A New Era for the Treatment of Lupus

While the last few years have been difficult with the COVID-19 pandemic, there have been great leaps in the advancement of the care of patients with lupus. In 2020 and 2021, two new drugs (anifrolumab and voclosporin) were approved for the treatment of lupus or lupus nephritis; and a third one, belimumab (previously approved for the treatment of lupus), was approved for the treatment of lupus nephritis.

Anifrolumab (Saphnelo)

Anifrolumab was approved by the FDA in 2021 for the treatment of adult patients with moderate or severe systemic lupus erythematosus. Currently, Anifrolumab is not approved for the treatment of lupus nephritis or lupus affecting the central nervous system. Anifrolumab is used in combination with other drugs, such as hydroxychloroquine and glucocorticoids (steroids). It works by blocking molecules that can trigger the immune system to attack different parts of the body.

Anifrolumab is given as an infusion. Infusions are administered through a needle that is inserted into a vein by a healthcare professional. The infusions last for 30 mins and must be repeated every 4 weeks.

Anifrolumab has shown improvement in lupus affecting the skin and the joints (arthritis). Anifrolumab can cause side effects, but most of them are mild, such as colds or bronchitis. We do not know if anifrolumab is safe to use during pregnancy.

This drug is now being tested to see if it’s effective in the treatment of lupus nephritis (kidney inflammation due to lupus).

Voclosporin (Lupkynis)

Voclosporin was approved by the FDA in 2021 for the treatment of adult patients with active lupus nephritis (kidney inflammation due to lupus). Voclosporin is used in combination with other drugs, including hydroxychloroquine (Plaquenil), glucocorticoids (steroids), and mycophenolate mofetil (CellCept). This new medication is an immunosuppressant, a type of drug that decreases the strength of the immune system. In clinical trials, patients receiving voclosporin were twice as likely to respond favorably to treatment (decreased kidney inflammation) than those who did not receive voclosporin.

Voclosporin is a capsule taken twice a day (up to six capsules). Similar to other medications that decrease the strength of the immune system, infections are not an unusual side effect.

Voclosporin can increase blood pressure and cause kidney problems. Prolonged use of voclosporin may increase the risk of some cancers, such as lymphoma and skin cancers.

Belimumab (Benlysta)

Belimumab was initially approved in March of 2011 for the treatment of lupus (after decades without new FDA-approved drugs), and in December of 2020 received a new approval: lupus nephritis. Belimumab is used in combination with other drugs such as hydroxychloroquine (Plaquenil) and mycophenolate mofetil (CellCept).

Belimumab can be given as an infusion or as a self-injection. When given as an infusion, the medication is administered through a needle inserted in a vein. These infusions last for one hour and are repeated every four weeks. The self-injection form is injected under the skin every week. Belimumab’s most common side effects include nausea, headaches, muscle aches, and infections like colds. Rarely, it can also cause patients to have a low mood. Overall, these new drugs provide new hope in the treatment of lupus and lupus nephritis and the pipeline of new treatments for lupus remains strong. We may be entering a new era in the treatment of lupus. If you have lupus, you may want to discuss these new treatment options with your rheumatologist.