Condition

Lupus

Systemic autoimmune disease affecting multiple organs

5M
People Affected
15
Active Trials
400K
New Cases/Year
5,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Prednisone
90% Effectiveness• 95% Confidence• 45% Safety• 56 trials• 75K participants
HIGH EvidenceGood ValueDose: 5-60 mg daily, tapering
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
45
DangerousModerateSafe

Time to Effect

Hours to days

Duration

Weeks for acute flares, lifetime for chronic low-dose

Response Rate

85%

Remission Rate

%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

8

Common Side Effects:

Weight gain, fluid retention: 60%
Mood changes, insomnia: 40%
Increased infection risk: 30%
Osteoporosis, diabetes, hypertension (long-term): 20%

Annual Cost of Care

Drug Cost

$75

Monitoring

$600

Side Effects

$750

Total Annual

$1,425

Cost-Effectiveness

GOOD

QALYs Gained

0.5

Cost per Responder

$1,676

Treatment Outcomes
Primary Outcomes
SLEDAI-2K Score10 points (0-105 scale)
-45% (-4.5 points)
Anti-dsDNA Antibody Levels200 IU/mL
-40% (-80 IU/mL)
Erythrocyte Sedimentation Rate (ESR)40 mm/hr
-40% (-16 mm/hr)
C-reactive Protein (CRP)15 mg/L
-60% (-9 mg/L)
Joint Pain (VAS Scale)7/10 on VAS Scale
-50% (-3.5 points)
Secondary Benefits
Fatigue (FACIT-Fatigue Scale)20/52 points (lower score = more fatigue)
+40% (+8 points)
Health-Related Quality of Life (SF-36 Physical Component Summary)35 points (0-100 scale, higher is better)
+14% (+5 points)
Complement C3 Levels70 mg/dL
+25% (+17.5 mg/dL)
Common Side Effects
Weight gain, fluid retention
+60%
Mood changes, insomnia
+40%
Increased infection risk
+30%

Clinical Trial Phases:

Phase 4
2
Voclosporin
88% Effectiveness• 85% Confidence• 35% Safety• 10 trials• 1.2K participants
HIGH EvidencePoor ValueDose: 23.7 mg twice daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
35
DangerousModerateSafe

Time to Effect

3-6 months

Duration

1-2 years induction, then maintenance

Response Rate

45%

Remission Rate

%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

8

Common Side Effects:

Hypertension: 40%
Kidney function impairment (elevated creatinine): 25%
Headache: 25%
Increased infection risk: 15%

Annual Cost of Care

Drug Cost

$90,000

Monitoring

$1,200

Side Effects

$700

Total Annual

$91,900

Cost-Effectiveness

POOR

QALYs Gained

1

ICER

$255,000/QALY

Cost per Responder

$204,222

Treatment Outcomes
Primary Outcomes
Urinary Protein Creatinine Ratio (UPCR)2.5 mg/mg
-45% (-1.1 mg/mg)
Complete Renal Response Rate (vs. Placebo)22.5% (Placebo Response Rate)
+80% (+18.3% (absolute difference in response rate))
SLE Disease Activity Index 2K (SLEDAI-2K)10 points
-20% (-2 points)
Daily Oral Corticosteroid Dose15 mg Prednisone equivalent
-50% (-7.5 mg Prednisone equivalent)
Secondary Benefits
Anti-dsDNA Antibodies250 IU/mL
-30% (-75 IU/mL)
Complement C3 Levels0.6 g/L
+25% (+0.15 g/L)
Fatigue Assessment Scale (FAS) Score20/30
-10% (-2 points)
Common Side Effects
Hypertension
+40%
Kidney function impairment (elevated creatinine)
+25%
Headache
+25%

Clinical Trial Phases:

Phase 3Phase 4
3
Hydroxychloroquine
85% Effectiveness• 90% Confidence• 65% Safety• 38 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 200-400 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Lifetime

Response Rate

60%

Remission Rate

25%

Number Needed to Harm (NNH)

2500

Common Side Effects:

