From the Guidelines
Lupus treatment should prioritize hydroxychloroquine in all patients, with a dose not exceeding 5 mg/kg real body weight, as recommended by the most recent guidelines. This approach is based on the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1. The treatment aims at remission or low disease activity and prevention of flares.
Key Treatment Components
- Hydroxychloroquine is the foundation of treatment for all lupus patients, given its ability to reduce flares and organ damage while improving survival rates by modulating immune responses.
- Glucocorticoids (GC) should be minimized to less than 7.5 mg/day (prednisone equivalent) during chronic maintenance treatment, and withdrawn when possible.
- Immunomodulatory agents such as methotrexate, azathioprine, or mycophenolate can expedite the tapering or discontinuation of GC.
- Belimumab should be considered for add-on treatment in persistently active or flaring extrarenal disease.
- Rituximab may be considered in organ-threatening, refractory disease.
Disease Management
The management of lupus also involves assessing patients for their antiphospholipid antibody status, infectious disease risk profile, and cardiovascular disease risk profile, and tailoring preventative strategies accordingly 1. Regular monitoring of disease activity through blood tests and clinical evaluations is crucial, along with lifestyle modifications such as sun protection, regular exercise, and stress management.
Treatment Goals
The ultimate goal of lupus treatment is to achieve remission or low disease activity while minimizing medication side effects through the use of the lowest effective doses. By following the most recent and highest quality guidelines, healthcare providers can improve outcomes for patients with lupus, reducing morbidity, mortality, and enhancing quality of life 1.
From the FDA Drug Label
1.3 Systemic Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults.
2.4 Dosage for Systemic Lupus Erythematosus in Adults The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses.
Lupus Treatment: Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults. The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses 2.
- Key Points:
- Hydroxychloroquine is used to treat systemic lupus erythematosus.
- The recommended dosage for adults is 200 mg or 400 mg daily.
- Important Considerations:
- Dosage should be administered orally with food or milk.
- Tablets should not be crushed or divided.
From the Research
Treatment Options for Lupus
- The primary goal of treatment is to achieve disease remission or quiescence, defined by minimal symptoms, low levels of autoimmune inflammatory markers, and minimal systemic glucocorticoid requirement while the patient is treated with maintenance doses of immunomodulatory or immunosuppressive medications 3.
- Hydroxychloroquine is considered the backbone of SLE treatment and is associated with a significant reduction in mortality 4, 3.
- Glucocorticoids and immunosuppressive drugs are also used in combination with hydroxychloroquine to manage SLE, but their use is limited due to potential side effects 4, 5.
- Biologic agents, such as belimumab and rituximab, are used in refractory or organ-threatening disease, and have shown promising results in reducing disease activity and improving quality of life 4, 6.
Immunomodulatory and Immunosuppressive Therapies
- Conventional immunosuppressive therapy includes corticosteroids, methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine, cyclosporine, and tacrolimus 6.
- Tacrolimus and mycophenolate mofetil have shown a trend toward lower renal relapse rates and a more favorable safety profile compared to azathioprine and cyclophosphamide 7.
- The choice of immunomodulatory or immunosuppressive therapy depends on the individual patient's disease severity, organ involvement, and response to treatment 4, 3.
Biologic Agents
- Belimumab, a B cell targeting agent, has been approved for the treatment of SLE and has shown beneficial effects in reducing disease activity 4, 6.
- Rituximab, an anti-CD20 targeting agent, is also used in SLE and has shown promising results in reducing disease activity and improving quality of life 4, 6.
- Anifrolumab, an interferon I receptor-targeting agent, has also shown beneficial effects in SLE and is being further evaluated as a potential treatment option 6.