Refractory Lupus: A Different Approach

Some people with lupus don’t find relief from their symptoms with normal treatment. This is known as Refractory Lupus, and it requires a different approach.

Lupus treatments have come to a point where long-term survival and even remission is possible. However, many people don’t respond or find their symptoms reduced by the “gold standard” of lupus treatments for lupus. You can read more about lupus medications here. This includes glucocorticoids  such as prednisone, hydroxychloroquine, immunosuppressives, antimalarials, and certain anticancer drugs. This condition is known as Refractory Lupus. 

While uncommon, there are still many people who struggle with refractory and resistant lupus. In a study looking at 257 patients with systemic lupus erythematosis, about 6.2% of people being treated for lupus had refractory lupus, defined as not having improvement of symptoms even after intensive treatment. 

Lupus nephritis and systemic lupus, and neuromyelitis optica can all develop into refractory lupus. A good diet, good exercise, and a healthy lifestyle that avoids tobacco and alcohol can help, but researchers are developing alternatives to the gold standard medical treatment to relieve the symptoms further. 

Currently, researchers are looking at biologics and other therapies, such as mesencymal stromal cell or hematopoietic therapy, as potential treatments for refractory lupus.

Biologics for Refractory Lupus

Biologics are relatively new therapies that target the specific parts of the immune system that go haywire in lupus. They are produced by laboratory-modified cells to help people take control of their immune system. They are made from modified forms of immune system particles, such as antibodies, that are found naturally in the body. Some biologics mark autoimmune cells for destruction, others block cytokines, the signals that set off the overactive immune system. B cell-targeted therapies in particular have a lot of potential for people with refractory lupus.

Biologics are very precise and effective but also require people to go to the hospital and get an infusion or find a trained medical caretaker to help them with the injections. That makes them something of a burden for the patient.

Rituximab for Refractory Lupus?

Rituximab is one such a promising therapy for reducing symptoms in refractory lupus. Rituximab is a biologic drug that is often perscribed as a chemotherapy to combat non-Hodgkin’s lymphoma (which is a cancer that affects the white blood cells,) and rheumatoid arthritis. 

Researchers looked at 26 papers and compared the results of a total of 300 patients with an average follow up time of 60 weeks. Those who took B-cell ablation with the chimeric anti-CD20 antibody rituximab (RTX) had reduced symptoms of refractory lupus nephritis, and a few even entered remission. 

The side effects are fairly mild and are mostly because the medication is delivered via infusion, which can be stressful for the body. However, these symptoms can include fever, shaking, chills, tiredness, headache, or nausea

A Lupus Warrior’s Takeaway

Most biologics are currently not commonly available, unfortunately: Rituximab, calcineurin inhibitors, and other biologics (such as belimumab) are presently in the midst of some very promising clinical trials. It will take a few years for these trials to conclude and the researchers to have enough data to ensure that the side effects are acceptable.