Each patient experiences his or her own unique combination of symptoms. Thus, each treatment regimen is unique. There are four main drug classes that are currently used to treat lupus.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Over-the-counter NSAIDs are used to alleviate pain and swelling. There are also prescription-strength NSAIDs available when these are not effective. Up to 80% of lupus patients take an NSAID for symptoms.
Hydroxychloroquine, a drug used to combat malaria, is also used to treat lupus. Antimalarial drugs may reduce the risk of serious infection in patients with lupus. They may also prevent overactive immune cells from reproducing. Further, antimalarial agents interfere with inflammatory signaling of immune cells, which reduces the autoimmune response; fewer autoantibodies are produced, and organ damage is slowed.
Prednisone, one of the most common corticosteroids prescribed for lupus patients, reduces inflammation. Steroids are potent and tend to work quickly. Thus, doctors prescribe the lowest dose necessary for an effect and ease patients off steroid treatment to prevent side effects. Mood swings, face puffiness, and increased appetite are among the uncomfortable side effects of prednisone use.
The most severe cases of lupus are treated with immunosuppressants. The drugs inhibit proteins essential to immune cell signaling pathways, thus blocking heightened immune responses. Azathioprine (Imuran, Azasan), mycophenolate (CellCept), leflunomide (Arava) and methotrexate (Trexall) are the most commonly prescribed immunosuppressants. In 2011, Belimumab (Benlysta) became the first new FDA approved drug in 50 years of research in lupus treatments. The drug is used to treat patients with active, autoantibody-positive lupus (systemic lupus erythematosus) who are receiving standard therapies listed above. It interferes with B-lymphocyte stimulator (BLyS) protein and reduces the number of dysfunctional B-cells in lupus patients.
Unfortunately, many drugs used to treat lupus induce unpleasant side effects. These side effects can be as minor as upset stomach from antimalarial drugs or as major as increased risk of heart disease from NSAIDs. Researchers are studying new methods to treat lupus, but the lack of successful clinical trials hamper progress.
It is exceptionally difficult to develop treatments for lupus for a variety of reasons. The greatest barrier is the fact that there is no precise cause for lupus, which means researchers cannot select a specific protein to use as a target for inhibitors. Additionally, no two patients experience the same symptoms or flare patterns. This adds a level of complication to patient selection and endpoint definition for clinical trials.
Alternative treatments and remedies
When medications do not work, or when patients do not wish to be treated with drugs, alternatives exist. Patients may feel better simply by making lifestyle changes such as getting adequate rest, protecting themselves from the sun, exercising regularly, quitting tobacco use, and eating nutrient-rich healthful diets. Complementary agents include fish oil supplements with omega-3 fatty acids and supplemental vitamin D. Dehydroepiandrosterone (DHEA), which is a hormone, has also been shown to alleviate patients’ symptoms and reduce the dose of corticosteroids necessary for patients to feel relief.
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