Because lupus symptoms and severity vary among patients, treatment with lupus medication is different for each patient, too, says Neil Kramer, MD, a rheumatologist at Overlook Medical Center in Summit, New Jersey. Patients may receive one or more of the following drugs:
Hydroxychloroquine
Most patients with SLE (unless otherwise advised by their rheumatologist) are recommended to take hydroxychloroquine (HCL), an oral antimalarial medication, to reach low disease activity or remission.
HCL (Plaquenil) helps prevent lupus flares, minimizes joint inflammation, and controls fever, fatigue, pleurisy (inflammation of the sac surrounding the lungs), and pericarditis (inflammation of the lining around the heart). The drug is also “the backbone of therapy” for most skin rashes associated with lupus, says Kramer. Mouth sores may also be alleviated with this drug.
Corticosteroids
Doctors may prescribe a low-dose corticosteroid, such as prednisone (Deltasone), for short-term symptom control.
Corticosteroids may also be used to get rid of lupus flares, or the appearance of symptoms after a period of remission, says Francis Luk, MD, a rheumatologist at AdventHealth in Hendersonville, North Carolina. “Depending on severity and type of flare and how many flares the patient has recently experienced, rheumatologists may adjust medications,” he adds.
Corticosteroids are usually taken as a pill. They’re sometimes prescribed as a topical cream for skin rash associated with lupus. According to guidelines from the American College of Rheumatology, corticosteroids should be tapered and withdrawn as soon as possible, as they can cause many unwelcome side effects.
Immunosuppressants
When lupus starts affecting other organs of the body, doctors often prescribe drugs that suppress the immune system, says Kramer. (Lupus causes the body’s immune system to mistakenly attack itself. Immunosuppressive medication helps stop that from happening.)
Patients have the option of trying many different medications for their lupus manifestations that are being tested in clinical trials. For example, doctors may use cyclophosphamide, mycophenolate mofetil (CellCept), azathioprine (Imuran), or cyclosporine (Neoral). Tacrolimus (Prograf) may also be an effective option for lupus nephritis.
In addition to helping with lupus nephritis, these drugs may be prescribed to reduce inflammation of the heart and the lining surrounding the lungs. Disease-modifying antirheumatic drugs (DMARDs) used to treat rheumatoid arthritis, such as methotrexate (Trexall), may be an effective and well-tolerated option for reducing swelling in patients with severe arthritis, adds Caricchio. DMARDs are another type of immunosuppressant.
Targeted Therapy
If HCL and other drugs don’t provide enough symptom relief, doctors may prescribe the drug belimumab (Benlysta), which is given by injection or infusion. It lowers levels of autoantibodies, or the antibodies that target the body’s own cells and tissues.
Belimumab was the first medication to gain approval for the treatment of SLE in the past 50 years. It has been helpful in limiting the use of prednisone and in helping avoid severe flares of the illness, says Kramer.
Another targeted treatment, anifrolumab (Saphnelo), was approved in 2021 by the FDA, making it the second new FDA-approved lupus therapy in the past 10 years.
Nonsteroidal Anti-Inflammatory Drugs
Treatment for Lupus Rash
In addition to the oral antimalarial hydroxychloroquine, doctors may prescribe topical steroids for lupus rash.
Topical creams containing tacrolimus or pimecrolimus, which modulate the skin’s immune response, may help manage lupus rash. Doctors may also recommend that people with lupus avoid the sun or use a sunscreen with an SPF of at least 55 when going outside.
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