Lupus is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own tissues and organs. This misdirected immune response can lead to widespread inflammation and damage across various parts of the body, including joints, skin, kidneys, and the brain. Immunotherapy represents a modern, targeted strategy for managing lupus by specifically modulating the immune system to restore balance. These advanced treatments offer new possibilities for individuals living with this complex condition.
How Immunotherapy Targets Lupus
Immunotherapy works by re-educating or rebalancing the immune system, rather than broadly suppressing it. In lupus, the immune system exhibits dysregulation, characterized by the abnormal activity of B cells, which are immune cells responsible for producing antibodies. These B cells can produce autoantibodies that target the body’s own healthy tissues, leading to inflammation and damage.
Immunotherapy intervenes in these processes at a cellular or molecular level. Some therapies reduce the number or activity of problematic B cells, decreasing autoantibody production. Other approaches target specific signaling pathways or cytokines, which are proteins that act as messengers between immune cells and contribute to inflammation. By modulating these components, immunotherapy seeks to restore immune balance and reduce the autoimmune attack.
Specific Immunotherapy Treatments for Lupus
Several immunotherapy drugs are currently used or approved for lupus, each with a distinct mechanism of action.
Belimumab
Belimumab, known as Benlysta, is a B-cell activating factor (BAFF) inhibitor. It targets a soluble protein called BLyS (B lymphocyte stimulator), involved in the survival, differentiation, and maturation of B cells. By blocking BLyS, belimumab reduces the number of abnormal B cells and autoantibody production. This medication is administered either intravenously or as a subcutaneous injection.
Anifrolumab
Anifrolumab, marketed as Saphnelo, targets the type I interferon receptor subunit 1. Type I interferons are signaling proteins often elevated in people with lupus, contributing to inflammation and disease activity. By blocking this receptor, anifrolumab inhibits downstream signaling pathways, reducing the inflammatory response. Anifrolumab is given as a 30-minute intravenous infusion once every four weeks in a medical facility.
CAR T-cell Therapy
Another emerging immunotherapy involves cell-based therapies, such as Chimeric Antigen Receptor (CAR) T-cell therapy. This experimental approach filters out a patient’s T-cells, genetically engineers them to recognize and target lupus-causing B cells, and then reinfuses them. This aims to “reset” the immune system by specifically depleting B cells. While still largely in clinical trials for lupus, this therapy has shown promise in inducing deep B-cell depletion and potentially long-lasting remission.
Beginning Immunotherapy Treatment
The decision to begin immunotherapy for lupus involves a thorough evaluation by healthcare providers. Doctors assess various factors, including disease activity, specific lupus manifestations, and history with previous treatments. This assessment helps determine if immunotherapy is a suitable option.
Initial evaluation steps include diagnostic tests to confirm the lupus diagnosis and ascertain the extent of organ involvement. These may involve blood tests for specific autoantibodies, inflammatory markers, and organ function, as well as urine tests and imaging studies. This detailed picture helps tailor the treatment plan.
During initial treatment phases, patients can expect careful monitoring for potential medication reactions. For intravenous infusions, patients receive the first few doses in a clinical setting under observation. The healthcare team provides detailed instructions on preparation for each dose, which may include pre-medications to minimize infusion-related reactions.
Managing Life with Immunotherapy
Immunotherapy for lupus aims to reduce disease flares, which are periods of increased disease activity and symptoms. Patients often experience improved quality of life as inflammation decreases and symptoms become more manageable. These treatments can also help prevent further organ damage.
Immunotherapy treatments can be associated with potential side effects. These vary depending on the specific medication but can include infusion-related reactions, infections, and other immune-related adverse events. Healthcare providers closely monitor for these side effects through regular blood tests and clinical evaluations, adjusting the treatment plan as needed.
Consistent adherence to the prescribed treatment regimen is important for long-term success. Regular follow-up appointments with the healthcare team assess treatment effectiveness, monitor for side effects, and make necessary adjustments. Open communication with doctors about any new symptoms or concerns ensures the best possible long-term management of lupus.