Treatments for lupus systemic erythematosus (SLE) have greatly improved over time due to advances in the understanding of the condition. The past few decades, however, have not produced expected additional progress in lupus treatment. A new commentary from researchers in Spain reviews the current situation with lupus therapies, including their recommendations for what can be done to improve SLE treatment.
“Whilst outcomes related to active disease have greatly improved, damage accrual tends to be slowly increasing, especially damage secondary to high-dose glucocorticoids, which could lead not only to increased morbidity but also to a worse long-term prognosis,” wrote Amaia Ugarte and Guillermo Ruiz-Irastorza of the Autoimmune Diseases Research Unit at the University of The Basque Country, Spain.
In the 1950s, only 55 to 65 percent of those with SLE were expected to live for 10 years or more. However, due to better treatments for SLE, rates rose to over 90 percent toward the end of the 20th century. Still, life expectancy is lower than that for people without SLE.
Other problems persist due to the treatments themselves, such as damage as a consequence of glucocorticoids, a commonly used drug for autoimmune diseases. Unfortunately, glucocorticoids have many side effects, including tissue destruction with prolonged use. Prednisone is a frequently prescribed glucocorticoid that may not have detrimental effects initially, but causes accumulated damage after years of use, such as cardiovascular disease and infection.
The authors recommend hydroxychloroquine as an alternative immunosuppressant treatment for those with SLE. Originally indicated for malaria, hydroxychloroquine can also treat autoimmune conditions such as lupus and arthritis.
The authors additionally recommend changes in glucocorticoid dosing, including “using pulse methylprednisolone in acute situations, avoiding high doses of oral prednisone, and taking as a rule maintenance doses not higher than 5 [milligrams per day].”
The researchers emphasize that lifestyle changes should also play a role in preventing SLE from progressing, including “weight control, regular exercise and smoking cessation, vaccines administration, social support, etc.”
The paper aims to move SLE treatment and management forward from its current plateau. Hopefully, these and other evidence-based suggestions will be taken into account by clinicians to aid in the development of further guidelines for SLE treatment.
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