Indications for the use of steroids are hypersensitivity disorders and immune mediated diseases. The induction period usually lasts 2 weeks. It is important not to lower the dose quickly in order to prevent a flare up of the disease. At the same time, life-threatening side effects from high doses of steroids are possible. Every case is different and therapy should be tailored to the individual case.
Steroids are poor immunosuppressive agents and weak inhibitors of antibody production.
Their efficacy in autoimmune disease is probably due to their anti-inflammatory properties. Azathioprine interferes with DNA and RNA synthesis. It is effective in suppressing T cell function and T cell dependent antibody production. Potential toxicities include anemia, leukopenia, thrombocytopenia, vomiting, pancreatitis, hepatotoxicity and diarrhea. Patients should be closely monitored for bone marrow suppression, especially in the first 6 months of therapy.