Immunosuppressive therapy in autoimmune disease — A review

  • T. J. Counihan
  • C. Feighery


The above is by no means intended to be a comprehensive compendium of all currently available immunosuppressive therapies, but rather is designed to provide guidelines regarding some of the newer therapeutic options open to the clinician when faced with a patient with signs of a progressive and potentially destructive autoimmune process. It is worth noting that we are entering a period of rapid development with regard to our knowledge of the pathogenesis and underlying mechanisms of disease and one could envisage eventually categorizing autoimmune disease in terms of a specific immunological aberration and then administering an agent with selective action to correct the critical deficiency or imbalance. This goal may prove naive or unrealistic.


Systemic Lupus Erythematosus Cyclosporin Systemic Lupus Erythematosus Patient Lupus Nephritis Primary Biliary Cirrhosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Miescher, P. A., Beris, Ph. Immunosuppressive therapy in the treatment of autoimmune diseasaés. In: Springer Seminars in Immunopathol. 1984: (7), 69–90.Google Scholar
  2. 2.
    Dmowski, W. P. Danazol — a steroid derivative with multiple and diverse biological effects. Br. J. Clin. Pract. 1988: (8), 343–7.Google Scholar
  3. 3.
    Fauci, A. S. Immunosuppressive and anti-inflammatory effects of the glucocorticoids. In: Baxter, J. D., Rousseau, G. G. (eds.). Glucocorticoid hormone action. 1979: -449. Springher Vergag, Berlin.Google Scholar
  4. 4.
    Thorn, G. W. Clinical considerations in the use of corticosteroids. N. Eng. J. Med. 1966: 274, 755–81.Google Scholar
  5. 5.
    Paulus, H. E., Furst, D. E., Dromgoole, S. H (eds.). In Corticosteroids in the Rheumatic Diseases. p. 443–76. In: Drugs for Rheumatic Diseases. Churchill Livingstone 1987.Google Scholar
  6. 6.
    Fauci, A. S., Dale, D. C., Balow, J. E. Glucocorticoid therapy: mechanisms of action and clinical considerations. Ann. Int. Med. 1976: 84, 304–15.PubMedGoogle Scholar
  7. 7.
    Russell, A.S., Bretscher, P. A. Immunosuppressive therapy in systemic lupus erythematosus. J. Rheumatol. 1987: (Suppl. 13), 14, 194–8.Google Scholar
  8. 8.
    Kimberly, R. P., Lochshin, M. D., Sherman, R. L., McDougal, J. S., Inmann, R. D., Christian, C. L. High dose intravenous methylpredniso-lone pulse therapy in systemic lupus erythematosus. Am. J. Med. 1981: 70, 817–24.PubMedCrossRefGoogle Scholar
  9. 9.
    Austin, H. A. IIIrd, Klippel, J. H., Balow, J. E., Nicole, G. H. Le Riche, Steinberg, A.D., Plotz, P. H.etal. Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs. N. Eng. J. Med. 1986: 314, 614–9.Google Scholar
  10. 10.
    Delecoeuillerie, D., Joly, P., Cohen, De Lara A., Paolaggi, J. B. Polymalgia rheumatica and temporal arteritis; a retrospective analysis of prognostic features and different corticosteroid regimens. Ann. Rheum. Dis. 1988: 47, 73309.CrossRefGoogle Scholar
  11. 11.
    Haris, E. D. Jnr. Glucocorticoid use in rheumatoid arthritis. Hosp. Prac. 1983: 18, 137–46.Google Scholar
  12. 12.
    Hollander, J. L. Arthrocentesis technique and intrasynovial therapy. In: Arthritis and allied conditions: A Textbook of Rheumatology, 10th ed. McCarthy, D. (ed.). p. 541–53. Lea & Febiger 1985.Google Scholar
  13. 13.
    McCarthy, D. J., Carrera, G. F. Intractable rheumatoid arthritis; treatment with combined cyclophosphamide, azathioprine and hydrochloroquin. JAMA 1982: 248, 1718–23.CrossRefGoogle Scholar
  14. 14.
    Healey, L. A., Wilske, K. R. Reforming the pyramid. A plan for treating rheumatoid arthritis in the 1990’s. In New Directions in Antirheumatic Therapy. In Rheumatic diseases Clinics of North America 1989: 15, (3), 615–9.PubMedGoogle Scholar
