From the Guidelines
The treatment for a Systemic Lupus Erythematosus (SLE) flare should prioritize minimizing long-term steroid exposure and controlling inflammation quickly, with a focus on hydroxychloroquine as a cornerstone treatment, and corticosteroids like prednisone for more severe flares, as recommended by the most recent guidelines 1.
Key Considerations
- Hydroxychloroquine is recommended for all patients with SLE, with a daily dose not exceeding 5 mg/kg real body weight, due to its beneficial effects in reducing flare rates, organ damage, and cardiovascular events, as well as its satisfactory safety profile 1.
- For mild to moderate flares, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may help manage joint pain and inflammation.
- Corticosteroids like prednisone are often necessary for more severe flares, starting at 0.5-1mg/kg/day, then tapered to minimize long-term exposure.
- Immunomodulatory agents like methotrexate, azathioprine, or mycophenolate may be considered for patients with persistently active or flaring disease, to expedite the tapering or discontinuation of glucocorticoids 1.
- Belimumab, a biologic medication, may be added for patients who remain active despite standard therapy.
Monitoring and Prevention
- Regular monitoring of blood work, symptoms, and disease activity is crucial to prevent flares and minimize organ damage.
- Patients should increase rest, avoid sun exposure, and maintain a healthy lifestyle to reduce the risk of flares.
- The goal of treatment is to achieve remission or low disease activity, and prevent damage accrual, while minimizing drug side-effects and improving quality of life 1.
Recent Guidelines
- The 2024 KDIGO clinical practice guideline for the management of lupus nephritis recommends hydroxychloroquine use in patients with SLE, due to its benefits in reducing flare rates, organ damage, and cardiovascular events, as well as its satisfactory safety profile 1.
- The 2019 EULAR recommendations for the management of SLE emphasize the importance of hydroxychloroquine, glucocorticoids, and immunomodulatory agents in the treatment of SLE flares, and recommend a tailored approach to treatment based on disease severity and affected organs 1.
From the FDA Drug Label
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.
The treatment for a Systemic Lupus Erythematosus (SLE) flare includes hydroxychloroquine. The recommended dosage is 200 mg once daily or 400 mg once daily or in two divided doses 2.
Belimumab is also indicated for the treatment of active systemic lupus erythematosus (SLE) in patients 5 years of age and older who are receiving standard therapy. The dosage for adult and pediatric patients with SLE is 10 mg/kg at 2-week intervals for the first 3 doses and at 4-week intervals thereafter 3.
- Key points:
- Hydroxychloroquine dosage: 200 mg once daily or 400 mg once daily or in two divided doses
- Belimumab dosage: 10 mg/kg at 2-week intervals for the first 3 doses and at 4-week intervals thereafter
- Standard therapy should be used in conjunction with belimumab.
From the Research
Treatment of SLE Flare
The treatment of a Systemic Lupus Erythematosus (SLE) flare involves several approaches, including:
- Reducing disease exacerbations, hospitalizations, and organ damage due to the disease or treatment toxicity 4
- Achieving 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 4
- Using hydroxychloroquine as the standard of care for SLE, which has been associated with a significant reduction in mortality 4
- Individualized treatment with immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, typically used for treating moderate to severe disease 4
Medications for SLE Flare
Several medications have been approved for the treatment of SLE, including:
- Belimumab, which was approved for active SLE in 2011 and for lupus nephritis in 2020 4
- Voclosporin, which was approved for lupus nephritis 4
- Anifrolumab, which was approved for active SLE 4
- Cyclophosphamide, which remains the 'gold standard' treatment for severe organ-threatening SLE, especially renal and central nervous system lupus 5
Treatment Goals
The primary goals of treatment for an SLE flare include: