Azathioprine (Imuran) can be used alone, but is often administered in combination with prednisone. When used with prednisone, Imuran often allows a lower total dose of prednisone to be administered. Prednisone is a corticosteroid that helps regulate the immune system that has become over-active due to the disease process of Lupus.
Prednisone should not be stopped with the addition of Imuran to the treatment. Prednisone dose should remain the same until there is improvement shown after beginning the Imuran. Then the prednisone should be tapered slowly at one to five milligrams a week to avoid serious
Prednisone is a synthetic hormone commonly referred to as a "cortisteroid." Prednisone is very similar to the hormone cortisone, which the body manufactures. In part, prednisone acts as an immunosuppressant. The immune system protects against foreign bacteria and viruses. In some illnesses (such as Lupus), the immune system produces antibodies, which become overactive and cause many symptoms, some can be quite serious symptoms. Prednisone suppresses the production of these antibodies. Prednisone is the drug of choice in treating auto-immune disease, such as Lupus. Especially for patients who do not improve or are not expected to respond to NSAIDs or antimalarials (such as Plaquenil), or those who have organ threatening disease.
Plaquenil is not an immunosuppressant drug and will do very little to suppress the production of harmful antibodies in Lupus. However it is thought to help immunosuppressant drugs to do this and Plaquenil may slow down the substances which harm the joints. Hydroxychloroquine is thought to act by interfering with the production and release of blood cells that are involved in the body's immune defense system. Hence the autoimmune response of the antibodies against its own body, is reduced and as result the amount of damage to the cells is minimized and prevented. As it has the potential to prevent progression of the disease, by limiting the damage caused, it is often referred to as a disease-modifying antirheumatic drug (DMARDS) and is commonly used very early in the treatment of Lupus.
Hopefully this information will help you to make an informed decision about your treatment regimen. I wish you the very best.
Peace and Blessings
Look For The Good and Praise It!