From the Guidelines
The treatment for a Systemic Lupus Erythematosus (SLE) flare should prioritize hydroxychloroquine, at a dose not exceeding 5 mg/kg real body weight, as the foundation therapy, with glucocorticoids (GC) minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn, according to the 2019 EULAR recommendations 1. When managing an SLE flare, the primary goal is to achieve remission or low disease activity and prevent future flares.
- Hydroxychloroquine is recommended for all patients with lupus, due to its ability to reduce disease activity and prevent flares 1.
- Glucocorticoids (GC) should be used at the lowest effective dose, with the aim of minimising them to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawing them, to reduce the risk of long-term side effects 1.
- Immunomodulatory agents, such as methotrexate, azathioprine, or mycophenolate, can be used to expedite the tapering or discontinuation of GC, and to control disease activity 1.
- In cases of persistently active or flaring extrarenal disease, add-on belimumab should be considered, while rituximab (RTX) may be considered in organ-threatening, refractory disease 1. The treatment approach should be individualised, taking into account the severity of the flare, the affected organs, and the patient's overall health status, with the aim of reducing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
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. INDICATIONS AND USAGE BENLYSTA is a B-lymphocyte stimulator (BLyS)-specific inhibitor indicated for the treatment of: • patients 5 years of age and older with active systemic lupus erythematosus (SLE) who are receiving standard therapy;
The treatment for a Systemic Lupus Erythematosus (SLE) flare may include:
- Hydroxychloroquine: 200 mg given once daily, or 400 mg given once daily or in two divided doses 2
- Belimumab: 10 mg/kg at 2‑week intervals for the first 3 doses and at 4‑week intervals thereafter, as an intravenous infusion over a period of 1 hour 3
From the Research
Treatment for SLE Flare
The treatment for a Systemic Lupus Erythematosus (SLE) flare typically involves a combination of medications to manage symptoms and prevent further flares. Some key points to consider include:
- Hydroxychloroquine is often considered an anchor drug in SLE treatment due to its multiple beneficial effects 4, 5, 6
- Immunossuppressants such as azathioprine and mycophenolate mofetil are commonly used to treat moderate to severe SLE 4, 5, 7
- Glucocorticoids (GCs) may be prescribed to reduce inflammation, but determining a safe dose for chronic daily use is crucial 4, 8
- Biologic agents such as belimumab, voclosporin, and anifrolumab have been approved for SLE treatment and may be used in addition to synthetic drugs 5
Medication Options
Some medication options for SLE flare treatment include:
- Hydroxychloroquine: reduces disease activity, morbidity, and mortality 5, 6
- Azathioprine: associated with reduced mortality and improved survival 6
- Mycophenolate mofetil: may reduce the incidence of flares 7
- Glucocorticoids: may be used to reduce inflammation, but with caution due to potential side effects 4, 8
- Biologic agents: may be used in addition to synthetic drugs to treat SLE 5
Treatment Goals
The primary goal of SLE treatment is to achieve disease remission or quiescence, defined by:
- Minimal symptoms
- Low levels of autoimmune inflammatory markers
- Minimal systemic glucocorticoid requirement
- Maintenance doses of immunomodulatory or immunosuppressive medications 5