Lupus Treatment Options

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) reduce inflammation and are often used to manage joint or chest pain, fever and swelling. Some NSAIDs, like ibuprofen (e.g., Advil, Motrin) and naproxen (e.g, Aleve), are available over-the-counter, while others require a doctor’s prescription (e.g., celecoxib [Celebrex], diclofenac [Voltaren], and indomethacin [Indocin]). NSAIDs may be used under a doctor’s supervision, alone or in combination with other lupus treatments.

Originally developed to treat malaria, anti-malarial medications such as hydroxychloroquine (Plaquenil) have immune-modulating properties beneficial in lupus and can help relieve: muscle and joint pain; skin rashes; pericarditis (inflammation of the lining of the heart); pleuritis (inflammation of the lining of the lungs); fatigue; and fever. Hydroxychloroquine may also protect against damage to organs such as the kidneys and central nervous system (brain and spinal cord) and may significantly reduce flares.¹

1. Johns Hopkins Lupus Center. Treating Lupus with Anti-Malarial Drugs. Accessed July 21, 2025.

Corticosteroids, such as prednisone, are synthetic forms of cortisol, a hormone that suppresses inflammation. They are often used to quickly control active disease or flares. Due to their potential side effects, such as weight gain, diabetes, high blood pressure, and bone loss, doctors aim to use the lowest effective dose, often alongside other medications.

Immunosuppressants suppress overactive immune responses and are typically used in moderate to severe systemic lupus erythematosus (SLE), especially in lupus nephritis (LN)—lupus with kidney involvement—and neuropsychiatric systemic lupus erythematosus (NPSLE)—lupus with brain or spinal cord involvement. Immunosuppressants also help manage severe joint, skin, and systemic symptoms in moderate to severe SLE. 

Common immunosuppressants include: mycophenolate mofetil (CellCept) and azathioprine (Imuran), which are frequently used to preserve kidney function in LN; methotrexate (Rheumatrex, Trexall), often prescribed for joint and skin symptoms; and voclosporin (Lupkynis), which has been shown to reduce kidney inflammation and help protect kidney function.  

The U.S. FDA approved Gazyva® (obinutuzumab) from Genentech to treat active LN in combination with standard of care. Obinutuzumab is a Type II engineered humanized monoclonal antibody designed to attach to CD20, a protein found on the surface of certain types of B cells. 

The risk of side effects—including infections, liver toxicity, and other long-term complications—increases with prolonged immunosuppressive use, so careful monitoring is essential. 

Unlike traditional immunosuppressants, targeted immunomodulatory (immune-regulating) biologics are designed to act more selectively. They target specific immune pathways involved in moderate to severe SLE to help reduce inflammation and flares.

Belimumab (Benlysta) is approved for use in people aged 5 and older with active SLE or active lupus nephritis, in combination with standard therapy. It works by targeting a protein that promotes the survival of B cells. This reduces the number and activity of B cells, including autoreactive B cells that mistakenly target the body’s own tissues.

Anifrolumab-fnia (Saphnelo) is a biologic approved for adults with moderate to severe SLE who are receiving standard therapy. It works by blocking the type I interferon receptor, interfering with a key inflammatory pathway that is often overactive in lupus. Blocking this receptor helps reduce interferon-driven immune activation and inflammation affecting multiple organs.

Another biologic, rituximab (Rituxan), is sometimes used off-label for to treat refractory lupus, meaning lupus that does not respond adequately to standard therapies. While rituximab is not FDA-approved specifically for lupus, doctors might prescribe it in certain cases, particularly for severe disease.

In addition to medications for lupus itself, patients may need treatment for lupus-related health issues such as high cholesterol, high blood pressure, infections, or osteoporosis (weak, brittle bones).