Medication	Indication	Dosage	Monitoring and precautions	Cost*
First-line treatment
Glucocorticoids	Low dose for treating SLE without major organ damage; high dose for cerebritis, lupus nephritis, refractory conditions, and thrombocytopenia	Low dose: ≤ 7.5 mg of prednisone per day High dose: 40 to 60 mg of prednisone per day	Glucose levels every three to six months and total cholesterol and bone density testing annually; use with caution in patients with hyperlipidemia, hypertension, hyperglycemia, infection, or osteoporosis	$5 (—) for 30 10-mg prednisone tablets; $7 (—) for 60 20-mg prednisone tablets
Hydroxychloroquine	Recommended for all patients with SLE; long-term protective effect on SLE-related organ damage	5 mg per kg of body weight per day (200 to 400 mg per day)	Baseline funduscopic examination, visual field testing, and spectral-domain optical coherence tomography should be performed at the time of initiation; annual screening is performed in those at high risk but can be deferred to every five years in low-risk patients at the time of initiation, then annually	$6 (—) for 30 200-mg tablets
Nonsteroidal anti-inflammatory drugs	Lupus joint pain	Depends on preparation	Complete blood count and renal testing annually; use with caution in patients with gastrointestinal bleeding, liver or kidney disease, or hypertension	Depends on preparation
Second-line treatment
Azathioprine	Lupus nephritis, severe SLE	1.5 to 2.5 mg per kg per day	Complete blood count and metabolic panel at least every three months to monitor for hepatotoxicity, lymphoproliferative disorders, and myelosuppression	$15 (—) for 60 50-mg tablets
Methotrexate	Arthritis, cutaneous lupus, serositis, severe SLE	7.5 to 25 mg per week	Complete blood count and metabolic panel at least every three months to monitor for hepatic fibrosis or myelosuppression; additional monitoring for fibrosis and pulmonary infiltrates	$3 (—) for 12 2.5-mg tablets
Third-line treatment
Anifrolumab (Saphnelo)	Moderate and severe SLE, lupus nephritis	300 mg every four weeks administered via intravenous infusion	Monitor for respiratory tract infections and hypersensitivity	Only administered by a health care professional
Belimumab (Benlysta)	SLE	10 mg per kg per intravenous dose 200 mg subcutaneously once per week	Monitor for serious infection and malignancies	Only available at specialty pharmacies
Cyclophosphamide	Lupus nephritis, severe SLE	500 to 1,000 mg per m2 intravenously once per month	Complete blood count and metabolic panel at least every three months to monitor for hemorrhagic cystitis, immunosuppression, malignancy, and myelosuppression	Only administered by a health care professional
Mycophenolate mofetil	Lupus nephritis, refractory SLE	2 to 3 g per day	Complete blood count and metabolic panel at least every three months to monitor for infection and myelosuppression	$30 (—) for 240 250-mg capsules
Rituximab (Rituxan)	Refractory severe SLE	One-time administration of two 1-g doses intravenously, two weeks apart	Complete blood count every two to four months; use with caution in patients with a history of infusion reaction	Only available at specialty pharmacies
Voclosporin (Lupkynis)	Lupus nephritis	23.7 mg orally every 12 hours	Establish baseline estimated glomerular filtration rate prior to initiating, then every two weeks for the first month and every four weeks thereafter; monitor blood pressure every two weeks	Only available at specialty pharmacies