5 Medications for Lupus Treatment

Key Takeaways

Lupus is an autoimmune disease with no cure.
Treatment options are available to ease symptoms, prevent lupus flare-ups, and slow the progression of the disease.
Along with lifestyle changes, there are several drugs available to treat lupus.

Systemic lupus erythematosus (SLE or lupus) belongs to a group of conditions called autoimmune diseases, in which the immune system, which is designed to fight infection, mistakenly attacks healthy tissue in different parts of the body. There is no cure for lupus, but it can be treated. Treating lupus consists of a comprehensive approach, with medication therapy being the mainstay in managing symptoms and slowing down the disease's progression. Please continue reading to find out some of the medications that are prescribed to lupus patients.

What are lupus symptoms?

The overactive immune response in lupus affects many parts of the body, including the skin, joints, kidneys, heart and blood vessels, lungs, and brain. Depending on which body system is affected, the disease looks different in every person and can cause a range of health problems. For example, some people with lupus have kidney involvement, which is referred to as lupus nephritis or lupus kidney disease. Depending on the level of severity and time of diagnosis, some people can have the disease under control, while others will eventually have kidney failure as the disease progresses. Besides lupus nephritis, others with moderate to severe SLE have heart disease, lung problems, or brain involvement.

The symptoms of lupus can develop slowly or suddenly; they can be mild or severe, and they can come and go or be permanent. Most people with mild disease tend to have “lupus flares,” where the symptoms get worse for some time and then improve or even disappear for a period of time.

Common symptoms of lupus include fever, fatigue, joint pain, swelling, and stiffness, muscle aches, skin rashes (usually a rash on the cheeks and nose in a butterfly shape), skin lesions that are worse with sun exposure, fingers and toes turning blue or white on exposure to cold or during stressful periods, dry eyes, headache, chest pain, shortness of breath, confusion, and memory problems.

Certain triggers can make lupus symptoms worse, for example, sun exposure, infections, stress, and some medications, including certain antibiotics, blood pressure medications, and anti-seizure drugs.

How do doctors make a lupus diagnosis?

Doctors can make a lupus diagnosis based on the results of urine and blood tests, such as:

Urinalysis: red blood cells and proteinuria (protein in the urine) may be indicative of lupus nephritis
Kidney and liver function: these blood tests are used to detect liver or kidney problems
Complete blood count: abnormal levels of hemoglobin, white blood cells, or platelets may occur in lupus
Erythrocyte sedimentation rate (ESR): This test is not specific for lupus. Besides lupus, elevated ESR can be a sign of inflammation, infection, or cancer.
Antinuclear antibody (ANA) test: A positive ANA test indicates an overactive immune system. A positive ANA test does not automatically mean you have lupus. When someone is tested positive for ANA, more specific antibody testing is recommended.
Imaging tests: chest X-ray to detect abnormalities such as fluid or inflammation of the lungs; Echocardiogram (ECG) is used to detect heart problems
Biopsy: In the cases of lupus nephritis, a renal biopsy is necessary to determine the treatment approach since a kidney biopsy allows healthcare providers to learn more about the kidneys. Biopsy of other organs is also performed in other types of lupus.

Can systemic lupus erythematosus be treated?

Systemic lupus erythematosus (lupus) can be treated. There is no cure for the condition, but medications can help to reduce inflammation, ease symptoms, and slow down the disease's progress.

What drugs are typically prescribed to treat lupus?

Some of the medications used to treat lupus include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These are over-the-counter and prescription medications used to reduce pain and treat inflammation and fever in lupus patients. Examples include ibuprofen (Motrin, Advil), naproxen sodium (Naprosyn, Aleve), celecoxib (Celebrex), etodolac (Lodine), and meloxicam (Mobic). Side effects of NSAIDs include stomach ulcers and bleeding and an increased risk of kidney problems and heart problems.

Corticosteroids

These are anti-inflammatory medications prescribed to control lupus, including severe lupus with brain or kidney involvement. Examples of steroid medicines include prednisone, methylprednisolone (Medrol), and dexamethasone (Decadron). Intramuscular injections of triamcinolone are sometimes used to treat flares. Steroids carry a risk of serious side effects, including easy bruising, weight gain, thinning of the bones, diabetes, high blood pressure, mood changes, and infections, especially at high doses or with long-term treatment.

