Even though the causes of lupus are usually unclear, the disease can now be treated relatively well. In addition to drugs that regulate the immune system, general accompanying measures such as physical therapies, pain treatment and lowering blood pressure can be useful. Individual treatment depends on which organs are affected and how active the disease is. Different drug therapies are used for this purpose.
The most important therapeutic elements of SLE include the antimalarials hydroxychloroquine and chloroquine. They are mainly indicated for skin and mild joint involvement. This therapy can also be considered as relapse prevention. If the activity of SLE cannot be sufficiently influenced by antimalarials and low-dose corticosteroids (cortisone), immunosuppressive therapy with azathioprine is indicated. Alternatives for immunosuppressive therapy include methotrexate (MTX) and ciclosporin (CyA).
In cases of severe organ involvement, cyclophosphamide (CYC) therapy is indicated. Randomised trials have demonstrated the superiority of cyclophosphamide therapy over steroid monotherapy in the treatment of active renal involvement. Due to the lower rate of side effects and better efficacy, intravenous bolus therapy has prevailed over peroral continuous medication. This is carried out according to the NIH protocol or Austin regimen (6 CYC boluses) or according to the EURO protocol (6 CYCBoluses at an interval of 14 days). Mycophenolate mofetil (MMF) is one of the best-studied immunosuppressants worldwide in systemic lupus erythematosus (SLE). Published studies on the efficacy of MMF in the treatment of lupus nephritis have shown comparable efficacy to i.v. cyclophosphamide. This makes MMF a less toxic alternative to CYC in a selected patient population.
Leflunomid was used effectively and safely in a prospective study in SLE patients with mild to moderate disease activity.
New therapy methods:
Belimumab
After decades, a new drug has been approved for SLE. Belimumab is the first biologic for the treatment of patients with clearly active SLE despite standard therapy. Belimumab is a drug from the group of human monoclonal antibodies and is administered intravenously (once a month) as an infusion. Belimumab is marketed under the
marketed under the name Benlysta.
Mode of action
It is likely that in lupus and certain other autoimmune diseases, elevated levels of BLyS contribute to the production of autoantibodies that attack and destroy the body's own healthy tissues. BlyS is a naturally occurring protein that is required for B lymphocytes to mature into antibody-producing plasma cells. Belimumab blocks the binding of soluble BLyS, a B cell survival factor, to its receptor on B cells. Thus, belimumab prevents the survival of these cells, including autoreactive B cells, and reduces the differentiation of B cells into immunoglobulin-producing plasma cells.
(Source: doccheck.com; deutsche-apothekerzeitung.
en)
Rituximab is a monoclonal antibody against the CD20 antigen present on B lymphocytes. By specific binding of the anti-CD20 antibody, B lymphocytes, the precursors of the autoantibody-forming plasma cells, are specifically labelled and eliminated. Initial positive reports on the use of rituximab in patients with SLE still need to be confirmed by further controlled studies.
