Use of Cytotoxic Agents and Cyclosporine in the Treatment of Autoimmune Disease: Part 2: Inflammatory Bowel Disease, Systemic Vasculitis, and Therapeutic Toxicity

doi:10.1059/0003-4819-129-1-199807010-00012

Use of Cytotoxic Agents and Cyclosporine in the Treatment of Autoimmune Disease: Part 2: Inflammatory Bowel Disease, Systemic Vasculitis, and Therapeutic Toxicity

Moderator (Langford) Discussants (Klippel, Balow, James, Sneller) An edited summary of a Clinical Staff Conference held on 26 March 1997 at the National Institutes of Health, Bethesda, Maryland. Authors who wish to cite a section of the conference and specifically indicate its author may use this example for the form of the reference: Sneller MC. Systemic vasculitis, pp 51-4. In: Langford CA, moderator. Use of cytotoxic agents and cyclosporine in the treatment of autoimmune disease. Part 2: inflammatory bowel disease, systemic vasculitis, and therapeutic toxicity. Ann Intern Med. 1998; 129:49-58. Grant Support: Dr. James's contribution was supported in part by grant DK47708 from the National Institutes of Health. Requests for Reprints: Carol A. Langford, MD, MHS, National Institutes of Health, Building 10, Room 11B-13, Bethesda, MD 20892. Current Author Addresses: Drs. Langford and Sneller: National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 10, Room 11B-13, Bethesda, MD 20892.

Abstract

When cytotoxic agents were introduced, their ability to disrupt nucleic acid and protein synthesis led to their effective use for the treatment of neoplastic disease.During the course of this use, however, it became apparent that these agents also suppress the immune system. This usually unwelcome effect was subsequently studied and beneficially directed toward the treatment of non-neoplastic diseases in which autoimmune mechanisms were considered important to pathogenesis. As a result of these investigations, cytotoxic agents and, more recently, cyclosporine have emerged to become an important part of the therapeutic regimen for many autoimmune diseases. Nonetheless, these medications may still cause treatment-induced illness or even death. It is therefore particularly important to weigh the benefits and risks of cytotoxic therapy when treating a non-neoplastic disease.

This two-part Clinical Staff Conference reviews data on the efficacy and toxicity of cytotoxic drugs and cyclosporine in selected autoimmune diseases. In part 2, we focus on the role of these agents in treating inflammatory bowel disease and systemic vasculitis and review the toxic effects of these agents.