Role of immunosuppressants in treating SLE..

                    

                      Ramai jugak yang bertanya ..apa function immunosuppressant drugs yg patients SLE kena ambil tu?kenapa nak kena chemo segala macam tu?SLE ni kanser ke?kebetulan,aku terjumpa 1 artikel tajuk"Role of immunosuppressants in treating SLE "dalam majalah Health Today(edition April 2011)..so,boleh la aku try to share serba sedikit...try to guna bahasa rojak..BM+BI supaya senang sikit untuk faham:-)..tapi ada sesetengah medical terms yg aku tak berani nak translate sebab takut lari maksud..ye lah,lagipun aku ni bukannya doctor..hehe

                 Systemic Lupus Erythematosus (SLE),more commonly referred to as lupus is an autoimmune condition,he/she develops antibodies that attack healthy tissues in the body.SLE can affect the joints,muscles and even the organs in the body such as kidney,skin,brain,etc..& Lupus Nephritis is when SLE affect the kidney,while Cerebral Lupus is the name for SLE affect brain..(SLE ni bila antibody yg sepatutnya menyerang virus,etc tapi telah bertindak menyerang tisu yg sihat di dalam badan seperti sendi,buah pinggang ,kulit,otak dan sebagainya).

             SLE is a chronic disease ,although patients can have an absence of symptoms (remission ) for long periods.Nonetheless,symptoms can flare up from time to time without warning.There is no cure yet for SLE .The purpose of treatment is to slow down the body's autoimmune activity ,which is responsible for the symptoms.(SLE merupakan penyakit kronik,walaupun tiada simptoms untuk beberapa ketika (remission)tetapi simptoms boleh muncul secara tiba-tiba(relapse) tanpa amaran..ish ni la yg paling menakutkan..sebab tu la,kalau demam ke,terus je ke hospital sebab kita tak tahu ka apa yg akan berlaku.Setakat ni,SLE masih belum ada penawar,rawatan cuma boleh untuk mengurangkan autoimmune activity yg sebabkan semua simptoms )..

          Treatment also helps lessen the severity of symptoms ,which include butterfly skin rashes ,fever,hair loss,depression ,mouth ulcers and kidney damage.Another aim of treatment is to reduce inflammation of affected organs.(Rawatan yg dilakukan cuma dapat mengurangkan simptoms seperti butterfly rashes,demam,rambut gugur & kerosakan buah pinggang.Rawatan ni juga boleh mengurangkan imflammation organ2 yg terlibat)...

         There are a number of immmunosuppressive agents used to treat SLE.They include steroids,azathioprine(brand name IMURAN) ,methotrexate ,cyclophosphamide(brand name CYTOXAN) and mycophenolate mofetil(MMF..brand name Cell Cept)..ada juga brand name nama lain tapi yg ni lah yg biasa aku dengar /guna...(Segala nama2 ubat di atas adalah beberapa contoh immunosuppressive drugs yg digunakan untuk merawat SLE..macam aku antara immunosuppresive drugs yg aku ambil secara oral adalah prednisolone(steroids) & azathioprine..& cyclophosphamide pula di beri di hospital sebulan sekali sebanyak 6 kali..caranya adalah IV(Intravenous theraphy) a.k.a ubat tu dimasukkan melalui vein/urat di tangan tu)...

             Steroids are used to treat severe inflammation , which is found in many conditions e.g kidney inflammation .It can also works as an immuno-suppressant .Unfortunately ,steroids come with a number of side effects. These adverse effects include weight gain, increased risk of osteoporosis and infections and appearance or increase of facial hair & acne.(Steroids juga merupakan salah 1 immuno-suppressant.Walaubagaimanapun,terdapat pelbagai kesan sampingan steroids seperti  berat badan bertambah,meningkatkan risiko osteoporosis(tulang rapuh),mudah mendapat jangkitan ,dan juaga meningkatkan pertambahan bulu di muka).

                 Besides causing nausea and hair loss, cyclophosphamide can also cause a loss of bone marrow function leading to anaemia and a reduction in white blood cells and platelets.( Cyclophosphamide juga boleh menyebabkan loya,muntah ,rambut gugur,anaemia disamping darah putih & platelet yg semakin berkurang.Sepanjang 6 kali  treatment dengan cyclophosphamide  aku memang selalu muntah,kurang selera makan , rambut gugur,dan senang dapat jangkitan..demam,batuk,selsema tu perkara biasa terjadi..kebiasaannya ,kalau ada sebarang  masalah kesihatan aku akan terus ke hospital ..kebiasaannya kalau demam,batuk,selsema , cyclo chemo akan di tunda sehingga badan betul2 sihat…biasanya 2 minggu selepas cyclo chemo(short form untuk cyclophosphamide chemotheraphy),akan ada appointment untuk ambil darah..biasanya untuk check white blood cells & platelets..kebiasaannya white blood cell dan platelets akan jadi rendah sedikit 2 minggu selepas cyclo chemo..jadi,kena lebih berhati-hati untuk jaga diri dalam tempoh ni .Cyclophosphamide juga boleh mengganggu kesuburan .Biasanya pesakit tidak digalakkan untuk mengandung dalam tempoh cyclo chemo sehingga 2 tahun selepas  cyclo chemo& juga tidak boleh breast feed baby..biasanya bila dah start cyclo chemo ,dose steroids akan makin berkurang…contohnya aku,sebelum cyclo chemo aku ambil 13 tablets steroids perday…bila start cyclo chemo,tinggal  2 tablets).

                   Another immuno-suppressant is Azathioprine..Azathioprine is helpful as it reduces the dosage of  steroids required .Due to their  strength ,immuno suppressant are usually only prescribed for serious cases of SLE where there is major organ involvement..Azathioprine can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Your kidney function may also to need to be tested. Do not miss any scheduled visits to your doctor.Call your doctor at once if you have a fever, chills, sore throat, body aches, weakness, muscle pain, easy bruising or bleeding, mouth sores, pale stools, darkened urine, or severe nausea, vomiting, and diarrhea. 

                              If you need to have any type of surgery, tell the surgeon ahead of time that you are using azathioprine. You may need to stop using the medicine for a short time.Do not receive a "live" vaccine while you are being treated with azathioprine and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you.This medication can affect fertility (your ability to have children), whether you are a man or a woman. Talk with your doctor if you have concerns about this.(Selepas 6 kali cyclophosphamide ,aku sambung pula dengan ubat azathioprine 100mg per day..ubat ni senang sebab version makan & side effects pun kurang(bagi aku la tapi ada patient yg tak ok dengan ubat ni).ubat ni ..azathioprine ni boleh lower kan blood cells jadi agak mudah untuk jatuh sakit..seperti biasa,patients SLE kena sentiasa alert dengan perubahan diri..kalau demam,sakit tekak,selsema,muntah ,cirit birit ..etc kena cepat2 ke hospital..bagi orang lain maybe semua tu perkara biasa tapi bagi kita akan jadi luar biasa..jadi sentiasa la beringat...harga azathioprine ni pun mahal tapi mahal lagi ubat MMf kat bawah ni..hehe)

               Mycophenolate mofetil(MMF/Cell Cept) is also type of immunosuppressant and is used quite widely in the treatment of lupus nephritis .originally indicated to prevent organ rejection after transplant,this drugs shows promising  results in the treatment of SLE symptoms..MMF is registered in Malaysia since July 2006 to treat SLE patients with renal involvement ….compared with several other medications ,MMF is  better tolerated and has fewer side effects..Since its benefits outweigh its adverse effects ,MMF is particularly helpful for lupus nephritis and for patients who do not respond well to other treatment …

As most SLE patients  are young and of child bearing age ,MMF is a good  alternative drug for  those who suffer  from less severe lupus nephritis or who cannot tolerate the conventional drug(cyclophosphamide ) but who wish to get pregnant once the disease is under control..A side from that , MMF also helps  control  the overall disease and reduces the required dosage of steroids..The disadvantage of MMF is the price is very expensive.However ,if MMF is taken during pregnancy ,it may cause birth defects or foetal death...(MMF /Cellcept ni sangat mahal..biasanya di hospital kerajaan..ni pilihan terakhir sebab stok untuk sebulan mencecah ribuan ringgit..tapi ramai je patient yg aku kenal ambil ubat ni (di hospital kerajaan) apabila badan tak boleh tolerate/bagi reaksi yg positif  dengan cyclophosphamide ataupun azathioprine..seperti mana-mana immunmosuppresive drugs pun tak boleh diambil semasa mengandung sebab boleh menyebabkan kecacatan & kematian bayi )..

          Walaupun terdapat bermacam-macam side effects immunosuppresive drugs ni..kita sebagai patient SLE harus redha..ni h satu daripada iktiar /usaha kita untuk mengawal SLE..yup,SLE tak boleh di sembuhkan cuma boleh di kawal..sejujurnya,SLE berada dalam keadaa terkawal pun aku dah bersyukur sangat walaupun terpaksa bergantung dengan ubat-ubatan...kadang-kadang dalam hidup kita tak boleh dapat semua yg kita nak..kita dapat sesuatu & terpaksa korban kan sesuatu...bersyukur apa yg ada:-)  

References:

1)    http://www.emedicinehealth.com/drug-azathioprine/article_em.htm

2)Health Today magazine , April 2011 edition 

3)Health Today magazine ,Jun  2009 edition