What are the treatment options for Systemic Lupus Erythematosus (SLE)?

From the Guidelines

The treatment of Systemic Lupus Erythematosus (SLE) should aim at remission or low disease activity and prevention of flares, with hydroxychloroquine recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight, and glucocorticoids minimized to less than 7.5 mg/day (prednisone equivalent) during chronic maintenance treatment. The treatment options for SLE are diverse and depend on the severity and manifestations of the disease.

• For mild lupus, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may help manage joint pain and inflammation.
• Antimalarials such as hydroxychloroquine are often prescribed as a first-line treatment for most lupus patients, helping to reduce flares and damage over time 1.
• For moderate to severe lupus, corticosteroids like prednisone may be used to quickly control inflammation, though they're typically tapered to the lowest effective dose due to side effects.
• Immunosuppressants including methotrexate, azathioprine, or mycophenolate mofetil are added for organ-threatening disease or as steroid-sparing agents 1.
• Belimumab, a biologic medication administered intravenously or subcutaneously, may be prescribed for active disease not responding to standard therapies. The treatment should also include sun protection, regular exercise, adequate rest, and stress management, as UV exposure and stress can trigger flares. Regular monitoring of kidney function, blood counts, and other organ systems is essential, as lupus can affect multiple body systems and treatment side effects need careful management 1. It is also important to assess patients with SLE for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile, and preventative strategies should be tailored accordingly 1. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion 1.

From the FDA Drug Label

The safety and effectiveness of BENLYSTA administered intravenously plus standard therapy were evaluated in 4 randomized, double‑blind, placebo‑controlled trials involving 2,581 adult patients with SLE... Patients were on a stable standard therapy SLE treatment regimen comprising any of the following (alone or in combination): corticosteroids, antimalarials, NSAIDs, and immunosuppressives 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 options for Systemic Lupus Erythematosus (SLE) include:

• Belimumab (IV): administered in combination with standard therapy, which may include:
  • Corticosteroids
  • Antimalarials
  • NSAIDs
  • Immunossuppressives
• Hydroxychloroquine (PO): 200 mg given once daily, or 400 mg given once daily or in two divided doses 2 2

From the Research

Treatment Options for Systemic Lupus Erythematosus (SLE)

The treatment of SLE aims to prevent organ damage, improve health-related quality of life, and prolong survival 3. The current treatment options for SLE include:

• Antimalarials, such as hydroxychloroquine (HCQ), which is considered the backbone of SLE treatment 3, 4
• Glucocorticoids, such as prednisone, which are used to treat acute flares and prevent organ damage 3, 4
• Immunosuppressive drugs, such as azathioprine, which are used to treat severe disease and as steroid-sparing agents 3, 5
• Biologic agents, such as belimumab and rituximab, which are used to treat refractory or organ-threatening disease 3, 6

Combination Therapies

Combination therapies have been shown to be effective in treating SLE. For example:

• The combination of low doses of rituximab, followed by hydroxychloroquine, prednisone, and low doses of mycophenolate mofetil, has been shown to be effective in Latin American patients with active SLE 6
• The combination of hydroxychloroquine and quinacrine has been shown to be effective in inducing remission in SLE patients with major organ involvement 7

Dosage and Administration

The dosage and administration of SLE treatments vary depending on the specific treatment and patient population. For example:

• Hydroxychloroquine is typically administered at a dose of 200-400 mg/day 4, 6
• Glucocorticoids, such as prednisone, are typically administered at a dose of ≤5-2.5 mg/day for long-term maintenance treatments 4
• Azathioprine is typically administered at a dose of 100-150 mg/day 5, 7