Immunosuppressive treatment is required. It includes a combination of high doses of glucocorticoids (prednisone) and other immunosuppressive drugs (cyclophosphamide, azathioprine, chlorambucil). Therapy is life-long. Prednisone is used at initial dosage of 1 milligrams per pound of body weight given twice daily for 10 to 14 days (induction period). After the induction period, the dosage is gradually tapered over a period of several weeks until an every-other-day regimen is achieved. Gastrointestinal ulcerations may complicate long-term administration of high doses of glucocorticoids. Dogs receiving high doses of glucocorticoids should be monitored for vomiting, diarrhea and loss of appetite. Complete blood counts are recommended every two weeks for the first few months of therapy to evaluate white blood cell and platelet counts.
Azathioprine (Imuran®) is used at a dosage of 1 milligrams per pound of body weight every day or every other day. Azathioprine can cause bone marrow suppression, liver disease and pancreatitis (inflammation of the pancreas). Bloody diarrhea also may occur in some instances. A lag phase of 6 to 8 weeks is necessary before the full effect of azathioprine is achieved.
Chlorambucil (Leukeran®) can be used in conjunction with glucocorticoids at a dosage of 0.1 milligram per pound of body weight every other day. It also has the potential for bone marrow suppression but may be safer than azathioprine. A lag phase of eight weeks is necessary before full efficacy of chlorambucil is achieved. Cyclophosphamide is another immunosuppressive drug of the same class as chlorambucil that can be used to treat systemic lupus erythematosus.
Gold salts also have been used to treat animals with immune-mediated disease. They should be avoided in dogs with kidney disease due to their potential for causing kidney damage and protein loss in the urine.
The prognosis for dogs with systemic lupus erythematosus is guarded and depends on the extent of kidney damage (glomerulonephritis) and the severity of anemia and thrombocytopenia (low platelet count). As many as 40 percent of dogs with systemic lupus erythematosus die within one year after diagnosis due either to the disease itself or to adverse effects of treatment.