From the Guidelines
To treat a systemic lupus erythematosus (SLE) flare, the primary approach should involve minimizing glucocorticoids (GC) to less than 7.5 mg/day (prednisone equivalent) and considering the initiation of immunomodulatory agents such as methotrexate, azathioprine, or mycophenolate to expedite the tapering or discontinuation of GC, as recommended by the 2019 EULAR update 1. When managing an SLE flare, it's essential to consider the severity and the organs involved. The treatment aims at achieving remission or low disease activity and preventing future flares.
- For patients with SLE, hydroxychloroquine is recommended at a dose not exceeding 5 mg/kg real body weight, as part of the standard care 1.
- During a flare, especially in cases of persistently active or flaring extrarenal disease, adding belimumab should be considered, while rituximab may be an option for organ-threatening, refractory disease 1.
- The treatment strategy should also include assessing the patient's antiphospholipid antibody status, infectious disease risk profile, and cardiovascular disease risk profile, and implementing tailored preventative strategies accordingly 1.
- It's crucial for patients to work closely with their healthcare provider to adjust their treatment plan based on their specific symptoms, medical history, and response to previous treatments.
- Additionally, lifestyle adjustments such as resting adequately, avoiding sun exposure, managing stress, and maintaining medication adherence are important components of managing an SLE flare.
From the FDA Drug Label
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;
DOSAGE AND ADMINISTRATION • Intravenous Dosage for Adult and Pediatric Patients with SLE or Lupus Nephritis:−10 mg/kg at 2‑week intervals for the first 3 doses and at 4‑week intervals thereafter.
The treatment for a systemic lupus erythematosus (SLE) flare is belimumab (BENLYSTA), which can be administered intravenously at a dose of 10 mg/kg at 2-week intervals for the first 3 doses and at 4-week intervals thereafter. Additionally, hydroxychloroquine can be used for the treatment of SLE at a dose of 200 mg given once daily, or 400 mg given once daily or in two divided doses 23.
From the Research
Treatment Options for SLE Flare
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat musculoskeletal symptoms, serositis, and headache in SLE patients, with up to 80% of patients receiving NSAIDs 4
- Belimumab, a human immunoglobulin G1λ monoclonal antibody, is approved for the treatment of non-renal SLE and has been shown to reduce disease activity and the incidence of flares 5
- Mycophenolate mofetil (MMF) has been studied as a potential treatment for SLE, with some studies suggesting it may reduce the rate of severe flares and lower the incidence of lupus nephritis 6, 7, 8
Medication-Specific Considerations
- NSAIDs may increase the risk of certain side effects in SLE patients, including renal side effects, cutaneous and allergic reactions, and hepatotoxic effects 4
- Belimumab has been shown to be generally well-tolerated, with low rates of immunogenicity 5
- MMF may be associated with a lower risk of severe flares and lupus nephritis, but may also increase the risk of infections and other adverse events 6, 7, 8
Treatment Regimens
- A low-dose regimen of MMF and steroids may be effective for treating lupus nephritis, with potential benefits including reduced toxicity and improved long-term safety 7
- The use of voclosporin, MMF, and steroid therapy is being investigated in an ongoing randomized controlled trial 7
- MMF and intravenous cyclophosphamide (IVC) have been compared as induction treatments for lupus nephritis, with similar response rates and secondary endpoints 8