Immunosuppressive Medicines for Lupus

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Immunosuppressive Medicines for Lupus


Generic NameBrand Name
azathioprine (AZA)Imuran
methotrexate (MTX) Rheumatrex
mycophenolate mofetilCellCept

Depending on the drug, an immunosuppressive medicine may be given in pill form, weekly injections, or by intravenous (IV) pulse therapy (injection given monthly).

How It Works

Lupus (systemic lupus erythematosus, or SLE) is an autoimmune disease, in which the immune system attacks the body's own tissues as though they were foreign substances. Immunosuppressive medicines reduce inflammation and suppress the immune system.

Why It Is Used

Azathioprine, cyclophosphamide, and mycophenolate mofetil are used to treat severe kidney disease associated with lupus.

Methotrexate is used to control skin rash and joint pain caused by lupus. It may be tried to allow less corticosteroid medicine to be used.1

How Well It Works

Methotrexate may help control skin rashes and joint pain.2 There also are reported benefits for controlling more severe lupus symptoms, such as inflammatory conditions of the kidneys and tissues around the heart and lungs. But there has been little research in these areas.

Other immunosuppressive medicines are used for more severe lupus. Most studies have been done using one of the immunosuppressives, along with corticosteroids, for lupus that is causing serious kidney problems (lupus nephritis). But they are also used to try to control other serious symptoms of lupus, such as inflammation around the heart and lungs. Azathioprine, cyclophosphamide, and mycophenolate mofetil are the most commonly used medicines. They can take several weeks to reach full effectiveness, but they generally help decrease serious symptoms. As the immunosuppressive takes effect, the amount of corticosteroids can usually be reduced.2

Side Effects

Side effects of immunomodulator medicines include:

  • Nausea, vomiting, diarrhea, or stomach ulcers.
  • Rash.
  • General feeling of being ill (malaise).
  • Liver inflammation.

Rare side effects include:

  • Suppression of blood cell production (bone marrow suppression), which may increase the risk of infection or serious bleeding. Return to normal blood cell production may take several weeks after the medicine is stopped.
  • Fever
  • Inflammation of the pancreas (pancreatitis). This may occur with azathioprine (AZA).

Extremely rare side effects of azathioprine include a possible increased risk of cancer. Mycophenolate mofetil may increase the risk of cancer of the lymph system (lymphoma) and other types of cancer.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Combinations of immunosuppressants and corticosteroids can be very effective but can also increase the risk of side effects. So regular follow-up and monitoring by your doctor is essential.

Some people may take medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs) or antimalarial drugs while they are taking immunosuppressive medicines. Your doctor will work with you to find the best medicine or combination of medicines for you.

Immunosuppressants can cause birth defects. Do not take immunosuppressants if you are pregnant or wish to become pregnant. If you are a man who is taking this medicine, do not try to conceive a child.

Immunosuppressive and cytotoxic medicines have been associated with a small increase in the risk for certain cancers. But if you have severe, possibly life-threatening lupus, you may decide that a medicine's risk is outweighed by its potential benefits.

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  1. Tassiulas IO, Boumpas DT (2009). Clinical features and treatment of systemic lupus erythematosus. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1263–1300. Philadelphia: Saunders Elsevier.
  2. Hahn BH (2012). Systemic lupus erythematosus. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2724–2735. New York: McGraw-Hill Medical.


ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerNancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
Last RevisedMay 10, 2012

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