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A background treatment is a treatment that will act on the immune system and lead to a modification of the evolution of the lupus disease in the long term. It is therefore possible to bring into this category many drugs with only one thing in common: to modify the natural evolution of the disease.
Hydroxychloroquine / Chloroquine
These drugs belong to the class of synthetic antimalarials. These are very important drugs for the treatment of lupus. Their mechanism of action is poorly understood, but it is thought that it intervenes at several levels of the immune response to modulate it.
Cortisone is a drug used to fight inflammation during the flare. It is also a treatment that can modify the activity of certain immune cells, such as lymphocytes, and thus reduce the signs of lupus activity. As such, it is therefore also a substantive treatment. However, you should avoid taking it in the long-term and your doctor will try to wean you off.
They aim to reduce the immune hyperactivity observed during lupus and to limit the doses of corticosteroids administered ("cortisone sparing").
The main immunosuppressants used during lupus are:
- mycophenolate mofetil and its close relative mycophenolic acid
Methotrexate is mainly used in severe joint damage and some skin forms.
Azathioprine, cyclophosphamide and mycophenolic acid are prescribed in lupus with severe visceral involvement (kidney damage, neurological damage).
The "new" immunomodulators called biologics
A biotherapy (or biologic agent) is a drug that will act on a very precise "biological" target, that is chosen because it intervenes in the mechanisms involved in autoimmune diseases.
Belimumab is a venous biotherapy that has a marketing authorisation (MA) which is used when systemic lupus remains very active despite standard treatment. The subcutaneous route is also available. Belimumab can also be used in cases of proliferative kidney damage and in children from 5 years of age. This biotherapy is a monoclonal antibody that targets a protein named Blys. This protein plays a role in the development of B lymphocytes.
Rituximab is another targeted biotherapy against B lymphocytes, which can sometimes be used in the treatment of some severe forms of lupus.
Anifrolumab is a monoclonal antibody directed against type I interferon receptors. It modulates the often increased interferon response in systemic lupus. It is indicated as an add-on therapy for the treatment of adult patients with moderate to severe, active autoantibody-positive systemic lupus erythematosus (SLE), despite receiving standard therapy.