Lupus happens because of an immune system misfire. Your immune cells mistakenly attack your organs and tissues, causing damage and inflammation. The main lupus treatments today – immunosuppressants and corticosteroids – work by lowering your immune response and bringing down inflammation.
Managing this autoimmune disease is tricky because lupus affects so many organs – joints, skin, kidneys, heart, brain, and lungs. If you've tried a few treatments without success, help could be on the way.
The search is on for new and more effective lupus treatments. Many of them work by calming the overactive immune response.
Here are just a few of the latest treatment approaches that have been recently approved or are working their way through clinical trials.
B-Cell Therapies
B cells are part of your immune system. They're like little soldiers in your body's army against germs. When they spot a foreign invader like bacteria or a virus, B cells release proteins called antibodies to stop it.
When you have lupus, your B cells turn against you. They make autoantibodies that attack your own organs. B cells also make chemicals that trigger more inflammation. A few new medicines kill or block B cells to treat lupus. Some of these drugs are monoclonal antibodies, which are lab-made proteins that act like the antibodies your immune system makes.
Obinutuzumab (Gazyva) is a monoclonal antibody that destroys B cells. It's already a treatment for blood cancers like chronic lymphocytic leukemia (CLL) and follicular lymphoma. Now researchers are looking at whether it might treat lupus, too. So far, results have been promising.
Rituximab (Rituxan) was first approved to treat lymphoma. Today it's also a treatment for rheumatoid arthritis. For many years, researchers have been trying to find out whether rituximab might treat lupus, too. Studies so far haven't shown much success, but rituximab might still work for more severe forms of lupus, or for lupus nephritis – kidney inflammation that lupus sometimes causes.
A few other medications block B cells instead of killing them. In studies, obexelimab improved lupus symptoms and prevented flares in some people who used it
Other lupus treatments in development work on BAFF, a protein that sends out signals to activate B cells. Blisibimod and TACI-Ig (Atacicept) block these signals. In one study, blisibimod helped people with lupus lower their steroid dose.
T-Cell Therapies
T cells are another type of immune cell that seeks out and kills germs. When you have lupus, your T cells make chemicals that increase inflammation. T cells also direct your B cells to make more autoantibodies.
In 2021, voclosporin (Lupkynis) was approved by the FDA to treat lupus nephritis. It blocks T cells from triggering an immune response in the kidneys. Tacrolimus (Prograf) interferes with T-cell function and is already approved to prevent rejection after an organ transplant. Research shows it might help with lupus, too.
Plasma Cell Treatments
Plasma cells are immune cells that release autoantibodies in lupus. These cells don't respond well to current lupus treatments that suppress the immune system.
The cancer drug daratumumab (Darzalex) destroys plasma cells directly. In one very small study, daratumumab led to a big improvement in lupus symptoms. Researchers need to do more studies to learn whether this drug might be useful for treating lupus.
Targeting Interferon
Interferons are part of your body's immune defenses. In people with lupus, immune cells called plasmacytoid dendritic cells release too much interferon, which produces a lot of inflammation. A couple of new treatments in studies either kill dendritic cells or reduce the amount of interferons these cells release.
Disease-Modifying Drugs
Leflunomide (Arava) stops the excess production of immune cells to reduce inflammation in the joints. It's already approved to treat rheumatoid arthritis. Small studies have shown that it also helps to relieve lupus joint symptoms. More research is needed to confirm whether leflunomide might be an effective lupus treatment.
Lupus Kidney Disease
Lupus can damage the kidneys to the point where these organs can't filter your blood. Lupus nephritis is the name for lupus kidney disease.
As mentioned above, voclosporin (Lupkynis) targets T cells to reduce inflammation in the kidneys. Another way to reduce kidney damage is to diagnose and treat lupus nephritis early. Researchers have found more than 230 different proteins in the urine, called biomarkers, that might one day help doctors find and treat lupus nephritis more easily.
Stem Cell Transplant
There are many new medicines to treat lupus, but they don't work for everyone. Sometimes lupus progresses to the point where it damages organs. Studies are under way to see whether stem cell transplant might be an option for people with severe lupus that hasn't improved with other treatments.
Stem cells are the very early cells that grow into other cell types, including immune cells. A stem cell transplant replaces your damaged immune cells with healthy ones from your own body or from a donor.
Some studies are looking at transplants of mesenchymal stem cells. These are a special kind of stem cell that may prevent your immune system from turning against your own body.
These are just some of the new lupus treatments researchers are studying. If you're interested in learning more about them, you might join a clinical trial. One of these studies could give you access to a new medicine before it's approved. Ask the doctor who treats your lupus if any studies might be a good fit for you.
