Medications for Lupus
Lupus can affect the body in many different ways. There are many different medications used to address these different symptoms and problems.
This website provides an overview of the different types of medications, their uses, and most common side effects: www.lupus.org/resources/medications-used-to-treat-lupus
Hydroxychloroquine (Plaquenil): a prescription drug used to treat the symptoms of malaria, rheumatoid arthritis, and lupus.
Steroids (also known as prednisone or methylprednisolone) are a common medication used to treat inflammation from Lupus. They are fast acting and effective options to reduce symptoms and prevent damage caused by lupus. It is important to balance the benefits of these medications with their side effects. Steroids are associated with an increased risk of infection, weight gain, bruising, stretch marks, high blood pressure, osteoporosis (thin bones), depression, glaucoma (high eye pressure) and cataracts.
Azathioprine (Imuran): this is a drug that is given to treat lupus and may also be given when someone receives a kidney transplant. This is an immunosuppressant drug, meaning it suppresses the immune system. It works by reducing DNA replication to decrease the number of immune cells that can attack the body, resulting in less inflammation.
Methotrexate (Rheumatrex): used in the treatment of inflammatory arthritis and autoimmune disease, including rheumatoid arthritis, lupus and others. Methotrexate blocks DNA generation to reduce cell replication which is thought to reduce the proliferation of overactive immune cells.
Mycophenolate mofetil (Cellcept) and mycophenolate sodium (Myfortic): these are immunosuppressant drugs that reduce the production of T and B cells to reduce inflammation caused by autoimmune disease and are also given after an organ transplant to reduce organ rejection.
Cyclosporin (Neoral, Restasis): this is a medicine that is used to reduce inflammation from autoimmunity or to prevent the body from rejecting a transplanted organ. Oral cyclosporine may be used to treat autoimmune kidney disease or some types of blood disorders. Eye drops of cyclosporin (Restasis) are used to treat dry eye from inflammation (keratoconjunctivitis sicca).
Cyclophosphamide (Cytoxan): this is a chemotherapy and immunosuppressive drug used to treat severe lupus, cancer and other conditions.
Voclosporin (Lupkynis): an oral drug used to treat lupus nephritis. Volclosporin blocks a protein called calcineurin which then reduces the activation of T cells, stopping them from causing inflammation in the kidneys.
- Belimumab (Benlysta): a treatment for lupus and lupus nephritis. It is a monoclonal antibody that reduces the survival of B cells. It is given as a subcutaneous injection (under the skin) or an intravenous infusion (into the vein). It can reduce arthritis, mouth sores, rash and kidney disease related to lupus inflammation. It can reduce the risk of severe lupus flares and reduce the dose of steroids.
- Anifrolumab-fnia (Saphnelo): a monoclonal antibody infusion therapy for moderate to severe lupus that can improve overall disease activity, skin rash, arthritis and help reduce steroid doses. Anifrolumab reduces the activity of type 1 interferon signaling which reduces overactive immune function in some lupus patients.
- Rituximab: an infusion monoclonal antibody medication that reduces B-cells and is used to treat certain autoimmune conditions, such as hemolytic anemia, rheumatoid arthritis and vasculitis.
Many vaccinations are recommended for people with lupus. Some vaccines work best if given before immunosuppressive drugs are started. Others may need to be timed in a certain way with your medications, but many are safe and effective in lupus patients even when on therapy.
Safe vaccines include:
- The flu shot (ask for the injection and avoid the nasal spray)
- Pneumonia vaccine
- Human papillomavirus (HPV) vaccine
- Tetanus, diphtheria and acellular pertussis Td/Tdap) vaccine
- Shingrix, the non-live recombinant herpes zoster (Shingles) vaccine
- COVID-19 vaccinations
- The American College of Rheumatology recommends that immunocompromised people receive mRNA vaccines instead of the Johnson & Johnson vaccine.
- Data has shown the risk of triggering a lupus flare from the vaccine is very low.
- Most people with lupus gain good protection from the vaccine, although those taking very high doses of steroids or rituximab may gain less protection.
- See https://www.lupus.org/resources/covid19-vaccine-and-lupus for up to date information on COVID-19 vaccines for people with lupus.
Live vaccines may be harmful to people who are immunosuppressed. These include:
- The flu nasal spray
- Zostavax, the live herpes zoster (Shingles) vaccine
- Varicella (chickenpox) vaccine
- Measles, mumps and rubella (MMR) vaccine
Talk to your doctor about what vaccines are recommended for you.