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Treatments for Lupus

Overview
Ace Inhibitors
Alternative Therapies
Anti-Malarials (Plaquenil)
CellCept® (Mycophenolate Mofetil)
Cyclophosphamide
Methotrexate
Periodontal Treatment
Prednisone/Steroids
Rituximab (Rituxan)
Stem Cell Transplants
Tacrolimus
Vitamin D

Overview

Lupus treatment includes care for symptoms as they arise, plus treatments aimed at slowing down the overall course of the disease, such as anti-inflammatories, steroids, and immunosuppressants. Every lupus patient should also have their Vitamin D status regularly monitored, and optimized. (Also see Autoimmune Diseases and Overview of Lupus)

Lupus Treatment Currently, there is no cure for lupus. But treatments can ease symptoms and reduce complications. Mayo Clinic

Belimumab alters transitional B-cell subset proportions in patients with stable systemic lupus erythematosus. We show that Belimumab-mediated B-cell activating factor depletion reduces the Transitional 2 subset in patients. PubMed, Lupus, 2019 Oct;28(11):1337-1343. (Also see Clinical Trials)

Early–stage predictors for treatment responses in patients with active lupus nephritis (LN). The change percentage of urinary protein-to-creatinine ratio >59% and the serum albumin >32.9g/l at the third month were valuable for predicting remission at the sixth month in LN. PubMed, Lupus. 2019 Mar;28(3):283-289.

How is systemic lupus treated? There is no permanent cure for systemic lupus. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. Many patients with mild symptoms may need no treatment or only intermittent courses of antiinflammatory medications. MedicineNet

Ace Inhibitors

Does Renin-Angiotensin System Blockade Protect Lupus Nephritis Patients From Atherosclerotic Cardiovascular Events? A Case–Control Study. Our data do not support the hypothesis that ACE inhibitors/ARBs may be protective against atherosclerotic CVEs in lupus nephritis patients. PubMed, Arthritis Care Res (Hoboken).

Alternative Therapies

Twelve-Week Internet-Based Individualized Exercise Program in Adults With Systemic Lupus Erythematosus: Protocol for a Randomized Controlled Trial. Exercise can lead to various benefits in patients with systemic lupus erythematosus such as increased aerobic capacity and exercise tolerance, resulting in an increased quality of life, decreased depression, and decreased fatigue. PubMed, JMIR Res Protoc, 2020 Nov 3;9(11):e18291.

Anti-Malarials (Plaquenil, Hydroxychloroquine)

Baseline use of hydroxychloroquine (HCQ) in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19. These efficacy data establish that patients with lupus on baseline therapy with HCQ are not universally protected from COVID-19. BMJ Journals, Ann Rheum Dis, 05/07/2020.

Successful treatment with hydroxychloroquine for systemic lupus erythematosus with cutaneous involvement accompanied by a xanthomatous reaction. As yet unrecognized factors may play a role in the development of a xanthomatous reaction in discoid lupus erythematosus. PubMed, Lupus, 2019 Dec 1:961203319890677.

HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects. PubMed, Autoimmun Rev, 2018 Dec;17(12):1153-1168. (Also see Antiphospholipid and Antimalarials)

Anti-Malarials in the Treatment of Lupus. Anti-malarials are particularly effective in treating skin and joint symptoms that may occur in SLE. They have been demonstrated to improve muscle and joint pain; inflammation of the lining of the heart (pericarditis); inflammation of the lining of the lung (pleuritis); and other symptoms of lupus such as fatigue and fever. Lupus Foundation of America.

CellCept® (Mycophenolate Mofetil)

Mycophenolate mofetil (MMF) reduces STAT3 phosphorylation in systemic lupus erythematosus (SLE) patients. The inhibition of STAT3 phosphorylation by MMF may explain the effectiveness of this treatment in SLE patients, since increased levels of p-STAT3 are associated with disease pathology. PubMed, JCI Insight, 2019 Jan 24;4(2).

Cyclophosphamide

Cyclophosphamide (generic) was also formerly known by the brand name Cytoxan.

Raised Plasma Levels of Asymmetric Dimethylarginine (ADMA) Are Associated with Pathological Type and Predict the Therapeutic Effect in Lupus Nephritis (LN) Patients Treated with Cyclophosphamide. Low plasma ADMA may help to predict complete remission in proliferative LN patients treated with cyclophosphamide as induction therapy. PubMed, Kidney Dis (Basel), 2020 Sep;6(5):355-363.

Diet and Nutrition for Lupus

Diet and Nutrition. In general, you should try to eat a nutritious, well-balanced, and varied diet that contains plenty of fresh fruits and vegetables, whole grains, moderate amounts of meats, poultry, and oily fish, as fish oil has been found to help reduce inflammation. Lupus Foundation.

Methotrexate

Methotrexate (MTX) in systemic lupus erythematosus (SLE). The use of MTX is associated with significant reductions in SLE Disease Activity Index and the average dose of corticosteroids in adult patients with SLE. PubMed, Lupus. (Also see Methotrexate)

Periodontal Treatment

Rare Diseases (RDs) with Periodontal Manifestations. Around 14 percent of RDs with an orofacial involvement showed periodontally relevant manifestations, which present not only as a result of gingivitis and periodontitis, but also gingival hyperplasia in connection with an underlying disease. PubMed, Int J Environ Res Public Health, 2019 Mar 9;16(5).

Prednisone

Glucocorticoids and antimalarials in systemic lupus erythematosus: an update and future directions. In moderate-severe flares, pulse methyl-prednisolone are more effective and much less toxic than increasing the oral doses of prednisone. PubMed, Curr Opin Rheumatol, 2018 Sep;30(5):482-489. (Also see Glucocorticoids, Steroids (Prednisone) Warnings)

Rituximab (Rituxan)

Cellular aspects of the pathogenesis of lupus nephritis. Better understanding of the pathogenesis of tubulointerstitial inflammation will identify novel therapeutic targets predicted to improve outcomes in our patients with lupus nephritis. PubMed, Curr Opin Rheumatol, 2021 Mar 1;33(2):197-204. (Also see B Cells and T Cells)

Biologic Sequencing in Systemic Lupus Erythematosus (SLE): After Secondary Non-response to Rituximab, Switching to Humanised Anti-CD20 Agent Is More Effective Than Belimumab. Our data suggests that patients with secondary non-depletion and non-response to rituximab, should be switched within the same biologic class to another anti-CD20 agent. PubMed, Front Med (Lausanne), 2020 Aug 27;7:498. (Also see B Cells and T Cells)

Stem Cell Transplants

Stem Cell Transplant Research for Scleroderma. ISN.

Tacrolimus

Tacrolimus (TAC) use in lupus nephritis: A systematic review and meta–analysis. In moderately severe lupus nephritis, there is some evidence supporting efficacy of TAC or multi–target TAC+ mycophenolate (MMF) over IV cyclophosphamide, but no evidence supporting TAC over MMF. PubMed, Autoimmun Rev, Autoimmun Rev.

Vitamin D

Vitamin D receptor (VDR) FokI, TaqI, and ApaI polymorphisms and susceptibility to systemic lupus erythematosus (SLE): an updated meta–analysis. This meta–analysis showed that polymorphisms in VDR FokI, TaqI, and ApaI are not associated with SLE susceptibility in overall, European and Asian populations. PubMed, Clin Rheumatol 02/21/2018.

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