Immunosuppressive Medications for the Treatment of Lupus

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Immunosuppressives are used in the treatment of lupus because they are potent drugs that help control disease activity in major organs. CellCept (mycophenolate mofetil, or MMF) is one such immunosuppressant that is often used in patients with lupus nephritis (in which the disease attacks the kidneys). As with all immunosuppressives, CellCept is available only by prescription.

CellCept has been shown to significantly reduce steroid dosage for patients with lupus nephritis or treatment-resistant systemic lupus erythematosus.

This medication is considered a first-line therapy for lupus nephritis, often replacing Lyophilized Cytoxan (cyclophosphamide).

How CellCept Works

People with lupus have immune systems that mistaken the body's own tissues for invaders and mount an attack on these tissues. When this happens, victims can suffer inflammation (the primary feature of lupus), pain, and tissue damage.  Immunosuppressives such as CellCept work by weakening the body's immune system so it will not produce the autoantibodies responsible for this process. 

Risks of CellCept

Though CellCept can be a great drug therapy for some patients, because it works by suppressing dividing cells in the immune system, it also inhibits the bone marrow's blood-forming cells. Careful monitoring through regular blood draws can help identify this if it occurs, and your dosage may be adjusted based on the result.

Possible Adverse Effects of CellCept

Here are some things that can happen while on CellCept:

  • Constipation
  • Diarrhea
  • Stomach pain
  • Upset stomach
  • Vomiting
  • Difficulty falling asleep or staying asleep
  • Pain in the back, muscles or joints

As always, contact your doctor immediately if you develop any of the following symptoms:

  • Swelling of the hands, feet, ankles, or lower legs
  • Difficulty breathing
  • Uncontrollably shaking hands
  • Unusual bruising or bleeding
  • Headache
  • Fast heartbeat
  • Fatigue
  • Dizziness
  • Pale skin
  • Weakness
  • Black and tarry stools
  • Red blood in stools
  • Bloody vomit
  • Vomiting material that looks like coffee grounds
  • Loose, floppy muscles
  • White patches in mouth or throat
  • Swelling of gums
  • Vision changes
  • Rash

Who Shouldn't Take CellCept

Other considerations for taking CellCept include some of the increased risks associated with the drug. On Oct. 29, 2007, Roche, which manufactures CellCept, and the FDA notified healthcare providers that use of MMF is associated with increased risk of first trimester pregnancy loss and increased risk of congenital malformations, especially external ear and facial abnormalities including cleft lip and palate, and anomalies of the distal limbs, heart, esophagus, and kidney. Therefore, pregnant and nursing mothers, as well as those planning to have children (both men and women), should not take CellCept.

In addition, the following people should check with their doctor before taking CellCept:

  • Those taking acetazolamide, acyclovir, antibiotics; azathioprine, chlorothiazide, cimetidine, cholestyramine, colestipol, ethacrynic acid, furosemide, ganciclovir, isoproterenol, meperidine, morphine, oral contraceptives, phenytoin, probenecid, procainamide, quinine, salicylate pain relievers, choline magnesium tri salicylate, choline salicylate, diflunisal, magnesium salicylate and salsalate, and theophylline.
  • Those who suffer from liver or kidney disease
  • Those who suffer from Lsech-Nyhan or Keeley-Seegmiller Syndrome

Sources

  • Lupus Foundation of America Statement on Results for Clinical Study of CellCept released by Aspreva Pharmaceutical Company. Lupus Foundation of America. June 27, 2007.
  • MedlinePlus Drug Info. MedlinePlus.com. Revised Nov. 1, 2007.
  • Chat Transcript - Dr. Joan Merrill. Lupus Foundation of America, Dec. 6, 2006

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