Lupus Medications and Treatments

From the WebMD Archives

Lupus -- also called systemic lupus erythematosus, or SLE -- might not have a cure, but it's a highly treatable condition. Lupus medications can help lower long-term risks and keep symptoms under control. According to the Lupus Foundation of America, 80% to 90% of people with lupus can expect a normal lifespan with good treatment.

Things used to be different. In the 1950s, most people with lupus died within a few years of diagnosis. What’s changed the prognosis? A combination of earlier diagnosis, better lupus medications, and more aggressive treatment, says Lisa Fitzgerald, MD, assistant professor of medicine at Harvard Medical School.

Now, the goal of lupus treatment is not just to reduce the symptoms, but to maintain full function, says Bonnie Lee Bermas, MD, director of the Brigham and Women's Hospital Lupus Center in Boston.

"I want people to have the same level of functioning that they had before they got sick," Bermas tells WebMD. "I want them to do all the things they used to do." With the right lupus medication and good care, many people can.

Lupus Medications

Lupus is mainly treated with medicine. The types of drugs that have been used to treat lupus include NSAIDs, corticosteroids and other immune system suppressing drugs, hydroxychloroquine, and the newest lupus drug, Benlysta.

Lupus medications work in different ways. What they have in common is that they all reduce swelling in the body, Fitzgerald says. Which drugs you need -- either alone or in combination -- depends on your particular case.

  • NSAIDs. These common drugs -- like aspirin, ibuprofen, naprosyn, or indomethacin, help reduce swelling, stiffness, and pain. For some people with very mild lupus, NSAIDs alone are enough to control symptoms.
  • Antimalarial drugs. Hydroxychloroquine (Plaquenil) is used to treat malaria, and researchers have found that this drug also helps with lupus flares. These drugs work well with mild to moderate cases of lupus. They can help ease lupus symptoms such as joint swelling and skin rashes. But hydroxychloroquine is not used alone for severe cases of lupus in which the kidneys or other organs are involved.

    "Antimalarials have almost become like a daily multivitamin” for people with mild to moderate lupus," Fitzgerald says. The drugs’ side effects are generally mild, and these medicines may help prevent complications, improving a person’s long-term diagnosis.
  • Benlysta. Benlysta was approved in 2011 to treat lupus in combination with other lupus drugs. Although it does not benefit all patients with lupus, it helps some reduce doses of steroids, which can have troubling side effects. Benlysta, also called belimumab, is an antibody that recognizes and blocks a protein in the immune system that contributes to the immune system's attack on the body's own cells. The most common side effects are nausea, diarrhea, and fever.
  • Corticosteroids. Oral steroids – such as prednisone and prednisolone -- can be a lifesaving treatment for people with lupus. During serious lupus flares that affect organs such as the kidneys, high doses of steroids can quickly control symptoms.

    However, steroids can also have troublesome or severe side effects, including weight gain, mood changes, and depression. In the long-term, these medicines can increase the risk of osteoporosis and other bone complications, infections, and weight-related conditions such as diabetes or high blood pressure.

    "The goal with steroids is to get the person onto the lowest possible dose necessary to control symptoms," says Fitzgerald. As you get better, your rheumatologist will probably reduce the dose. Some people need long-term treatment with low-dose steroids; others can stop taking them altogether.

    Steroids also come as a topical treatment, which can help treat skin rashes caused by lupus.
  • Immunosuppressive drugs. Because lupus is a disease caused by an overactive immune system, drugs that suppress the immune system can help relieve symptoms. These powerful drugs include azathioprine, cyclophosphamide, methotrexate, mycophenolate mofetil, and others. They are generally used in people who have severe lupus, when corticosteroids haven't worked or aren’t an option.

    Immunosuppressives can cause serious side effects, because they block the body's ability to fight infection. If you take immunosuppressive drugs, you need to get medical attention at the first sign of an infection or illness.
  • New and experimental medications. A number of lupus medications -- many designed to target specific immune cells -- are being tested in studies. If you're interested, talk to your doctor about joining a clinical trial.
  • Other medications. Because lupus can affect so many different parts of the body, many people need other medications depending on their symptoms. These can include statins, diuretics, anticoagulants, drugs to strengthen bones, blood pressure medicines, antibiotics, stimulants, and others.

Keep in mind that it might take your rheumatologist some time to find the right lupus drug or combination. You may also need different medicines over time as your symptoms change.

"There is no one medication that helps all people with lupus," says Fitzgerald. "A drug might work well in some people and not at all in others. Unfortunately we don't have a way to predict who will benefit and who won't."