As we all know, there is no one treatment ([n]or cure) for lupus. How many times have you been asked, “So, there is no cure for that?”. OR how about that frustrated question from your love one as you are unable to move out of bed, “Aren’t you suppose to be getting better by now?” HOW DO YOU RESPOND TO THAT?!? We have all been playing the worst waiting game… Waiting for the right treatment to make us feel an ounce better; Waiting for our quality of life to get back to how it used to be; Waiting to start living our life again.
…Just waiting…
Lupus requires a trial and error of finding the right medication(s) to help you get to that magical state of “remission”… or at least to a state where you do not feel limited. Yesterday, I had my 11th infusion of Benlysta (I will be hitting the one-year mark in December). In addition to my infusion, I had my monthly visit with Dr. Lupus. While I was waiting for him, I was flipping through his collections of throw-away magazines in the room. I grabbed one and stumbled onto a full-spread advertisement for Benlysta. It featured a happy-looking woman enjoying some social time with family and friends with the phrase: “I am fighting lupus with Benlysta.” I chuckled to myself and threw the magazine (in a passive aggressive manner) back onto the pile. I have been on this magical Benlysta for almost a year… and yet I am still waiting for a better outcome. Yes, I have felt better from 2 years ago… but I have had more than my share of lupus flares and hospital visits. Feeling my frustrations, my doctor agreed that Benlysta-alone was not doing the trick— I have had 2 lupus-related hospital visits in the month of September, become a pill-popper to minimize the pain, and was sitting in front of the man with a temperature of 99.4 degrees. My doctor and I came to a shared decision to a new combination of Benlysta, prednisone and Imuran (azathioprine). This new combo will be sixth attempt to find lupus-relief.
Here is my lupus medication history.
MY TRIAL AND ERROR
Trial #1: Plaquenil (hydroxychloroquine) + Prednisone (duration ~8 months): It takes about 6 months for the effects of this anti-malaria to kick in. Before I can even get this pill in my hands, I had to get an approval from an opthamologist . Why? Because there is small risk (no more than 4% in unmonitored patients) of blindness. Pretty severe adverse effect, eh?
Error: Major muscle weakness. I found myself saying to my doctors, “I feel like my body is too heavy for my legs”.
Trial #2: Methotrexate + Prednisone (duration: ~4 months): I first started by taking the pill-form but had to switch to the injections to alleviate nausea often associated by ingesting the pills.
Error: Respiratory problems, an adverse effect of methotrexate. Saravanan and Kelly (Rheumatology 2006) stated: “As patients become less limited by their joint disease due to treatment, an increasing number report breathlessness as a result of respiratory involvement.” Keep in mind, fans, that I have asthma; so this put me at higher risk.
Trial #3: Benlysta + Prednisone (duration: ~2 months): I have previously talked about my journey with Benlysta. Go ahead… take a look at the past posts.
Error: It was not doing the trick.
Trial #4: Benlysta + Methotrexate + Prednisone (duration: ~3 months): I have talked about this as well. Go ahead… take a look. 🙂
Error: Overall, feeling of still-feeling-shitty and the respiratory problems. I felt like I had the flu. After this, it became very clear that methotrexate was not for me. Oddly enough, after I was taken off of methotrexate, I ended up in the hospital for heart and asthma problems. My pulmonologist explained that methotrexate was giving me some protective factor against asthma, and once I had given it up my air sacs decided to act up!
Trial #5: Back to Benlysta + Prednisone
Error: Still feeling shitty
Trial #6: Benlysta + Prednisone + Imuran
Before taking Imuran, your doc will run a genetic test. This is to determine if Imuran is the right drug for you. Certain risks that are associated with this drug are greater in those who have a specific genetic disorder. Your doctor will perform genetic testing prior to starting therapy to determine your risk.
I will keep you posted on my treatment journey… I am crossing my fingers that I will soon finish this damn “trial and error” phase of lupus.
For more info on lupus treatments, check out these two links from:
Stay Fabulous!
divawithlupus 
Hope 6 is the magic # for you!
Thank you sister!
I hope trial 6 is the lucky winner! Feel better soon!!!
I’m curious… what this genetic test to see if imuran is right for you? I just tried imuran and had a bad reaction to it. But I wasn’t given a test before hand… nor was I aware of such a test…
Thanks dear friend. Similar to other drugs, azathioprine has been shown to be effective, but there are concerns about the development of major adverse drug reactions. The risk of developing an adverse reaction can be predicted by doing a simple genetic testing. Without getting too geeky, the genetic testing screens the patients who would be more at-risk of developing azathioprine-induced adverse effects, including serious ones like bone marrow suppression or neutropenia (abnormally low white blood cell count). But like all testing, not everything is 100% valid- but the literature shows that the testing has some good predictive value. I hope this helps!
I just stumbled on your blog while perusing lupusny.org’s website, and I have to say it’s so refreshing to read that I’m not the only one going through lupus drug trial and errors! I’m currently on the prednisone+plaquinil+benlysta+imuran bandwagon. I’m still waiting on results, but will have my 4th Benlysta infusion soon. I just added the imuran last week. I’ve learned not to hold my breath for positive outcomes! Thanks for being a breath of fresh air when it comes to battling lupus.
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