Treatments
Lupus currently has no cure but there are treatments available that can control the disease. In lupus the immune system is overactive, so treatment involves calming it down. Not all medicines work for everyone. Your doctor might try a few medications to see which works best for you. They decide on a treatment for lupus by looking at the person’s symptoms, how severe the disease is, and which parts of the body are affected.
With careful treatment and monitoring, lupus can be very well controlled and people with lupus can live a healthy life.
This page will give you an overview of some of the medications used to control/treat lupus. It does not include every medication used to manage lupus and should not be taken as medical advice. You should talk to your doctor and healthcare team about what treatments might be right for you.
Immunomodulators
There are drugs that that change the way the immune system works. They don’t always suppress or boost the immune system completely but they help adjust, balance, or regulate immune activity depending on what’s needed. These include:
Anti-Malarials
Anti-malarials are used to calm the immune system. They are very safe. The most studied and commonly used anti-malarial is Hydroxychloroquine (HCQ). HCQ is proven to increase life span in people with lupus and is classified as a “disease modifying agent” in lupus. This means that it doesn’t just treat symptoms (like pain or swelling) but actually changes the course of the disease itself. HCQ might take some time to work, it usually starts helping after a month, but it may take a year for it to reach its full effectiveness. In mild disease, HCQ might be the only drug needed, but for symptoms that need to be resolved quickly like severe joint pain or profound fatigue, doctors usually prescribe steroids which work much faster. Some people may need immunosuppressants (drugs that suppress the immune system) along with HCQ depending upon the severity of the disease. HCQ is also used to treat lupus that affects the skin (cutaneous lupus). It is especially helpful when rashes or skin symptoms don’t get better with steroid creams or tablets. HCQ helps reduce inflammation and prevent new skin flares from appearing.
If you take hydroxychloroquine (HCQ), your doctor will arrange regular eye checks. This is because, in rare cases, HCQ can cause changes in the back of the eye (called the retina) after long-term use. Eye monitoring helps spot any problems early, before they affect your vision. If HCQ is not tolerated well your doctor may prescribe an alternate anti-malarial like Quinacrine or Mepacrine.
Corticosteroids
Steroids work very fast and are often used as a bridge-therapy where they quickly control lupus while waiting for other medication to take effect. People who have significant damage to their internal organs like kidneys, heart etc. due to lupus need steroids right away. Steroid ointments are often the first choice for mild-to-moderate symptoms of lupus that affects the skin (cutaneous lupus).
Steroids can be life-saving but they have a lot of side effects so it’s important to use other medicines to control lupus long-term so steroids can be stopped or reduced.. Short-term use may cause mood changes, increased appetite, fluid retention, high blood pressure, and sleep problems. When steroids are prescribed, doctors make a plan to slowly reduce the dose over time. This is because long-term use can lead to weight gain, thin skin, easy bruising, osteoporosis, muscle weakness, eye problems, and increased infection risk. Also, sudden stopping after long-term use can be dangerous, so the plan means they can stopped slowly and safely.
Immunosuppressants
As the name suggests, immunosuppressants suppress the body’s defence system (immune system) to prevent it from attacking healthy tissues. Examples include Methotrexate, Azathioprine, Mycophenolate Mofetil, Cyclophosphamide. Immunosuppressants can suppress the immune system, so they increase the risk of infection. They are usually used to control moderate to severe disease when anti-malarials alone are not enough.
Biologic Therapies
These medicines target specific parts of the immune system to control SLE. In addition to SLE, biologics can also be used to treat cutaneous lupus.
Biologics can be given directly into a vein over a period of time (IV infusion) or injected under the skin (subcutaneous Injection). Common side effects include fever, chills, rash, itching, headache, or feeling tired, especially during or right after the infusion (infusion reaction). Because biologics can lower B cells, they can increase the risk of bacterial, viral, or fungal infections.
Rituximab is a commonly used biologic in SLE. It works by targeting a protein which is found on certain white blood cells called B cells. The overall result is that the number of B cells in the body drops for a while. This helps lower inflammation and reduce harmful antibodies.
Another biologic used for SLE is belimumab. Belimumab is a medicine that blocks a protein called BLyS, which helps B cells survive. By blocking BLyS, it lowers the number of B cells that make harmful antibodies, helping to control lupus.
Voclosporin
Voclosporin is a treatment specifically for lupus of the kidneys (lupus nephritis). It works by blocking the function of calcineurin, a protein involved in activating white blood cells, an essential part of the body’s immune system. Like other treatments, it helps to stop the immune system from attacking the body’s own tissues.
Other Medications
Not all problems in lupus are caused by active inflammation, and these issues often need treatments beyond immunomodulating medicines.
- Blood flow issues: For example, some people with SLE have Raynaud’s phenomenon which causes poor blood flow to fingers and toes in response to cold or stress. Drugs that open blood vessels may be needed to improve circulation.
- Blood clots: Some people with SLE develop antiphospholipid syndrome (APS) due to specific antibodies, which increases the risk of clots. Blood thinners such as warfarin are used to treat clots. For patients who have antibodies but have never had a clot, aspirin may be prescribed to prevent them.
- Dryness (Sjogren’s disease): Between 30% (3 in10) and 50% (5 in 10) people with lupus also have Sjogren’s, which causes dryness in the eyes and mouth. Medications to increase fluid production may help.
- Pain management: Drugs like ibuprofen are commonly used for pain relief.
Managing drug side effects:
- For patients taking methotrexate, folic acid is recommended to reduce the risk of low blood counts.
- Pain killers like non-steroidal anti-inflammatory drugs (NSAIDs) and steroids can cause stomach upset, heartburn, or ulcers; doctors may prescribe medications to protect the stomach.
- Steroid-related bone problems: Long-term steroid use can cause osteoporosis, making bones weak and brittle. To prevent this, doctors may recommend calcium and vitamin D supplements and sometimes a medication called a bisphosphonate to keep bones strong.
Last updated: December 2025
