Considering Chemo for Lupus
When you hear the word “chemotherapy,” most people think of a particularly potent cancer treatment. While they aren’t wrong, chemotherapy can also be used to treat lupus, which many people heard about for the first time when actress and singer Selena Gomez told the press she received chemo treatment for her lupus.
Chemotherapy is typically reserved for more aggressive forms of lupus and may be taken over the course of several months.
There are three major chemo medications for lupus that are given to patients, so let's learn more about chemo for lupus treatment.
Mycophenolate mofetil (commonly known as CellCept) was originally created for recent organ transplant recipients.
CellCept works by lowering the immune system (thus making it work for lupus patients whose immune system is in overdrive), and for its original purpose, helps a patient’s body adapt to a new organ and not reject it. The dose a patient receives depends on the severity of their lupus and it may be taken in conjunction with a steroid to stabilize the patient even further.
Though most people think of hair loss as the number one side effect of chemotherapy, the drugs given to lupus patients do not typically make patients lose their hair. Instead, lupus itself and other treatments for lupus can cause hair thinning and loss, though no two people with lupus suffer the exact same symptoms.
Instead, those taking CellCept may notice other side effects:
- Loss of appetite
- Stomach upset
- Numbness and tingling feeling
- Swelling in the hands and feet
Because of the strength of this medication, it is not recommended that pregnant women take it. In fact, it is required that women have a negative pregnancy test before undergoing treatment with CellCept and should not attempt pregnancy for six weeks after ceasing the medication.
The most common serious side effect is infection, which you must notify your doctor of immediately if you begin to notice the signs of one as this may become life-threatening.
Many doctors will ask that patients take regular blood tests to ensure the CellCept is not doing further damage to the body.
Patients taking CellCept for lupus may have to wait several months to notice big changes to their health or to be able to tell if they are benefitting from the drug.
There is also a suggestion that people who take CellCept may be at a higher risk for developing cancer, however people who need to take it may already be in the pool of “increased risk” before they even begin the chemotherapy.
It is also recommended that patients who take CellCept wear sunscreen and avoid prolonged sun exposure, however if you’re already a lupus patient, you’ve likely already got that one covered. It is also important you attend and keep all regularly scheduled appointments with your doctor as this medication is particularly strong.
Methotrexate is the second major chemo drug given to lupus patients, and is typically the next resort after someone fails to respond to the traditional hydroxychloroquine (Plaquenil) and prednisone regimen.
In addition to treating lupus and rheumatoid arthritis, Methotrexate is also used to treat a variety of cancers including lymphoma, leukemia and osteosarcoma.
Although the medication is used to treat cancer, lupus patients typically take it orally and at a much lower dose than those who are receiving treatment for cancer. Additionally, those undergoing cancer treatment may also receive other drugs that are taken in tandem with Methotrexate to help combat their disease. As such, side effects may be more severe for those who have cancer.
This treatment is not taken every day and your doctor will prescribe you a very strict regime that must be followed for your particular case. Most people with lupus will take Methotrexate once or twice per week as an oral tablet. More than that can be lethal, so it is extremely important to follow the doctor’s directions precisely.
People taking this drug may experience:
- Temporary hair loss — though on such a low dose for lupus, it is not typical and is more often not total hair loss
- Pale skin
- Rash or itching
As with CellCept, those taking Methotrexate need to have a negative pregnancy test before beginning to take the medication and must not be breastfeeding. Females should use birth control and males should use a condom for at least 90 days after stopping the medication to ensure that pregnancy does not inadvertently occur.
Also as with CellCept, an infection is a serious risk for those taking the medication, so patients must be on high alert for the signs and symptoms of an infection.
The last main chemotherapy medication lupus patients may take is Cytoxan. It is typically used to treat leukemia, ovarian cancer, neuroblastoma, eye cancer and breast cancer, in addition to rheumatologic diseases.
It is typically taken in the form of a shot and is used to treat more severe and serious types of lupus by lowering the immune system’s activity. Cancer patients take Cytoxan in combination with other medication and at a higher dose than lupus patients.
Cytoxan may make it more difficult for wounds to heal and patients may experience bruising with lupus a lot more easily than they did before taking the medication. It is not recommended to participate in activities that may induce injuries.
As with the other chemo medications, there is a risk of developing a serious infection. Thus, patients are advised to tell their doctor if they notice any symptoms out of the ordinary, particularly chills or fever. It is also not recommended that pregnant or breastfeeding women take Cytoxan.
Common side effects of Cytoxan may include:
- Loss of menstrual period
- Hair loss (though rarely full hair loss for lupus patients)
- Appetite loss
- Pale skin
- Feeling generally unwell
- Skin rash
- Stomach pain
- Change in the color or texture of nails
While an option for those who have severe lupus symptoms, chemo for lupus is never the first option and always done after other methods have proved ineffective.