Cytotoxic drugs in systemic autoimmune diseases.
Inhibition of cell proliferation, together with the depression of synthesis of non-specific and specific cellular products, are the modes of action of cytotoxic drugs. In systemic autoimmune diseases these actions result in immunosuppressive and anti-inflammatory effects. The adoption of cytotoxic treatment, as well as the choice of the cytotoxic agent and therapeutic strategy in individual patients, depend on the disease status, on the patient's tolerance to previously administered drugs and on the theoretical risk of major side effects. The oncogenic risk and its relationship with the cumulative dose or the duration of traditional administration schedules must be taken into account, even if this is not constant for all cytotoxic drugs. Both in life-threatening and in seriously disabling systemic autoimmune diseases cytotoxic drugs are employed, according to general guidelines, to induce complete or partial remission of active disease in patients intolerant or refractory to corticosteroids and/or to other disease-modifying drugs. Combinations of cytotoxic drugs and other non-specific immunosuppressive agents as well as innovative therapeutic regimens (pulse therapy, alternation of treatments) have been used with encouraging results: in the future cytotoxic drugs may perhaps be used in association with specific immunosuppressive agents in a complementary combination to halt pathologic processes in systemic autoimmune diseases.
Mathieu
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Institute of Internal Medicine, University of Cagliari, Italy.
Carcassi
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D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001327:Autoimmune Diseases / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents