What do you view as reasonable alternatives to cyclophosphamide in the treatment of neuropsychiatric lupus?

In general, I very seldom, if ever, rely on cyclophosphamide anymore to treat lupus in general, and much less neuropsychiatric lupus, with few exceptions. As above mentioned, we start off with corticosteroids, followed by a second-line agent, which can be azathioprine, CellCept, Rituxan, etc. We hav...

“A reasonable alternative” to cyclophosphamide in NPSLE is an amazing statement that belies the reality of this state. We have to recognize that NPSLE includes underlying pathophysiology that includes inflammation of meninges, cerebral tissue, and/or vasculature that may or may not be separate from ...

There is peer-reviewed evidence that sirolimus blocks seizures in patients with tuberous sclerosis. We do have the experience that sirolimus helps all forms of SLE, including neuropsychiatric lupus. Our experience is consistent with the overwhelming evidence that mTOR activation is found in patients...

CNS lupus is perhaps one of the most challenging diagnoses, especially for a community rheumatologist. Due to toxicity of cyclophosphamide, it is scary to start it unless I am convinced that it is a true vasculitis rather than multi factorial process including thrombosis/psychiatric manifestations. ...