Lupus is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissues and organs, causing inflammation and damage. Traditional treatments, like broad immunosuppressants, often had significant side effects and limited relief. Biologics offer a more precise, targeted approach to managing lupus symptoms and improving patient outcomes.
How Lupus Biologics Work
Biologics are medications derived from living organisms, not synthesized chemically. Unlike traditional drugs that act broadly, biologics target specific components of the immune system involved in autoimmune diseases like lupus. They identify and neutralize particular proteins, cells, or signaling pathways that contribute to the misguided immune response, slowing inflammatory processes and preventing tissue damage.
Think of it like a highly specialized key fitting into a specific lock. In lupus, the immune system produces excess inflammatory proteins or overactive immune cells. Biologics bind to these problematic elements, blocking their activity and preventing harm. This precision allows for a more personalized treatment approach, aiming to reduce symptoms with potentially fewer widespread side effects.
Specific Biologic Therapies for Lupus
Currently, two biologics are approved by the FDA specifically for lupus: belimumab (Benlysta) and anifrolumab (Saphnelo). Rituximab (Rituxan) is also sometimes used off-label.
Belimumab
Belimumab is a human monoclonal antibody that targets and inhibits B-lymphocyte stimulator (BLyS), also known as BAFF. BLyS is a protein that supports the survival and function of B cells, which produce autoantibodies in lupus. By binding to BLyS, belimumab prevents its interaction with B-cell receptors, reducing the activation and survival of autoreactive B cells and lowering autoantibody production. Belimumab can be administered either intravenously (IV infusion) or as a subcutaneous (under-the-skin) injection. For intravenous administration, it is typically given at a dose of 10 mg/kg on days 0, 14, and 28, then every 28 days thereafter. Subcutaneous injections are usually 200 mg weekly.
Anifrolumab
Anifrolumab is a monoclonal antibody that targets the type I interferon receptor subunit 1 (IFNAR1). Type I interferons, like IFN-α, are often elevated in lupus patients and drive inflammatory processes. By blocking IFNAR1, anifrolumab inhibits type I interferon signaling, reducing the activation and proliferation of immune cells and decreasing inflammatory cytokine production. Anifrolumab is administered as an intravenous infusion, typically 300 mg every four weeks.
Rituximab
Rituximab is a chimeric human/murine monoclonal antibody that targets the CD20 protein on B cells. By binding to CD20, rituximab depletes CD20+ B cells involved in the autoimmune response. Although clinical trials for rituximab in lupus have had mixed results, it is sometimes prescribed off-label, particularly for skin-related symptoms. Rituximab is given as an intravenous infusion in a medical office.
Receiving Biologic Treatment
Starting biologic therapy for lupus involves several practical considerations. Biologics are typically considered for adults with moderate to severe lupus whose disease is not adequately controlled by conventional treatments. They are generally not the first-choice option.
Before initiating biologic treatment, patients undergo a thorough pre-treatment screening. This includes blood tests and screening for infections such as tuberculosis (TB) and Hepatitis B, as biologics can increase the risk of infection. The healthcare team reviews patient medical history and test results to ensure the treatment is suitable.
The initial administration usually involves an intravenous infusion in a medical office or clinic, though some biologics like belimumab also have a subcutaneous option for self-administration at home. During the infusion, healthcare providers monitor the patient for any immediate reactions. Common side effects include increased risk of infections, such as respiratory infections and herpes zoster, and infusion-related reactions. Other potential side effects might include headache, nausea, fatigue, and injection site reactions if administered subcutaneously. Healthcare providers monitor for these potential risks throughout the treatment course.
Living with Biologic Treatment
Patients on biologic treatment can anticipate improvements in their lupus symptoms and better overall disease management. While individual responses vary, some patients may experience reduced disease activity and fewer symptom flare-ups. For instance, patients on anifrolumab have reported symptom improvement within weeks and a reduction in the need for oral steroids.
Ongoing monitoring by healthcare providers is a regular part of living with biologic treatment. This involves regular appointments to assess disease activity, monitor for potential long-term side effects, and adjust treatment as needed. Patients are advised to avoid live vaccines while on therapy, as biologics can impact the immune system. The outlook for individuals on these therapies is generally positive, with biologics contributing to an improved quality of life.