What are some medications used for lupus and do they give some relief

[wvcry]

[lupus-support1 Administrator]

Welcome wvcry!

The question you are ask is very complex. This is because each person with SLE may present differently and therefore this is a question that you should ask your lupus specialist.

Lupus is treated with drugs and these can be divided into four main groups, depending on the severity of the disease.

ASPIRIN AND NON-STEROIDALS

Anti-inflammatory drugs (NSAIDS), used for patients who suffer mainly from joint, muscle pain. In the case of patients with "sticky blood", ASPIRIN in low doseage of 75/150mg daily is used to thin the blood.

ANTI-MALARIALS

These are of help in patients with skin and joint involvement. These drugs may be sufficient for patients with moderately active lupus to avoid using steroids. Hydroxychloroquine (Plaquenil) and mepacrine are most commonly used.

STEROIDS

Such as prednisolone have been vital in the improvement in lupus care and in some cases are life saving. They have a profound effect on inflammation and suppress active disease. The doseage depends on the severity of the disease. Once the disease is under control the patient can be weaned off gradually.

IMMUNOSUPPRESSANTS

These drugs are widely used in more severe cases. The most commonly used are azathiaprine, methotrexate and cyclophosphamide. Regular blood testing is required initially 2-3 weekly, subsequently 4-6 weekly whilst on this medication as these drugs also suppress the blood forming cells in the bone marrow, and can affect the liver in the case of azathiaprine and methotrexate.

In more aggressive lupus IV cyclophosphamide is administered over a period of months. Other agents sometimes include IV Immunoglogulin therapy for the treatment of thrombocytopenia. Thalidomide has also been used orally in some cases of aggressive skin disease. Iloprost infusions may be given for Raynaud's where circulation is severely diminshed in hands and feet. Methyl prednisolone infusions can be of benefit to patients with severe joint involvement.

There are other drugs such as Mycophenolate mofetil in the treatment of SLE and systemic vasculitis.

In 2011,a new drug received FDA approval and is the first specific drug for SLE for many years. However, this drug is only helpful for certain patients.

Benlysta operates on a population of immune cells known as B cells, which normally churn out the antibodies that bind and mark bacteria and viruses for destruction by other immune cells. In lupus patients, these B cells somehow get overstimulated and misguided, and are trained to target healthy body cells instead. Benlysta is designed to interfere with a protein critical to B cell activity, thus suppressing its search-and-destroy mission in the body.

Sunmmary of 4 new medications for SLE:

1. Belimumab (Benlysta), which is given intravenously, works on knocking out the white blood cells, called B lymphocytes, that make antibodies. It hasn’t been shown to be an effective treatment for lupus patients with kidney disease. But if you do not have kidney problems, you may see some benefit.

2. Rituximab has been used in rheumatoid arthritis patients with good results, and it’s being studied for use in patients with lupus as well. It also knocks out B lymphocytes that produce antibodies. Lupus is a disease where trying to knock down the production of antibodies is important.

3. Thalidomide and lenalidomide, which work on the immune system, are showing some promising effects on lupus that affects the skin. They’re FDA-approved for other conditions but are being used off label and in clinical trials for lupus patients. Part of the appeal is that these medications are taken as a pill rather than an injection, unlike similar drugs for joint problems.

4. Tofacitnib, which has been shown to slow joint damage, was recently approved for use in rheumatoid arthritis patients. There’s hope that it will help lupus patients as well.

I hope this is helpful. However, I must repeat that only your lupus specialist can prescribe the best medication for each patient.

You can find more information at the LuPUS Message Board if you are interested as there is a section on Medication.

With good wishes,

Ros