hydroxychloroquine + mycophenolate mofetil + prednisone + rituximab

This is a combination regimen consisting of four immunomodulatory and immunosuppressive agents frequently used in the management of severe or refractory autoimmune diseases, such as systemic lupus erythematosus (SLE) and lupus nephritis.

• Hydroxychloroquine is an antimalarial drug with immunomodulatory effects, commonly used to reduce disease activity in SLE by interfering with lysosomal activity and antigen presentation in immune cells.
• Mycophenolate mofetil is a prodrug of mycophenolic acid that inhibits inosine monophosphate dehydrogenase, suppressing lymphocyte proliferation by blocking de novo guanosine nucleotide synthesis.
• Prednisone is a synthetic glucocorticoid corticosteroid that broadly suppresses inflammation and immune responses through genomic effects on multiple inflammatory pathways.
• Rituximab is a monoclonal antibody targeting CD20 on B cells, leading to their depletion via antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and induction of apoptosis.

This combination may be considered for patients with severe or refractory manifestations of autoimmune diseases where standard therapies are insufficient.