There is no cure for lupus—but there are treatments that can minimize the symptoms and delay disease progression. Because lupus affects each person differently and triggers a wide range of symptoms, treatment is typically tailored according to the individual patient. Here’s a look at the four families of drugs most commonly prescribed for lupus, plus a new class of experimental medications that has shown promise in clinical trials.
Nonsteroidal Anti-inflammatory Drugs
The class of drugs most frequently used to treat lupus, nonsteroidal anti-inflammatory drugs (NSAIDs) relieve inflammation and pain and reduce many ofthe symptoms of lupus, including:
- achy or stiff joints
- muscle pain
Examples of NSAIDs:
- celecoxib (Celebrex)
- ibuprofen (Advil and Motrin)
- nabumetone (Relafen)
- naproxen (Aleve)
- sulindac (Clinoril)
How They Work
NSAIDs block production of prostaglandins, the chemical culprits often responsible for pain and swelling associated with inflammatory disorders. Aspirin also has blood-thinning properties and helps prevent blood clots, a potentially dangerous lupus complication.
Side effects of NSAIDs include stomach irritation; serious GI complications, such as bleeding ulcers; and kidney problems. To reduce GI effects, NSAIDs are usually taken with food or milk. Your doctor may also prescribe medication to prevent ulcers, such as misoprostol (Cytotec), omeprzole (Prilosec), or lanzoprazole (Prevacid). Consult your doctor before taking over-the-counter NSAIDs, because excessive use can harm the kidneys.
Also known as steroids, these drugs work quickly and are more powerful than NSAIDs. Corticosteroids combat pain and swelling triggered by inflammation. They also control disease flares and are also used when lupus attacks internal organs.
Examples of corticosteroids include:
- Prednisone (the most widely prescribed)
How They Work
This family of medications dampens immune system response, mimicking the action of hormones naturally produced by the adrenal gland, such as cortisol, which helps regulate immune system activity. Corticosteroids contain different compounds than the anabolic steroids some bodybuilders and athletes use to bulk up muscles. Most often prescribed in pill form,corticosteroids also come in cream or gel form or may be administered as injections into joints or tissues or infused into a vein through an IV.
Steroids can have serious long-term side effects including thinning bones (osteoporosis), high blood pressure, diabetes, cataracts (clouding of the eye’s lens), and infections. They can also cause weight gain, acne, bloating, and a puffy or moon-shaped face and affect mood, provoking agitation, irritability, depression, and difficulty sleeping. Because the risk of side effects rises when corticosteroids are taken in high doses over a prolonged period, your doctor will try to find the lowest effective dose, to be taken as briefly as possible.
Hydroxychloroquine (Plaquenil), the most commonly prescribed antimalarial, helps in several ways:
It’s usually prescribed along with other treatments, such as steroids, or may be combined with other antimalarials, such as chloroquine (Aralen), to treat resistant skin disease.
How They Work
Antimalarials work by lowering antibody production, protecting against damaging effects of UV rays from the sun, and by improving skin lesions. Because these medications work slowly, it can take months for symptoms to improve after the medication is first prescribed.
Side effects include upset stomach, muscle weakness, temporary changes in skin color, and in rare cases, retina damage, leading to vision problems. Consult an eye doctor regularly if you’re being treated with antimalarial drugs.
To treat the most severe lupus flares and complications, doctors may turn to these potent drugs, some of which are also used for chemotherapy. Immunosuppressive drugs curb inflammation and dial down immune system activity, which helps reduce the following symptoms:
- damage to the kidneys or other organs
- blood vessel inflammation
- central nervous system problems
Examples of immunosuppressive drugs include:
- azathioprine (Imuran)
- cyclophosphamide (Cytoxan)
- methotrexate (Rheumatrex, Trexell)
How They Work
These drugs, which are taken orally or by IV, are sometimes combined with steroids to reduce the individual doses required for both types of medications, or are used when serious symptoms don’t respond to steroids.
Immunosuppressive drugs can seriously lower blood cell counts and raise the risk of infection. Side effects vary according to which drug is prescribed and at what dose, but may include bladder problems, infertility, hair loss, nausea, mouth sores, increased risk of infection and impaired liver or kidney function.
In 2011, the Food and Drug Administration (FDA) approved belimumab (Benlysta) for use in treating lupus. It was the first new drug to treat lupus in over 50 years.
Belimumab is one of a class of drugs called "monoclonal antibodies," which act like smart bombs, selectively striking disease-specific targets. It is also the first of a new class of drugs known as BLyS-specific inhibitors, which block activity of a naturally occurring protein (BLyS) involved in production of auto-antibodies that attack the body’s own tissues.
In a large clinical trial, lupus patients treated with belimumab, in combination with standard drugs, did better than those given only standard drugs. Patients also had fewer and less severe flares during one year of treatment.
Another type of monoclonal antibody, an experimental drug called epratuzumab, has shown promise in earlier stages of clinical studies.