Real-world data on anifrolumab, the new kid on the block in lupus

Real-world data on anifrolumab, the new kid on the block in lupusRecent years have been fruitful in the field of lupus, with 2 new molecules approved for treatment of systemic lupus erythematosus (SLE): voclosporin, which is combined with a background immunosuppressive therapy regimen for adults with lupus nephritis, and anifrolumab, which is indicated for patients with moderate-to-severe SLE whose conventional treatment has failed.Promising options for the future include obinutuzumab, deucravacitinib, and even more advanced targeted therapies such as CAR T-cell therapy (1).In the current issue, Miyazaki et al. ( 2) evaluated the real-world safety and efficacy of anifrolumab in a cohort of 45 Japanese patients with SLE (LOOPS registry).From November 2021, they included patients who did not achieve lupus low disease activity state (LLDAS) despite standard of care (SoC), patients who experienced flares after achieving LLDAS, and patients who achieved LLDAS under SoC treatment and then started anifrolumab in order to achieve remission and reduce or discontinue glucocorticoids (GCs).As a primary outcome measure, they evaluated retention rate at week 26.The secondary endpoints included disease activity (SLEDAI, LLDAS), remission (DORIS), GC dose, and flare rates.The authors also compared the effect of anifrolumab plus SoC with that of SoC alone on disease activity and GC dose using propensity score matching (inverse probability of treatment weighting, IPTW).After 26 weeks of treatment, the retention rate of anifrolumab was high (around 90%) both in patients who received treatment for failure of SoC and in those with lupus flares despite treatment.The retention rate was lower in patients whose GC dose was reduced (75%).Additionally, LLDAS and DORIS remission were achieved, respectively, in 66% and 22% of patients.The authors also reported a significant reduction in doses of GCs at week 12 in comparison with the SoC group.No differences in LLDAS rates were seen between belimumabexperienced patients and belimumab-naïve patients or between patients with mild and patients with moderate SLEDAI scores at baseline.After adjustment through propensity score matching (IPTW), the analysis of the subgroup who started anifrolumab for control of minor flares showed that disease activity improved in the