Lupus And Infusion Therapy

Lupus

It is sometimes necessary for people with lupus to receive medicine in the form of infusion therapy, which involves the delivery of these medications intravenously (through the veins). Different medicines may be used, such as Cytoxan and, more recently, Rituxan.

In this presentation, Ms. Leff describes the different indications for various medicines delivered via infusion therapy. She also explains what patients should be prepared for, how the process works, and what's involved in the follow-up.

Most importantly, however, she sheds some light on various upcoming therapies, including those currently undergoing clinical trials as well as several biologic agents on the horizon that may be aimed at slowing or stopping specific disease processes.

Medications Currently Used for Lupus

In order to control flares of joint pain, fatigue, or even organ involvement, your doctor may choose to administer doses of intravenous steroids, chemotherapeutic agents, or newer disease-modifying drugs. The following are some examples of these kinds of medications:

Methylprednisolone (Solumedrol, commonly known as pulse steroids)

While corticosteroids are produced naturally by the adrenal glands, this man-made version is specifically helpful in blocking and suppressing inflammatory reactions.

Given in large doses (500mg to 1 gram) using a small IV catheter, the medication is administered intravenously using an infusion pump. The administration process takes between one and two hours, with vital signs continually being monitored by the attending nurse. This medicine is typically given 1-3 days each month, or as needed.

Considered to be a "cornerstone treatment" in treating lupus, methylprednisolone is usually a fast-acting treatment with noticeable results within a very short time. It can, however, produce side effects ranging from high blood pressure and an increase in blood sugar (sometimes resulting in steroid induced diabetes) to sleep difficulties and mood swings. Some patients experience headaches, which can be medicated (with your doctor's permission) with Tylenol PM or a similar drug.

Considering the risks involving increases in blood sugar and blood pressure, it's important to resist the probable craving for sweets and salt known to be associated with this steroid pulse.

Cyclophosphamide (Cytoxan chemotherapeutic agent)

This medication is a chemotherapy medication administered by IV for about an hour, with a few hours of hydration (drinking water) included before and after the process. This medication, like all chemotherapeutic agents, suppresses the immune system by decreasing the amount of white blood cells in the body.

The entire process takes about five hours, but the lengthy process involved with the infusion is necessary to keep the body hydrated – an important factor in avoiding a condition called hemorrhagic cystitis, in which the urinary bladder becomes inflamed, causing pain and blood in the urine. Patients are urged to continue hydrating after returning home from therapy.

Lupus nephritis patients typically receive this treatment once a month for six months, then every three months for two years.

Possible side effects include nausea and vomiting (Ms. Leff says there are great anti-nausea drugs on the market and nausea isn't as much of a concern as it used to be with cyclophosphamide), some hair loss (but not as much as that found in the oncology [cancer care] population when undergoing chemotherapy), fatigue, increased risk of infection (as chemotherapy suppresses the immune system), anemia, fertility problems (Ms. Leff urges patients to try not to get pregnant while on cyclophosphamide), cystitis, and an increased risk of cancer.

Ms. Leff noted that 10-14 days after administration of cyclophosphamide, patients will be at their lowest white blood cell count, so it's important to watch out for neighbors and children with colds at this point. You don't want to get sick when your body isn't at full strength.