title: Systemic lupus erythematosus: review of synthetic drugs.
abstract: BACKGROUND
  Synthetic drugs are prescribed for nearly all patients with systemic lupus erythematosus (SLE), a multisystem autoimmune disease, to ameliorate symptoms and positively influence outcome. While only 2 biologic agents have been approved for the treatment of SLE, synthetic drugs are still the mainstay of therapy in SLE. The highly variable and unpredictable course of SLE poses a challenge for physicians as to what drug(s) should be prescribed for which patient.
  
  
  METHODS
  Previous and recent studies have evaluated several synthetic drugs in the treatment of SLE. This article reviews currently available evidence for the efficacy and safety of synthetic drugs in SLE and discusses future treatment perspectives.
  
  
  CONCLUSIONS
  Hydroxychloroquine should be considered an anchor drug in SLE because of the multiple beneficial effects of this agent. When patients present with persistent disease activity despite hydroxychloroquine therapy or need higher dosages and/or prolonged use of glucocorticoids (GCs), additional immunosuppressants should be promptly prescribed. Based on available evidence, azathioprine and mycophenolate mofetil are the drugs of first choice. Determination of a 'safe' GC dose for chronic daily use is of major importance and should be subject of further studies in large patient populations.
authors.affiliation: a Department of Rheumatology , Amsterdam Rheumatology and immunology Center, location VU University Medical Center , De Boelelaan 1117, 1081 HV Amsterdam , the Netherlands.
authors.forename: M W P
authors.initials: MW
authors.lastname: Tsang-A-Sjoe
authors.affiliation: a Department of Rheumatology , Amsterdam Rheumatology and immunology Center, location VU University Medical Center , De Boelelaan 1117, 1081 HV Amsterdam , the Netherlands.
authors.forename: I E M
authors.initials: IE
authors.lastname: Bultink
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007917:Leprostatic Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000962:Antimalarials; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007917:Leprostatic Agents; D006886:Hydroxychloroquine
keywords: azathioprine; cyclophosphamide; efficacy; glucocorticoids; hydroxychloroquine; methotrexate; mycophenolate mofetil; prednisone; synthetic drugs; systemic lupus erythematosus