IMMUNOSUPPRESSIVE TREATMENT OF SYSTEMIC L UPUS-ERYTHEMATOSUS

Immunosuppression in SLE must be adjusted to the current Level of dise ase activity. The spectrum of established treatment principles ranges from no treatment or non-steroidal antirheumatic drugs alone, to gluco corticoids, hydroxychloroquine, azathioprine and, finally, cyclophosph amide (Ctx). Repeated pulses of intravenous Ctx can be regarded today as established treatment for severe SLE manifestations. Administered i n combination with prior plasmapheresis, pulse Ctx has led to long-ter m treatment-free remission in some patients. Additional treatment opti ons, whose potential benefits remain to be defined, are cyclosporine A , methotrexate, highdose intravenous immunoglobulins and immunoadsorpt ion. 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 differen tiated application of Ctx in severs SLE, and discusses the prospects f or future development.