cyclophosphamide + azathioprine + prednisone + methylprednisolone

This is a combination regimen of four immunosuppressive and anti-inflammatory drugs—cyclophosphamide, azathioprine, prednisone, and methylprednisolone—used primarily in the management of severe autoimmune diseases such as systemic lupus erythematosus (SLE) with organ involvement (notably lupus nephritis), and certain types of vasculitis. Cyclophosphamide is an alkylating agent that suppresses immune cell proliferation by cross-linking DNA. Azathioprine is a purine analog that inhibits DNA synthesis in rapidly dividing cells, particularly lymphocytes. Prednisone and methylprednisolone are synthetic glucocorticoids that reduce inflammation by modulating gene expression to suppress pro-inflammatory cytokines and immune responses. This combination targets multiple pathways in the immune system to achieve disease control where monotherapy or dual therapy may be insufficient[1][4][6].