  15. 15.
    Huskisson, E. C. Azathioprine. In Anthirheumatic Drugs III. In Clinics in Rheumatic Diseases 10 (2), 325–32. Saunders 1984.PubMedGoogle Scholar
  16. 16.
    Stellon. A. J., Keating, J. I, Johnson, P. J., McFarlane, I. G., Williams, R. Maintenance of remission in autoimmune chronic active hepatitis with azathioprine after corticosteroid withdrawl. Hepatology 1988 (4): 781–4.Google Scholar
  17. 17.
    Yazici, H., Pazarli, H., Barnes, C. G. A controlled trial of Azathioprine in Behcet’s disease. N. Eng. J. Med. 1990: 322, 281–5.Google Scholar
  18. 18.
    Kinlen, L. T., Sheil A. G., Peto, J., Doll, R. Collaborative UK/ Australasian study of cancer in patients treated with immunosuppressive drugs. BMJ 1979: 2, 1461–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Proceedings of a symposium on hydroxychloroquin. Zvaifler N. J. (ed.). Am. J. Med. 1988: 85 (4a), pl-71.Google Scholar
  20. 20.
    Pavelka, K. Jnr., Pacelka, K. Snr., Peliskova, Z. Hydroxychloroquin sulphate in the treatment of rheumatoid arthritis: a double-blind comparison of two dose regimens. Ann. Rheum. Dis. 1989: 48, 542–6.PubMedCrossRefGoogle Scholar
  21. 21.
    McCune, W. J., Globus, J., Zeldes, W., Bohlke, P., Dunne, R., Fox, D.A. Clinical and immunological effects of monthly administration of intravenous cyclophosphamnide in severe systemic lupus erythematosus. N. Engl. J. Med. 1988: 318, 1423–31.PubMedGoogle Scholar
  22. 22.
    Scott, D. G. Classification and treatment of systemic vasculitis. Br. J. Rheumatol. 1988: 27(4), 251–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Fauci, A. S. Haynes, B. F., Katz, P., Wolff, S. M. Wegner’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for twenty-one years. Ann. Int Med. 1983: 98, 78–85.Google Scholar
  24. 24.
    Steinberg, A. D. Cyclophosphamide: should it be used daily, monthly or never? (Editorial) N. Engl. J. Med. 1984: 310, 458–9.PubMedGoogle Scholar
  25. 25.
    Kovarsky, J. Clinical pharmacology and toxicology of cyclophosphamide with respect to rheumatic diseases. In Semin. Arthritis Rheum. 1983: 12. 358–72.CrossRefGoogle Scholar
  26. 26.
    Ponticelli, C., Zuacelli, P., Passerini, P., Cagnolli, L., Cesana, B., Pozzi, al. Randomised trial of methylprednisolone and chlorambucil in ideopathic membranous nephropathy. N. Engl. J. Med. 1989:320, 8–13.PubMedGoogle Scholar
  27. 27.
    O’Duffy, J. D., Robertson, D. M., Goldstein, N. P. Chlorambucil in the treatment of uveitis and meningoencephalitis of Behcet’s disease. Am. J. Med. 1984:76, 75–84.PubMedCrossRefGoogle Scholar
  28. 28.
    Kaplan, M. M. Another treatment for primary biliary cirrhosis, (edit.). Gastroemerology 1987: 92, 254–7.Google Scholar
  29. 29.
    Kremar, J. Methotrexate therapy in the treatment of rhuematoid arthritis. In Rheumatic Disease Clinics of North America 1989: 15, 533–56.Google Scholar
  30. 30.
    Weinblatt, M. E., Coblyn, J. S., Fox, D. A. Efficacy of low-dose methotrexate in rheumatoid arthritis. N. Engl. J. Med. 1985: 312, 818–22.PubMedGoogle Scholar
  31. 31.
    Furst, D. E., Kroner, J. M. Methotrexate in rheumatoid arthritis. Arthritis Rheum. 1988: 32 (3), 305–14.CrossRefGoogle Scholar
  32. 32.
    Kozarek, R., Patterson, D. J., Gelfand, M., Botoman, V., Ball, T., Wilske, K. Methotrexate induces clinical and histological remission in patients with refractory inflammatory bowel disease. Ann. Int. Med. 1989: 110, 353–6.PubMedGoogle Scholar
  33. 33.
    Van den Hoogan, F. H.. Boerboom, A. M., van de Putte, L. B. Methotrexate in scleroderma: A case report. Am. J. Med. 1989: 87 (1), 116–7.Google Scholar
  34. 34.
    Klippel, J. H., Decker, J. L. Methotrexate in rheumatoid arthritis. (Editorial). N. Engl. J. Med. 1985: 312, 853–4.PubMedGoogle Scholar
  35. 35.
