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How it works, types and side effects

Chemotherapy is a drug treatment that uses strong chemicals to kill cancer cells or slow their growth. Chemotherapy drugs also suppress the immune system. This makes them useful in the treatment of certain autoimmune diseases, including systemic lupus erythematosus or lupus.

Lupus is a chronic autoimmune disease in which the immune system mistakenly attacks healthy cells and tissues in the body, potentially leading to widespread organ damage.

Although chemotherapy does not cure lupus, it can help manage the disease and improve a person’s quality of life.

This article describes the use of chemotherapy drugs as a treatment for lupus and lists some chemotherapy and other treatments for the disease. It also discusses the prognosis for someone living with lupus.

Lupus is a chronic autoimmune disease that can affect almost any type of body tissue. As such it has the potential to cause a wide range of symptoms and complications, including:

The goal of treatment is to prevent organ damage and achieve remission. The choice of treatment depends on the person’s symptoms and general health.

Few drugs are available specifically for the treatment of lupus. Treatment options usually include aspirin and prednisone.

However, in 2011, the Food and Drug Administration (FDA) approved belimumab (Benlysta) for the treatment of lupus and lupus nephritis. The latter is a kidney disease that can occur as a result of lupus.

Doctors don’t have a lot of lupus-specific drugs, and therefore they may use chemotherapy drugs to help put lupus into remission.

Chemotherapy drugs are the mainstay of cancer treatment, but they can weaken and suppress the immune system. Suppressing the immune system is an important part of treating lupus because it stops the overactive immune system from attacking healthy cells and tissues in the body.

Doctors can treat lupus with chemotherapy drugs such as:

As cancer treatments, these drugs help slow or stop the growth of cancer cells. However, they do not specifically target cancer cells. Instead, they target rapidly dividing cells, including white blood cells of the immune system.

Chemotherapy interferes with immune cell function. As a result, it can calm autoimmune reactions and reduce inflammation.

Doctors often use immunosuppressive drugs to calm an overactive immune system in people with lupus. Some of these drugs are also chemotherapy agents.

Methotrexate

Methotrexate is an immunosuppressive drug called a disease-modifying antirheumatic drug because it can reduce joint damage and long-term disability. Methotrexate also belongs to a group of chemotherapy drugs called antimetabolites.

People can take methotrexate as pills or injections under the skin, usually as a single dose once a week. Doctors occasionally prescribe the drug in two doses per week to improve absorption or reduce the risk of side effects.

Methotrexate is not suitable for people with abnormal kidney or liver function, as it can cause scarring of the liver. Consuming alcohol while taking methotrexate greatly increases the risk of liver damage.

Methotrexate can cause gastrointestinal (GI) upset. Rarely, it can cause respiratory symptoms, such as a persistent cough or shortness of breath.

Belimumab

Belimumab (Benlysta) is a specific lupus drug that doctors use in combination with other drugs, such as hydroxychloroquine and steroids.

Belimumab helps treat mild to moderate lupus that affects the skin, joints, and other organs. It is not a chemotherapy drug.

People may need to go to a clinic for a Belimumab infusion every 2 weeks for the first month, then every month thereafter.

Alternatively, doctors can prescribe a self-injection form for weekly administration. Symptom relief should occur within 12 weeks, but in some cases it may take longer.

The side effects of belimumab are generally mild and include:

People with a history of depression should be aware that belimumab may cause low mood and thoughts of self-harm.

Mycophenolate mofetil

Mycophenolate mofetil (CellCept) is an immunosuppressive drug that doctors often use to treat people with autoimmune diseases, especially kidney disease. It is not a chemotherapy drug.

A person takes mycophenolate twice a day and should have regular blood tests to check blood counts and liver function.

Side effects of mycophenolate include:

Prolonged use of mycophenolate may increase the risk of skin cancer and lymphoma.

Cyclophosphamide

Cyclophosphamide (Cytoxan) is a powerful immunosuppressant and chemotherapy drug that doctors may prescribe to help put severe lupus into remission.

A person can take cyclophosphamide by mouth daily or go to the clinic for a weekly or monthly injection. However, it may take several weeks for symptoms to improve and several months or longer for complete remission.

Doctors may prescribe cyclophosphamide for 3 to 6 months until a person’s lupus goes into remission. After that, a doctor can prescribe a less potent drug with less risk of side effects.

Potential side effects of cyclophosphamide include:

Lupus is a serious chronic disease. Despite medical advances, doctors need more effective treatments.

According to research, survival rates for lupus are approximately 85–90% within the first 10 years of diagnosis.

Large-scale research on chemotherapy for lupus is lacking, and more studies are needed to determine the effectiveness of these drugs.

However, a 2015 study combining the chemotherapy drugs vincristine and cyclophosphamide found that the combination helped keep lupus in remission by changing the number of certain immune cells called T cells.

In general, early diagnosis and treatment could improve a person’s outlook.

Doctors frequently use chemotherapy agents to treat autoimmune diseases. Low doses can help calm an overactive immune system. On the other hand, high doses may be necessary to completely suppress the immune system in the event of generalized and severe organ damage.

Other autoimmune diseases that may benefit from chemotherapy include:

Lupus is a chronic autoimmune disease in which the immune system mistakenly attacks healthy cells and tissues in the body.

Doctors can use chemotherapy drugs to treat lupus. These drugs suppress overactive immune responses, helping to relieve inflammation, limit organ damage, and improve quality of life.

Chemotherapy drugs are powerful drugs that can cause a variety of side effects, including gastrointestinal upset, muscle pain, and increased risk of infection.

A person should see a doctor if they are worried about the side effects of chemotherapy.