Monoclonal Antibodies for Lupus

Medically Reviewed by Sabrina Felson, MD on March 08, 2024
4 min read

When you have lupus, your body’s immune system turns against your healthy tissue and organs, such as skin, joints, brain, heart, lungs, and kidneys. One of the newer treatments for lupus, called monoclonal antibodies, enlists your immune system to fight the disease.

Monoclonal antibodies are a type of biologic drug that researchers make in a lab. They act like antibodies (immune system proteins) your body already has. They’re called “monoclonal” because they’re clones of one specific antibody. They target certain cells involved in the immune response that leads to the inflammation of lupus, rather than your entire immune system.

The FDA has approved two monoclonal antibodies for lupus:

A third, rituximab (Rituxan), is not specifically approved for lupus treatment, but doctors sometimes prescribe it in what’s called “off-label” use.

This drug works to reduce the number of abnormal B protein cells in your body. Researchers believe these cells play a role in lupus.

Studies found that belimumab reduced lupus symptoms and made flare-ups less frequent and less serious. These improvements lasted as long as 10 years. People who took it reported they were less tired, which helped their quality of life.

The FDA has approved belimumab for adults and for children over age 5. It’s not effective for everyone with lupus. Don’t take it if you’re using other biologic drugs to dampen your immune system’s response. It’s not approved for people with severe lupus affecting their central nervous systems. Some research shows it may not be as effective if you have African heritage.

One complication of lupus is lupus nephritis. When you have it, your body’s immune system attacks your kidneys, which can damage them and lead to kidney failure. Belimumab has been shown to help some people whose kidneys are affected.

There are two ways to take this drug. You can get IV infusions in a medical office, or inject it under your skin.

You might feel side effects while taking belimumab. The most common include:

Vaccinations, especially those that contain live viruses, may not be safe when you are on belimumab. You shouldn’t be around other people who’ve recently gotten vaccines with live viruses, like the chickenpox and oral polio vaccines. Talk to your doctor before you get any vaccines.

Interferon is a protein that signals your immune system to ramp up and attack infection. When you have lupus, your body sends too many of these warnings. Anifrolumab disrupts those signals.

Afrinolumab can reduce flare-ups of lupus symptoms. It can also help people who are slowly lowering their dosage of steroids. Long-term use of steroids can damage your adrenal glands, so doctors may have patients taper off the amount they take.

Don’t take anifrolumab if you’re already on belimumab. If your lupus seriously affects your kidneys or central nervous system, your doctor likely won’t recommend it. It’s also not approved for children.

You receive this drug by IV infusion in a medical office every 4 weeks. The infusions take about 30 minutes each.

Side effects of anifrolumab can include:

  • Upper respiratory tract infections and colds
  • Bronchitis
  • Reactions at the spot of your infusion
  • Shingles, also known as herpes zoster

As with belimumab, vaccinations with live viruses pose a danger to people on anifrolumab. Talk to your doctor before you get vaccinated. You may need to delay your treatment to receive vaccines. Anifrolumab is a relatively new drug, and scientists are still studying how it interacts with vaccines.

Doctors mostly use this drug to treat lymphoma, a cancer involving B cells. It’s also a treatment for rheumatoid arthritis.

Rituximab targets B cells, which play a role in lupus, so researchers tested it on people with the condition. The studies didn’t produce enough evidence that it works, so the FDA hasn't approved it for lupus.

Some doctors believe it can still improve lupus symptoms, and they’re allowed to prescribe it “off-label.” That means lupus is not officially listed as a condition it’s approved to treat.

Lupus researchers continue to study rituximab.

You receive rituximab as an IV infusion, which can take several hours.

Side effects may include:

  • Upper respiratory tract infections and colds
  • Bronchitis
  • Nausea
  • Diarrhea
  • Headaches
  • Swelling of your arms and legs
  • Muscle spasms
  • Anemia
  • Urinary tract infections

Don’t take vaccines that are made with live viruses before or during your treatment with rituximab. And avoid contact with people who have had recent live-virus vaccines. If you use rituximab, check with your doctor before getting vaccinated.

What should you expect to pay for monoclonal antibody treatment? That depends on your health insurance, among other factors. Not all insurers will cover these drugs.

In general, monoclonal antibodies are expensive, in part because they’re costly to manufacture. Any drug you receive by infusion may have added costs for the clinic where you receive it and the medical professional who oversees your IV.

The manufacturers of belimumab, anifrolumab, and rituximab all offer programs that may help offset your costs.