Lupus is an autoimmune disease that affects an estimated 1.5 million Americans and 5 million people worldwide. Lupus symptoms include extreme fatigue, pain or swelling in the joints, headaches, mild fever, sensitivity to sunlight or fluorescent light, chest pain, hair loss, mouth and nose sores and numbness in the fingers or toes.
While there is currently no cure for lupus, various treatments for lupus have been shown to help control the symptoms, manage the immune system’s response, and prevent other ailments that can result from the disease.
Infusion therapy for lupus is an option for those who cannot tolerate oral treatment. At Heartland Infusion Pharmacy, we place a catheter into a vein to provide medication to the patient that helps alleviate lupus symptoms. An IV infusion for lupus can take around 25 minutes up to several hours, depending on the level of treatment necessary and the medication administered.
There are a number of IV therapy medications currently being used to treat
The steroid methylprednisolone (brand name Solu-Medrol) is the cornerstone of treatment and can be given both orally and intravenously, sometimes at the
same time. IV infusion is started to maintain an oral dose or to decrease an oral dose.
A patient may taper off their oral steroids, for example, and experience a small flare. In this case the physician would administer a “pulse steroid,” which is a few days of a high dose of intravenous steroid to maintain the oral dose or even
taper off the oral dose. This is done because the side effects of intravenous steroids are often more temporary than those of oral steroids.
The typical dosage is 250mg to 1,000mg per day. Often patients will receive one
gram per day for up to three days. Infusion time is one to two hours. This medication is often used in conjunction with other medications.
Cyclophosphamide (Cytoxan) is a cytotoxic agent that suppresses both red and white blood cells in the bone marrow. This medication is typically used for patients with organ disease. It is used most frequently for kidney disease and sometimes for lung and heart disease. This medication is not used for generalized lupus flares or for skin issues.
The typical dosage is 500mg to 1,000mg. Dosage is based on the patient’s body surface area, which is calculated using height and “dry” weight (the patient’s weight without the excess fluid often seen in kidney disease). Cyclophosphamide takes an hour to infuse, but the entire treatment is a longer process and takes five to six hours. Patients sometimes also receive a medication called mesna (Mesnex) to avoid cystitis, a severe irritation of the bladder that can occur with cyclophosphamide therapy.
Patients undergo cyclophosphamide therapy every three to four weeks, with the frequency of administration determined by the physician and based on the severity of the patient’s illness. Because this treatment suppresses white and red blood cell counts, lab work is usually prescribed along with administration of this medication.
Rituximab (Rituxan, Truxima)
Rituximab (Rituxan) and biosimilar rituximab-abbs (Truxima) are biologic agents
that deplete B cells (cells that produce antibodies) by binding to CD20+, a protein on the surface of certain B cells. The medication has been approved for lymphoma and rheumatoid arthritis. It is used “off label”(without FDA approval)
for lupus because B cells play a very important role in the disease. This medication has mixed results in lupus, but works for some patients.
Rituximab dosage is 1,000mg to start and at two weeks, then every 16 to 20 weeks. Rituximab infusion can take up to six hours. The first infusion lasts five hours and is titrated starting at a low rate with an increase every half hour. If a patient reacts well to the first infusion, the second infusion will begin at a higher rate.
Belimumab (Benlysta) is the first biologic agent specifically for the treatment of lupus. Belimumab acts by blocking B lymphocyte stimulator–a protein found in very high levels in lupus patients–that allows B cells to live longer. B cells cause much of the autoantibody activity seen in lupus. This medication is indicated for autoantibody-positive, active lupus patients and is not for people who have
inactive lupus. Belimumab is not approved for people with organ disease.
The dosage is 10mg per kg. Patients are given a loading dose and will have medication three times every two weeks for three doses and then once every four weeks afterwards. Benlysta takes one hour to administer.
Intravenous Immune Globulin
Intravenous immune globulin (IVIg) is immune globulin IgG derived from human plasma. How IgG works is not clearly understood. This infusion is used for people who have lupus with myositis, complaints of body aches and pains, and muscle weakness.
IVIg dosage is based on the patient’s weight. The length of infusion varies significantly (anywhere from 2 to 10 hours) and is based on the dosage (total grams) and rate, as well as how the patient reacts to the infusion. The infusion rate begins slowly and is titrated on an individual basis.
Anifrolumab-fnia (Saphnelo) is the newest intravenous medication for Lupus, approved by the FDA in 2021. Anifrolumab is a fully human monoclonal antibody. The medication works by binding to certain cytokines, Type I interferons. Type I interferons are cytokines involved in the inflammatory process. A large percentage of adults with lupus have an increase of type I interferon. Blocking these types of interferons can help to lessen disease activity. The medication is used for people with moderate to severe lupus.
The dosage is 300mg given intravenously over 30 minutes every four weeks. People being treated with anifrolumab-fnia should not receive live vaccines while on this treatment. There are other IV infused medications and supplements as well that are used to help relieve the symptoms of lupus. If you have interest in lupus treatment via
infusion therapy, please contact Heartland Infusion Pharmacy and we can answer your questions and help you begin the process with your physician of prescribing our services.