Tijdschrift voor geneeskunde vol:64 issue:21 pages:1113-1118
New treatments voor systemic diseases
Steroids are still the mainstay in the treatment of the systemic diseases. Depending on the type of disorder and the organs involved, steroids may needed to be associated with an immunosuppressive drug, which is quite often cyclophosphamide as a remission-induction therapy an azathioprine as a remission-consolidating treatment. Due to the toxicity of cyclophosphamide (hemorrhagic cystitis, bone marrow depression with resulting infections, hair loss, secondary cancers) attemps have been made to shorten the course of the cyclophosphamide treatment as well as to lower its dose or even to replace it entirely by a less toxic drug.
Mycophenolate mofetil has been proven to be as effective and safer in the remission induction of systemic lupus nephritis and probably also in hte ANCA-associated vasculitides. The use of mycophenolate mofetil in the remission consolidating phase is currently being investigated, both in lupus and in the ANCA-related vasculitides. Great expectations did arise that an anti-TNF therapy would be effective in the treatment of vasculitis, but the few randomized, placebo-controlled studies were not able to fulfill this optimism. However, a CD-20 directed treatment with rituximab appears promising. In systemic sclerosis, bosentan can slow down the progression of pulmonary hypertension.