphamide once a month in doses ranging from 0.75 to 1.0 grams per meter squared of body area. Within 2 to 18 weeks (after one to four doses), all seven patients had platelet counts within the normal range. In addition, six of the seven who were experiencing kidney problems showed kidney improvement. Although it is difficult to draw conclusions from only seven patients in a uncontrolled trial, the results suggest that intermittent pulses of cyclophosphamide may be effective for SLE patients who have failed to respond to other therapy, or for whom therapy such as splenectomy may not be appropriate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Autoimmune diseases, Cyclophosphamide

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Renal, neuropsychiatric, cardiovascular, pulmonary, and hematologic disease

Article Abstract:

The process of treating and diagnosing the many forms of lupus erythematosus may be complex. Lupus erythematosus is a chronic, invasive and debilitating inflammatory disease that can affect many organ systems of the body. Researchers reviewed more than 400 articles in the recently published literature to provide an overview of the treatments and methods for diagnosing lupus as it affects the kidney, central nervous system, heart, lung, and immune system. Corticosteroids seem to be the best choice of treatment for all forms of the disease except when the kidney is involved. Drugs that suppress the immune system seem to be more effective than corticosteroids in treating lupus in the kidney. However, the best combination of dose and length of treatment has yet to be resolved. Blood analyses are helpful in diagnosing most forms of the disease. Tissue sampling and some of the more advanced imaging tools, such as magnetic resonance imaging and computed tomography, are helpful in confirming a borderline diagnosis.

Heart diseases, Neurologic manifestations of general diseases, Neurologic manifestations, Renal manifestations of general diseases, Renal manifestations

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Dermatologic and joint disease, the antiphospholipid antibody syndrome, pregnancy and hormonal therapy, morbidity and mortality, and pathogenesis

Article Abstract:

No effective treatment exists for dermatologic and joint disease as well as the antiphospholipid antibody syndrome among patients with systemic lupus erythematosus. Researchers reviewed relevant studies published since 1990. Lupus erythematosus is a diverse disorder that produces scaly or rash-like skin discolorations and joint disease. Skin features often worsen after sun exposure, also know as photosensitivity. Antiphospholipid antibody syndrome is characterized by blood clotting or miscarriages. Treatment options include drugs that prevent blood clotting and warfarin. It is unclear whether lupus erythematosus becomes worse with pregnancy. Recent studies suggest that most lupus patients survive 10 years after their diagnosis. There seems to be agreement over a genetic predisposition followed by the activation of B cells and T cells. Other environmental and genetic factors may contribute as well.

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