cyclophosphamide + methotrexate + glucocorticoids

This is a **combination regimen** involving cyclophosphamide, methotrexate, and glucocorticoids (the latter includes drugs like prednisolone, prednisone, methylprednisolone, or dexamethasone). Cyclophosphamide is an **alkylating agent** that causes DNA crosslinking, inhibiting cancer and immune cell proliferation. Methotrexate is a **folate analog antimetabolite** and inhibits dihydrofolate reductase, impairing DNA synthesis and exerting additional immunosuppressive and anti-inflammatory effects likely via adenosine-mediated mechanisms. Glucocorticoids act via the **glucocorticoid receptor** to downregulate the expression of inflammatory cytokines and suppress the immune response. This combination is used to treat severe, refractory autoimmune conditions (such as polymyositis, systemic lupus erythematosus, and severe rheumatoid arthritis), some cancers, and vasculitides. The goal is to leverage their synergistic immunosuppressive and anti-inflammatory actions[1][2][3][4].