    Kroner, J. M. Methotrxate 1989 — the evolving story. (Editorial). J. Rheumatol. 1989: 16 (3), 261–3.Google Scholar
  36. 36.
    Kahan, B. Cyclosporin. (In Medical Intelligence). N. Engl. J. Med. 1989: 321: 1725–38.PubMedGoogle Scholar
  37. 37.
    Nussenblatt, R. B., Palestine, A. G., Chan, C. C. Cyclosporin “A” therapy in the treatment of intraocular inflammatory disease resistant to systemic corticosteroids and cytotoxic agents. Am. J. Ophthalmol. 1983: 96, 275–82.PubMedGoogle Scholar
  38. 38.
    Ellis, C. N., Gorsulowsky, D., Hamilton, T. Cyclosporin improves psoriasis in a double-blind study. JAMA 1986: 256, 3110–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Bougneres, P. F., Carel, J. C., Castano, L. Factors associated with early remission of Type I diabetes in children treated with cyclosporin. N. Engl. J. Med. 1988: 318, 663–70.PubMedGoogle Scholar
  40. 40.
    Tejani, A., Butt, K., Khawar, M. R. Cyclosporin induced remission of relapsing nephrotic syndrome in children. Kidney Int. 1986: 29, 206 (abstract).Google Scholar
  41. 41.
    Yocum, D. E., Klippel, J. H., Wilder, R. L., Gerber, N. L., Austin, H.A. IIrdel al. Cyclosporin “A” in severe treatment refractory rheumatoid arthritis: a randomised study. Ann. Int. Med. 1988: 109, 863–9.PubMedGoogle Scholar
  42. 42.
    Tugwell, P., Bombardier, C., Gent, M., Bennett, K., Benson, W., Carette, al. Low-dose cyclosporin versus placebo in patients with rheumatoid arthritis. Lancet 1990: 335, 1051–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Weisner, R. H., Ludwig, J., Lindor, K. D., Jorgensen, R.A., Baldus, W.P., Hamburger, H. A. A controlled trial of cyclosporin in the treatment of primary cirrhosis. N. Engl. J. Med. 1990: 322, 1419–24.Google Scholar
  44. 44.
    Fehr, J., Hoffman, V., Kappeler, U. Transient reversal of thrombocytopenia in ideopathic thrombocytopenic purpura by high dose intravenous gamma globulin. N. Engl. J. Med. 1982: 306, l254–8.Google Scholar
  45. 45.
    Needleman, S. W. Durable remission of pure red cell aplasia after treatment with high dose intravenous immunoglobulin and prednisone. Am. J. Haematol. 1989: 32 (2), 150–2.CrossRefGoogle Scholar
  46. 46.
    Wapner, R. J., Cowhock, F. S., Shapiro, S. S. Successful treatment in two women with antiphospholipid infusions. Am. J. Obstet. Gynecol. 1989: 161, 1271–2.PubMedGoogle Scholar
  47. 47.
    Shumak, K. H. Therapeutic plasma exchange. N. Engl. J. Med. 1984: 310, 762–71.PubMedGoogle Scholar
  48. 48.
    Klippel, J. H. Apheresis. In current Comment. Arthritis Rheum. 1984: 27 (10). 1081–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Soden, M., Hassan, J. Scott, D., Hanly, J., Moriarty, M., Whelan, A.etal. Lymphoid irradiation in intractable rheumatoid arthritis. Longterm follow-up of patients treated with 750 Rads or 2500 Rads. Arthritis Rheum. 1989: 32 (5), 523–30.PubMedCrossRefGoogle Scholar
  50. 50.
    Young, N., Speck, B. Antithymocyte and antilymphocyte globulins: clinical trials and mechanisms of action. In Young, N. S., Humphries, R. Aplastic anaemia: stem cell biology and advances in treatment. 1984: pp. 221–6. New York: Alan R. Liss.Google Scholar
  51. 51.
    Talal, N. The goals of immunologic intervention in autoimmune disease. J. Autoimmunity 1989: 2 (Suppl.), 257–64.CrossRefGoogle Scholar
  52. 52.
    Lider, O., Karin, N., Shinitzky, M., Cohen, I. R. Therapeutic vaccination against adjuvant arthritis using autoimmune T cells treated with hydrostatic pressure. Proc Natl. Acad. Sci. USA. 1987: 84, 4577–80.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 1991

Authors and Affiliations

  • T. J. Counihan
    • 1
  • C. Feighery
    • 1
  1. 1.Department of ImmunologySt. James’s HospitalDublin 8Ireland

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