From the Guidelines
Lupus treatment should aim at remission or low disease activity, with hydroxychloroquine recommended for all patients, unless contraindicated, at a dose not exceeding 5 mg/kg real body weight 1. The primary goal of lupus treatment is to control symptoms, prevent flares, and minimize organ damage while maintaining quality of life. Key treatment strategies include:
- Using hydroxychloroquine (HCQ) as a first-line treatment, with a daily dose not exceeding 5 mg/kg real body weight, to control skin rashes, joint pain, and fatigue while potentially preventing flares 1.
- Utilizing corticosteroids, such as prednisone, at the lowest effective dose for the shortest time possible to quickly reduce inflammation in more severe symptoms 1.
- Adding immunosuppressants like azathioprine, mycophenolate mofetil, or cyclophosphamide for organ-threatening disease 1.
- Considering belimumab, a biologic medication, for patients with inadequate response to standard-of-care treatments 1. Beyond medications, lupus management includes:
- Sun protection with SPF 50+ sunscreen and protective clothing
- Regular exercise
- Stress management
- Avoiding smoking Treatment approaches may vary depending on the specific manifestations of lupus, such as cutaneous, neuropsychiatric, haematological, or renal disease, and should be tailored to the individual's symptoms and disease severity 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 is 200 mg or 400 mg daily.
- It can be given as a single dose or in two divided doses.
From the Research
Treatment Options for Lupus
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat musculoskeletal symptoms, serositis, and headache in up to 80% of patients with systemic lupus erythematosus (SLE) 3, 4.
- The choice of NSAID needs to be individualized, and with optimal usage, NSAIDs can often be used to manage symptoms previously treated with corticosteroids 5.
- Corticosteroids are the cornerstone of therapy for serious disease manifestations, and different dosage regimens, such as intravenous methylprednisolone pulse therapy, and adjunctive agents, such as cyclophosphamide, are used in severe and potentially life-threatening disease 5.
Side Effects and Monitoring
- Treatment of SLE with NSAID requires awareness of the increased frequency of some side effects, such as renal side effects, cutaneous and allergic reactions, hepatotoxic effects, and central nervous system side effects 3, 4.
- Close monitoring of toxicity is necessary, particularly in patients with lupus nephritis, who are at risk for NSAID-induced acute renal failure 3, 4.
Emerging Treatment Options
- Biologic therapies, such as the CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab, are now widely used in clinical practice for the treatment of SLE, particularly in patients with refractory disease 6.
- Other biologic agents are in ongoing clinical trials, and conventional immunosuppressive agents, such as mycophenolate mofetil, azathioprine, and cyclophosphamide, are widely used in the management of SLE 6.