Antimalarial drugs

Medications used to treat malaria have an effect on the immune system. They can help to prevent lupus flares and treat lupus symptoms such as joint pain and inflammation. Antimalarial medications also improve other symptoms such as fever, skin rashes, pericarditis (inflammation of the lining around the heart), and fatigue. Antimalarials may help to lower the dose of other lupus medicines, such as corticosteroids and immunosuppressants. Examples of antimalarial drugs include hydroxychloroquine (Plaquenil), chloroquine (Aralen), and quinacrine (Atabrine). Side effects of these medications include skin rashes, stomach upset, and rarely, retinal damage in the eye. Hydroxychloroquine (Plaquenil) is the most commonly prescribed antimalarial medicine since it is believed to cause fewer side effects compared to other drugs in this class.

Immunosuppressants

These are medications that suppress the immune system. They are prescribed at the initial diagnosis of lupus and are to be continued after organ transplants. They are also used to treat autoimmune disorders such as lupus and rheumatoid arthritis. Examples include mycophenolate (Cellcept), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune), Gengraf), methotrexate (Rheumatex, Trexall, Xatmep), cyclophosphamide (Cytoxan), and leflunomide (Arava). Possible side effects of immunosuppressants include an increased risk of infections, liver damage, increased risk of cancer, and decreased fertility.

Biologic agents or monoclonal antibodies

These are medications that target specific parts of the immune system instead of the immune system as a whole. Belimumab (Benlysta) is an FDA-approved monoclonal antibody for lupus that is given by subcutaneous (under the skin) or intravenous injection (into a vein). Possible side effects include nausea, diarrhea, infections, and rarely, worsening depression. Another biologic agent, rituximab (Rituxan, Truxima), can help some people who have not responded to other medications.

Other medications

People with lupus may be prescribed other drugs depending on the symptoms and organs involved, such as antihypertensives for high blood pressure, statins for high cholesterol, antibiotics for infections, anticonvulsants for seizures, and medications to treat weak bones (osteoporosis).

Alternative treatments, complementary medicine, and other treatments

The Lupus Foundation of America recommends talking to your healthcare provider about taking supplements such as vitamin D and omega-3 fatty acids. Many people with lupus have a vitamin D deficiency; however, this vitamin has not been found to decrease lupus disease activity. Other supplements that may help with SLE include products that contain dehydroepiandrosterone (DHEA).

In addition, lifestyle changes, a healthy diet, acupuncture, and cognitive-behavioral therapy (CBT) can help people cope with this lifelong disease and improve their quality of life.

What is the first-line treatment for lupus?

The mainstay of lupus treatment is the antimalarial drug hydroxychloroquine (Plaquenil), which reduces flares and helps to control many symptoms in lupus patients. Steroids are effective at controlling symptoms of lupus. However, the long-term goal is to limit the daily dose to less than or equal to 7.5 milligrams (mg) per day. Initiation of immunosuppressive drugs is also helpful in preventing flare-ups while allowing the reduction of steroid dosage.

What is the best medication for lupus?

There is no single best lupus medication. Treatment for lupus depends on the signs and symptoms. The medications prescribed to people with lupus frequently need to be changed or their dosages adjusted as the disease flares and subside or the symptoms change over time.

What is the latest medication for lupus?

Three of the newest medications for lupus include:

Anifrolumab (Saphnelo)

This drug was approved by the FDA in 2021 for adults with moderate to severe systemic lupus erythematosus who are receiving other standard treatments for lupus. It blocks substances in the body that can cause the immune system to attack healthy tissues. Anifrolumab is not for lupus affecting the central nervous system or lupus nephritis. It helps with symptoms affecting the skin and joints. It is prescribed along with hydroxychloroquine and steroids. Anifrolumab is given by intravenous infusion that takes 30 minutes, and the treatment is repeated every 4 weeks. Side effects are typically mild and may include colds or bronchitis.

Voclosporin (Lupkynis)

This drug was approved by the FDA in 2021 as the very first oral medication for adults with active lupus nephritis (kidney disease due to lupus). It makes the immune system less strong. Clinical trials have shown that people who receive voclosporin have a two times higher chance of responding to treatment with decreased inflammation. It is used with other drugs such as hydroxychloroquine (Plaquenil), steroids, and mycophenolate mofetil (CellCept). This medicine is in the form of a capsule to be taken by mouth. Possible side effects include infections, increased blood pressure, kidney issues, and, with long-term use, an increased risk of skin cancers and lymphoma.

Belimumab (Benlysta)

This drug was approved in 2011 for lupus treatment. In 2020, it was also approved to treat lupus nephritis. Belimumab is used with other medications, such as hydroxychloroquine (Plaquenil) and mycophenolate mofetil (CellCept). It can be given as an intravenous infusion by a healthcare provider, which takes 1 hour and is repeated every 4 weeks. It can also be administered by self-injection under the skin every week. Possible side effects include headache, nausea, muscle aches, infections, and rarely, mood changes.

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