Nausea, diarrhea: 15%
Headache: 10%
Skin rash: 7%
Retinal toxicity (rare): 0.5%

Annual Cost of Care

Drug Cost

$200

Monitoring

$400

Side Effects

$100

Total Annual

$700

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$15,000/QALY

Cost per Remission

$2,800

Cost per Responder

$1,167

Treatment Outcomes
Primary Outcomes
SLEDAI-2K Score (Systemic Lupus Erythematosus Disease Activity Index 2000)8/105 points
-31.25% (-2.5 points)
Daily Oral Corticosteroid Dose (Prednisone equivalent)10 mg/day
-25% (-2.5 mg/day)
FACIT-Fatigue Score (Functional Assessment of Chronic Illness Therapy - Fatigue)25/52 points
+20% (+5 points)
Secondary Benefits
SF-36 Physical Component Summary (PCS) Score40/100 points
+12.5% (+5 points)
Erythrocyte Sedimentation Rate (ESR)35 mm/hr
-28.57% (-10 mm/hr)
Anti-dsDNA Antibody Titer150 IU/mL
-20% (-30 IU/mL)
Common Side Effects
Nausea, diarrhea
+15%
Headache
+10%
Skin rash
+7%

Clinical Trial Phases:

Phase 4
4
Mycophenolate Mofetil
80% Effectiveness• 85% Confidence• 35% Safety• 81 trials• 10K participants
HIGH EvidenceGood ValueDose: 1-3g daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
35
DangerousModerateSafe

Time to Effect

3-6 months

Duration

6-24 months induction, then maintenance (often lifetime)

Response Rate

60%

Remission Rate

40%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

15

Common Side Effects:

Nausea, diarrhea, abdominal pain: 40%
Increased infection risk: 30%
Leukopenia: 15%
Teratogenic: 100%

Annual Cost of Care

Drug Cost

$1,000

Monitoring

$800

Side Effects

$400

Total Annual

$2,200

Cost-Effectiveness

GOOD

QALYs Gained

0.7

ICER

$45,000/QALY

Cost per Remission

$5,500

Cost per Responder

$3,667

Treatment Outcomes
Primary Outcomes
24-hour Urine Protein3.5 g/24h
-60% (-2.1 g/24h)
SLEDAI-2K ScoreSLEDAI-2K score: 10 points
-50% (-5 points)
Serum C3 Complement LevelC3: 60 mg/dL
+40% (+24 mg/dL)
Anti-dsDNA Antibody TiterAnti-dsDNA: 400 IU/mL
-50% (-200 IU/mL)
Secondary Benefits
Prednisone Equivalent Daily DosePrednisone: 15 mg/day
-50% (-7.5 mg/day)
SF-36 Physical Component Summary (PCS)SF-36 PCS: 35 points
+20% (+7 points)
Fatigue Severity Scale (FSS)FSS: 5.0/7
-30% (-1.5 points)
Common Side Effects
Nausea, diarrhea, abdominal pain
+40%
Increased infection risk
+30%
Leukopenia
+15%

Clinical Trial Phases:

Phase 4
5
Belimumab
75% Effectiveness• 80% Confidence• 55% Safety• 63 trials• 5K participants
HIGH EvidenceModerate ValueDose: 10 mg/kg IV every 4 weeks or 200 mg SC weekly
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Lifetime

Response Rate

45%

Remission Rate

25%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

75

Common Side Effects:

Nausea, diarrhea: 12%
Infusion reactions: 12%
Infections (URI, UTI): 18%
Depression, insomnia: 7%

Annual Cost of Care

Drug Cost

$35,000

Monitoring

$700

Side Effects

$400

Total Annual

$36,100

Cost-Effectiveness

MODERATE

QALYs Gained

0.25

ICER

$130,000/QALY

Cost per Remission

$144,400

Cost per Responder

$80,222

Treatment Outcomes
Primary Outcomes
SLEDAI-2K Score11 points (0-105 scale)
-45% (-5 points)
Corticosteroid Dosage10 mg/day prednisone equivalent
-35% (-3.5 mg/day)
Anti-dsDNA Antibody Levels150 IU/mL
-40% (-60 IU/mL)
Complement C3 Levels60 mg/dL
+25% (+15 mg/dL)
Secondary Benefits
Fatigue (FACIT-Fatigue Scale)28 points (0-52 scale)
+18% (+5 points)
Quality of Life (SF-36 Physical Component Summary)35 points (0-100 scale)
+9% (+3 points)
Joint Pain (VAS Score)60 mm (0-100 mm scale)
-30% (-18 mm)
Common Side Effects
Nausea, diarrhea
+12%
Infusion reactions
+12%
Infections (URI, UTI)
+18%

