Lupus, also known as Systemic Lupus Erythematosus (SLE)

 Lupus, also known as Systemic Lupus Erythematosus (SLE), is a chronic autoimmune disease in which the immune system attacks healthy tissues, causing inflammation, pain, and damage to various organs. Lupus can affect the skin, joints, kidneys, brain, heart, and lungs. The exact cause of lupus is unknown, but it is believed to involve a combination of genetic, hormonal, and environmental factors. Common symptoms include fatigue, joint pain, skin rashes (particularly a butterfly-shaped rash on the face), and sensitivity to sunlight.

Medicines Used in the Treatment of Lupus (India)

Lupus treatment usually involves managing symptoms, controlling inflammation, and preventing flare-ups. There is no cure for lupus, but various medications help manage the condition and prevent complications. Below is a list of commonly used medications in the treatment of lupus, their mechanism of action, and brand names available in India.

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1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Mechanism of Action: NSAIDs inhibit the enzyme cyclooxygenase (COX), which is involved in the production of prostaglandins—substances that mediate inflammation and pain. By reducing prostaglandin levels, NSAIDs help to relieve pain and inflammation in lupus.
• Common Drugs:
  • Ibuprofen
  • Naproxen
• Brand Names in India:
  • Ibuprofen:
    • Brufen, Ibugesic
  • Naproxen:
    • Naprosyn, Napra

2. Corticosteroids

• Mechanism of Action: Corticosteroids are potent anti-inflammatory agents that suppress the immune system and reduce inflammation by inhibiting the release of inflammatory mediators. They are used to control acute lupus flares and reduce long-term organ damage.
• Common Drugs:
  • Prednisolone
  • Methylprednisolone
• Brand Names in India:
  • Prednisolone:
    • Wysolone, Omnacortil
  • Methylprednisolone:
    • Medrol, Solu-Medrol

3. Antimalarial Drugs

• Mechanism of Action: Antimalarial drugs, such as hydroxychloroquine, modulate the immune system and reduce inflammation. They help control lupus symptoms like fatigue, joint pain, and skin rashes and prevent flare-ups by affecting antigen presentation and decreasing the production of inflammatory cytokines.
• Common Drugs:
  • Hydroxychloroquine
• Brand Names in India:
  • Hydroxychloroquine:
    • HCQS, Plaquenil

4. Immunosuppressive Drugs (DMARDs - Disease-Modifying Antirheumatic Drugs)

• Mechanism of Action: Immunosuppressants reduce the activity of the immune system, preventing it from attacking healthy tissues. They are used in more severe cases of lupus or when major organs are affected.
• Common Drugs:
  • Methotrexate (inhibits DNA synthesis and decreases immune system activity)
  • Azathioprine (interferes with purine synthesis and T-cell activity)
  • Mycophenolate Mofetil (inhibits lymphocyte proliferation)
  • Cyclophosphamide (alkylating agent that suppresses immune response)
• Brand Names in India:
  • Methotrexate:
    • Trexate, Folitrax
  • Azathioprine:
    • Imuran, Azoran
  • Mycophenolate Mofetil:
    • Cellcept, Mycept
  • Cyclophosphamide:
    • Endoxan, Cyclophil

5. Biologic Therapies (Targeted Immunotherapies)

• Mechanism of Action: Biologic agents target specific components of the immune system, such as B cells, which play a role in lupus. These drugs are often used in severe cases of lupus that do not respond to conventional treatments.
• Common Drugs:
  • Belimumab (targets and inhibits B-cell activating factor, reducing the survival of B cells)
  • Rituximab (targets CD20 on B cells, leading to B-cell depletion)
• Brand Names in India:
  • Belimumab:
    • Benlysta (available in select markets)
  • Rituximab:
    • Rituxan, MabThera, Reditux

6. Calcineurin Inhibitors

• Mechanism of Action: Calcineurin inhibitors reduce the activity of T cells, which are involved in autoimmune attacks in lupus. These drugs are used for lupus nephritis (kidney involvement).
• Common Drugs:
  • Tacrolimus
• Brand Names in India:
  • Tacrolimus:
    • Tacroz, Prograf

7. Other Immunosuppressive Agents

• Mechanism of Action: These agents modulate the immune response, often used in cases of organ involvement or severe lupus.
• Common Drugs:
  • Cyclophosphamide (used in severe cases, especially with kidney involvement)
• Brand Names in India:
  • Cyclophosphamide:
    • Endoxan

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Lifestyle and Supportive Therapies

• Calcium and Vitamin D: Long-term corticosteroid use can cause bone loss, so supplements of calcium and vitamin D are often recommended.
• Sun Protection: Lupus patients are highly sensitive to sunlight, and sun protection with SPF creams and protective clothing is essential.
• Physical Therapy and Exercise: Regular exercise can help reduce joint stiffness and improve overall health.

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Conclusion

Lupus is a chronic autoimmune disease that requires long-term management with a combination of medications to control symptoms, prevent organ damage, and manage flare-ups. The main classes of drugs used include NSAIDs, corticosteroids, antimalarials, immunosuppressants, and biologics. In India, these medications are available under various brand names, and treatment is tailored to each patient’s needs based on the severity of their condition and organ involvement.