Immunosuppressive treatment of systemic lupus erythematosus.

Immunosuppression in SLE must be adjusted to the current Level of disease activity. The spectrum of established treatment principles ranges from no treatment or non-steroidal antirheumatic drugs alone, to glucocorticoids, hydroxychloroquine, azathioprine and, finally, cyclophosphamide (Ctx). Repeated pulses of intravenous Ctx can be regarded today as established treatment for severe SLE manifestations. Administered in combination with prior plasmapheresis, pulse Ctx has led to long-term treatment-free remission in some patients. Additional treatment options, whose potential benefits remain to be defined, are cyclosporine A, methotrexate, highdose intravenous immunoglobulins and immunoadsorption. Possibly, high dose chemotherapy with autologous stem cell rescue might become a future treatment option. This review describes present knowledge regarding immunosuppression in SLE, especially the differentiated application of Ctx in severs SLE, and discusses the prospects for future development.