Clinical Trial Phases:

Phase 3Phase 4
6
Azathioprine
70% Effectiveness• 85% Confidence• 35% Safety• 40 trials• 12K participants
MODERATE EvidenceExcellent ValueDose: 1-3 mg/kg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
35
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Lifetime for maintenance

Response Rate

50%

Remission Rate

25%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

15

Common Side Effects:

Nausea, vomiting: 15%
Leukopenia, thrombocytopenia: 15%
Increased infection risk: 20%
Hepatotoxicity (rare): 3%

Annual Cost of Care

Drug Cost

$200

Monitoring

$700

Side Effects

$300

Total Annual

$1,200

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.6

ICER

$25,000/QALY

Cost per Remission

$4,800

Cost per Responder

$2,400

Treatment Outcomes
Primary Outcomes
Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) Score10/105
-40% (-4 points)
Corticosteroid (Prednisone Equivalent) Dose20 mg/day
-60% (-12 mg/day)
Proteinuria (in Lupus Nephritis)2.5 g/24 hours
-40% (-1.0 g/24 hours)
Anti-dsDNA Antibody Titer200 IU/mL
-30% (-60 IU/mL)
Secondary Benefits
Fatigue (FACIT-Fatigue Scale)25/52
+15% (+3.75 points)
Number of Lupus Flares3 flares/year
-60% (-1.8 flares/year)
C-Reactive Protein (CRP)15 mg/L
-40% (-6 mg/L)
Common Side Effects
Nausea, vomiting
+15%
Leukopenia, thrombocytopenia
+15%
Increased infection risk
+20%

Clinical Trial Phases:

Phase 4
7
Rituximab
70% Effectiveness• 75% Confidence• 45% Safety• 36 trials• 8K participants
MODERATE EvidenceGood ValueDose: 1000 mg IV on days 1 and 15, repeated every 6-12 months
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
45
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Cycles (e.g., 2 infusions every 6-12 months), potentially lifetime

Response Rate

50%

Remission Rate

25%

Number Needed to Harm (NNH)

30

Common Side Effects:

Infusion reactions: 15%
Infections: 20%
Progressive multifocal leukoencephalopathy (PML - very rare): 0.01%

Annual Cost of Care

Drug Cost

$15,000

Monitoring

$800

Side Effects

$700

Total Annual

$16,500

Cost-Effectiveness

GOOD

QALYs Gained

0.4

ICER

$100,000/QALY

Cost per Remission

$66,000

Cost per Responder

$33,000

Treatment Outcomes
Primary Outcomes
SLEDAI-2K ScoreSLEDAI-2K score: 9/105
-33.3% (-3 points)
Anti-dsDNA AntibodiesAnti-dsDNA antibodies: 200 IU/mL
-25% (-50 IU/mL)
Daily Prednisone EquivalentDaily prednisone equivalent: 10 mg
-40% (-4 mg)
C3 Complement LevelC3 complement: 75 mg/dL
+20% (+15 mg/dL)
Secondary Benefits
FACIT-Fatigue ScoreFACIT-Fatigue score: 25/52
+12% (+3 points)
SF-36 Physical Component Summary (PCS)SF-36 PCS score: 38/100
+7% (+2.7 points)
24-hour Proteinuria24-hour proteinuria: 2.5 g/day
-20% (-0.5 g/day)
Common Side Effects
Infusion reactions
+15%
Infections
+20%
Progressive multifocal leukoencephalopathy (PML - very rare)
+0.01%

Clinical Trial Phases:

Phase 4