Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organ systems. Anifrolumab is a monoclonal antibody that antagonizes type I interferon receptors, thereby reducing disease activity.

this study aim to investigate the Anifrolumab’s efficacy and safety in treating lupus symptoms, focusing on organ domain-specific effects.

Methods: This study was conducted according to PRISMA guidelines. We searched PubMed, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov for clinical trials evaluating the efficacy and safety of Anifrolumab in treating Systemic Lupus symptoms. A meta-analysis was conducted via representative forest plots for the following outcome measures: BICLA, SRI(4), SRI(8), SLEDAI-2K, Glucocorticoid tapering, C3 & C4, UPCR, Flare rates, Joint disease, CLASI, and adverse effects. This study is registered on PROSPERO, CRD42023461606.

Results: Our search identified a total of 959 records, after screening and exclusion 16 studies were selected, 10 of which were included in meta-analysis. Most studies were of low risk of bias after risk of bias assessment. Compared to placebo, Anifrolumab (300mg) had a higher percentage of patients with BICLA  response (risk ratio (RR) 1.59 [95% confidence interval (CI)1.33, 1.89], p< 0.00001), greater reduction in SELDAI-2K score (mean difference (MD) -0.97 [95% CI -1.60, -0.34], p = 0.003), higher percentage of patients with 50% reduction in CLASI score (RR 1.85 [95% CI 1.35, 2.54], p = 0.0001) and in counts of both swollen joints and tender joints (RR 1.31 [95% CI 1.04, 1.65], p= 0.02) and lower flare rates (RR 0.75 [95% CI 0.60, 0.93], p = 0.01). When compared to placebo, Anifrolumab (300mg) did not increase serious adverse events, but a significantly higher incidence of adverse effects of special interest and of herpes zoster (RR 2.35 [95% CI 1.45, 3.80], p = 0.0005) was observed. Studies done on renal patients did not demonstrate significant reduction in 24-hr UPCR in the Anifrolumab group when compared to placebo (MD -0.02 [95% CI -0.13, 0.09], p = 0.74), nor in cumulative UPCR.

Conclusion: Anifrolumab (especially the 300mg IV dose) demonstrates its efficacy in reducing SLE disease severity across several outcome measures. However, its use as an add-on therapy in renal lupus appears less promising.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-anifrolumab-across-organ-domains-of-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/