Treatments for systemic lupus erythematosus (SLE)

Lupus is a chronic disease for which there is currently no cure. However, available treatments can control disease activity, treat flare-ups, prevent relapses, and reduce the risk of complications (and treat them if they do occur).

The objectives of the treatment

• Treat lupus flare-ups and any complications (due to the disease or to treatment prescribed during a previous flare-up);

• To achieve sometimes very long remissions and prevent relapses;

• To preserve quality of life and professional integration (or the child's schooling, if it is the child who is ill).

  
  

Treatment must be personalized, therefore adapted to each case. The choice of medication depends in particular on the manifestations of the disease, the organs affected, the severity of the damage (especially skin involvement) and the specific situation of each patient.

A multidisciplinary approach

Because lupus can affect different organs, several healthcare professionals may be involved in diagnosis, treatment, and follow-up: general practitioner, internist, rheumatologist, nephrologist, dermatologist, ophthalmologist, or other specialists depending on the symptoms present. This treatment is coordinated by the general practitioner or the lupus specialist.

Other professionals (dietitian, psychologist, occupational physician, school doctor, social worker) may also be called upon if necessary.

The long-term drug treatment

This treatment relies on various medications. These are sometimes combined for greater effectiveness.

Synthetic antimalarial drugs: hydroxychloroquine

Hydroxychloroquine is a synthetic antimalarial drug that is the primary disease-modifying treatment for lupus, except in cases of contraindication. It acts on the immune system and has anti-inflammatory properties. It helps prevent flare-ups of the disease and is also effective on skin and joint manifestations.

This long-term maintenance treatment requires medical monitoring: an ophthalmological examination with fundus examination must be carried out before the start of treatment (a retinal disease may contraindicate treatment) and checked regularly, in order to detect any possible adverse effects on the retina.

Corticosteroids

Corticosteroids are used to quickly control inflammation, particularly during certain flare-ups of the disease. They are the most commonly used medications to treat some acute forms of lupus, especially when there is kidney, neurological, or cardiac involvement.

The dose (usually prescribed at high doses initially) and the duration of treatment depend on the nature and severity of the symptoms.

When possible, as soon as the disease is controlled, the doctor will gradually reduce the dosage to a minimum; this helps limit the side effects associated with prolonged corticosteroid treatment. In the event of complete remission, the doctor may decide to discontinue the corticosteroids.

Caution: Corticosteroid treatment should never be abruptly changed or stopped by the patient without medical advice. Dietary recommendations associated with corticosteroid treatment must be strictly followed, and prolonged treatment requires close medical supervision due to potential side effects.

Immunosuppressants

Various immunosuppressive drugs are prescribed when lupus is more active, especially when certain organs are severely affected (kidneys and brain) or when initial treatments do not provide sufficient control of the disease.

Several molecules can be used depending on the situation, including methotrexate, azathioprine, mycophenolate mofetil or cyclophosphamide.

These treatments act on the immune system and require regular medical and biological monitoring, particularly due to the risk of side effects and especially that of viral or bacterial infections.

Biotherapies and targeted therapies

The biotherapies or biopharmaceuticals used are monoclonal antibodies prescribed for severe forms of lupus that are not adequately controlled by standard treatments. Their selection, or that of another targeted therapy, requires a specialist evaluation.

Belimumab, rituximab, and anifrolumab (in cases where belimumab fails) are among the treatments that can be used in these situations. They are administered intravenously in a hospital setting according to a well-defined protocol.

The treatment of organ damage

When an organ is affected, the treatment is adapted to the nature and severity of the damage and is done in conjunction with the specialist of that organ (the nephrologist for example in the case of kidney damage).

Renal, neurological, cardiac, pulmonary or hematological involvement may therefore require a specific therapeutic strategy and multidisciplinary management.

Associated treatments and prevention measures

The management of lupus is not based solely on medications that directly control the disease.

Depending on the situation, it may also include the prevention and treatment of cardiovascular risk factors, the prevention of osteoporosis, the updating of vaccinations compatible with the treatments received, the prevention of infections and protection against ultraviolet rays.

Appropriate physical activity, smoking cessation and good adherence to treatment also contribute to the overall management.

A personalized treatment plan that is regularly reassessed

Two people with lupus may receive different treatments. The doctor adapts the treatment plan according to the progression of the disease, its activity, the organs involved, the effectiveness of the treatments, and their tolerability.

It is essential to follow the prescriptions and never stop, restart or change a treatment without talking to the medical team, even when the symptoms have disappeared.

This information sheet is for general information purposes only. It does not replace a consultation or personalized medical advice for diagnosis and follow-up.

Sources: PNDS Systemic Lupus in Adults and Children (2024) — Reference Centers / RAISE / FAI²R Network; Health Insurance. Content reviewed and validated by Professor Saïd Norou DIOP, specialist in Internal Medicine, medical advisor for TAHIRAH CARE.