Autoimmune conditions
Group of diseases in which the immune system attacks the body's own tissues. Glucocorticoids suppress inflammation during flares and serve as part of maintenance therapy.
ICD-10 M35.94 drugs
Also known as: SLE, Rheumatoid arthritis, Vasculitis, Autoimmune hepatitis
Drugs used for this condition
- AMethotrexateFirst line · Antimetabolites, folic acid analoguesIn psoriasis and psoriatic arthritis, methotrexate is first-line systemic therapy for moderate-to-severe disease per AAD 2020 and GRAPPA 2021. In juvenile idiopathic arthritis – first-line disease-modifying therapy. Used in protocols for ANCA-associated vasculitis and giant cell arteritis.
- APrednisoloneFirst line · GlucocorticoidsCore drug for autoimmune disease flares – SLE, rheumatoid arthritis, vasculitis, autoimmune hepatitis. Acute situations require high doses (1 mg/kg daily) with subsequent gradual tapering. The goal is the lowest maintenance dose or full discontinuation to minimize cumulative toxicity.
- APrednisoneFirst line · Short-to-medium acting systemic glucocorticoidCornerstone therapy in autoimmune disease (systemic vasculitis, SLE, dermatomyositis, autoimmune hepatitis) to suppress acute inflammation. Long-term use requires osteoporosis prophylaxis (calcium+vitD, bisphosphonate in patients >40 on >7.5 mg/day).
- BAzathioprineSecond line · Immunosuppressants, thiopurinesIn systemic lupus erythematosus, azathioprine is used as a steroid-sparing maintenance agent: an alternative to mycophenolate mofetil in mild-to-moderate lupus nephritis and when pregnancy is planned (EULAR 2019), whereas mycophenolate mofetil is usually preferred for proliferative nephritis. In ANCA-associated vasculitis, azathioprine is an option for remission maintenance after induction (CYCAZAREM, Cochrane). Its role is support and alternative, not induction first-line. In reproductive-age patients it is one of the few immunosuppressants compatible with pregnancy (alongside tacrolimus and ciclosporin; hydroxychloroquine is separately recommended in SLE); the AEMPS ficha lists pregnancy as a relative contraindication, justified when benefit outweighs risk. TPMT activity (and where possible NUDT15) must be tested before start, with blood-count monitoring for myelosuppression; the increased risk of lymphoma and skin cancer persists.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit