Last updated Nov. 10, 2022, by Patricia Silva, PhD
✅ Fact-checked by Joana Carvalho, PhD
Each person with lupus is affected differently by the disease, and may experience a unique combination of symptoms. Thus, each treatment regimen for the autoimmune inflammatory disorder will be unique.
While there is no cure for lupus, several types of therapies can be considered for the treatment of the disease. The most common include:
- monoclonal antibodies
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- adrenocorticotropic hormone (ACTH)-based therapies
The main goal of treatment is to reduce the autoimmune response that causes the disease, control symptoms, and prevent organ damage.
A safe and adequate treatment plan must be discussed between the patient and the healthcare team.
Monoclonal antibodies are therapies developed to target a specific molecule or protein. They act like the body’s own antibodies and can help control autoimmune disease activity. Two types of monoclonal antibodies have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of lupus. These are:
- Benlysta (belimumab)
- Saphnelo (anifrolumab-fnia)
Marketed by GSK (formerly GlaxoSmithKline), Benlysta first was approved by the FDA in 2011 for the treatment of active lupus in adults. The FDA expanded that approval in 2020 for the treatment of lupus nephritis, also in adults. Lupus nephritis is a serious form of kidney inflammation associated with lupus.
In 2019, Benlysta was approved to treat lupus in children and, in 2022, to treat lupus nephritis in this younger patient population — specifically, children ages 5 and older with active lupus nephritis.
Benlysta is a monoclonal human antibody that targets and blocks the activity of B-lymphocyte stimulator, or BLyS, a protein that prolongs the survival of immune B-cells. These cells contribute to the production of harmful autoantibodies, which are antibodies that target the body’s own tissues and cause autoimmune diseases like lupus.
Saphnelo, marketed by AstraZeneca, was approved by the FDA in 2021 for the treatment of adults with moderate to severe lupus. The therapy is a monoclonal human antibody that targets and blocks the activity of type 1 interferon (IFN-1) receptor, which is involved in inflammation and the body’s immune response.
The most severe cases of lupus are treated with immunosuppressants. These therapies typically inhibit proteins essential to immune signaling pathways, thus blocking heightened immune responses.
Azathioprine (sold as Imuran, Azasan), mycophenolate mofetil (CellCept), and methotrexate (sold as Trexall, among others) are the most commonly prescribed immunosuppressants for lupus.
Lupkynis (voclosporin), marketed by Aurinia Pharmaceuticals, is an immunosuppressant approved by the FDA in 2021 to treat lupus nephritis in adults. It also was approved for the same indication in 2022 in the EU. Lupkynis works by preventing the activation of immune cells associated with inflammation, and by protecting the kidneys from irreversible damage caused by lupus nephritis.
Antimalarial therapies like chloroquine and hydroxychloroquine, sold under the brand name Plaquenil, among others, are used to fight malaria. But these treatments also can be used for lupus.
The therapies can help control lupus symptoms, namely muscle and joint pain, skin problems, and fatigue. Antimalarials also may help reduce lupus flares and inflammation — they interfere with inflammatory signals of immune cells and thereby reduce the autoimmune response.
These medications can be taken while on other lupus therapies.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
It is estimated that up to 80% of lupus patients take NSAIDs to cope with disease symptoms.
They are available as over-the-counter NSAIDs — meaning, without a prescription — as medications such as ibuprofen and aspirin, and also as prescription therapies. Patients are advised to always talk with their healthcare team about the use of over-the-counter medication.
NSAIDs are used to alleviate pain, fever, and inflammation, and they typically can be taken either alone or in combination with other therapies.
Corticosteroids, also called steroids, help reduce pain and inflammation. Prednisone is one of the most common corticosteroids prescribed to lupus patients. These therapies act by decreasing the activity of overactive immune cells.
Steroids are potent agents and tend to work quickly. Thus, doctors usually prescribe the lowest dose necessary to achieve therapeutic efficacy, and ease patients off steroid treatment to prevent side effects.
Mood swings, face puffiness, and increased appetite and resultant weight gain are among the known side effects of prednisone use.
One ACTH-based therapy approved for lupus is Acthar Gel (repository corticotropin). Although the exact mechanism of action of Acthar Gel is not completely understood, it is thought to stimulate the body’s production of cortisol, an anti-inflammatory hormone. By doing so, it decreases the activity of the immune system and reduces inflammation.
Several experimental therapies are in development now for lupus. Some of the ones in more advanced clinical stages include:
- dapirolizumab pegol, an investigational therapy in Phase 3 testing that is being developed by UCB for systemic lupus. The therapy works by blocking a molecule (CD40L) that plays an important role in the interaction between different immune cells thought to be involved in the autoimmune disease.
- litifilimab, also known as BIIB059, being developed by Biogen for both systemic lupus and cutaneous lupus erythematosus. Now in Phase 3 trials, it works by reducing the production of pro-inflammatory molecules by specific immune cells.
- obinutuzumab, in development by Roche for several disorders, including systemic lupus and lupus nephritis. It’s in Phase 3 development for lupus, and works by depleting immune B-cells.
- secukinumab (AIN457) and ianalumab (VAY736). These two candidates from Novartis are aimed at treating lupus nephritis, and both are in the Phase 3 stage. Secukinumab targets interleukin-17A to inhibit pro-inflammatory pathways that drive the disease, while ianalumab works by depleting immune B-cells involved in the autoimmune response.
- telitacicept, also known as RC18, an investigational therapy being developed by RemeGen for systemic lupus. It also is in Phase 3 testing. Therapy targets molecules critical for immune B-cell development, thereby reducing B-cell-mediated autoimmune responses implicated in lupus.
- daxdilimab, in development by Horizon Therapeutics for the treatment of systemic lupus, discoid lupus erythematosus, and lupus nephritis. Now in Phase 2, it targets a molecule called ILT7 that leads to the depletion of specific immune cells.
- efavaleukin alfa, from Amgen, is being developed for active systemic lupus. The therapy, now in Phase 2, works by promoting the expansion of regulatory cells to control the autoimmune response.
- LY3361237, in development by Eli Lilly for the treatment of systemic lupus. Designed to target a receptor on key immune cells to reduce their activation and the production of inflammatory molecules, this therapy is in Phase 2.
- PRV-3279, being developed by Provention Bio for systemic lupus, and now in Phase 2 development. The therapy works by inhibiting immune B-cell function and reducing autoantibody production.
- ravulizumab (sold as Ultomiris for other indications) and ALXN2050. Both are being developed by Alexion Pharmaceuticals, now part of AstraZeneca, for kidney diseases. The therapies are in Phase 2 clinical development for lupus nephritis, and both target specific elements of the complement system — an important player in the immune response, and whose activation and dysregulation can lead to uncontrolled inflammation and organ damage, especially to the kidneys.
People with lupus may consider some alternative or complementary treatments to help them cope with the disease and its symptoms. These include: massage, acupuncture, meditation, and herbal medicines or supplements. Patients are, however, always advised to discuss any therapeutic strategy or approach with their healthcare team.
Of note, according to the Lupus Foundation of America, some alternative treatments might not be safe to take when combined with certain medicines, and potentially could result in a worsening of symptoms. Moreover, many have not undergone rigorous scientific and clinical testing.
Lupus News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.