Real-world outcomes after anifrolumab initiation in systemic lupus erythematosus: a pragmatic treat-to-target analysis.

Authors

Dalifer Freites Núñez, Paloma Camarero Diaz, Sara Rodríguez Montes, Cristina Martínez Prada, Cristina Lajas Petisco, Lydia Abasolo, Benjamin Fernández Gutierrez

Published in

Clinical rheumatology. Oct 05, 2026. Epub Oct 05, 2026.

Abstract

Treat-to-target (T2T) strategies in systemic lupus erythematosus (SLE) emphasise remission or low disease activity together with glucocorticoid minimisation. Real-world evidence evaluating anifrolumab using predefined target-oriented outcomes remains limited. We evaluated outcomes after anifrolumab initiation within a pragmatic T2T framework.
This retrospective single-centre cohort included adults with SLE receiving anifrolumab. The study-defined pragmatic low disease activity composite required SLEDAI-2K ≤ 4, Physician Global Assessment ≤ 1, prednisone ≤ 7.5 mg/day, and absence of clinically significant renal activity. Prednisone ≤ 5 mg/day was explored in sensitivity analyses. Outcomes were assessed at baseline and 1, 3, 6, and 12 months. Longitudinal changes in SLEDAI-2K, PGA, and prednisone dose were analysed using linear mixed-effects models.
Nineteen patients were included (median baseline SLEDAI-2K 12.0 and median PGA 2.0). Composite attainment using prednisone ≤ 7.5 mg/day was 5.3% at 1 month, 47.4% at 3 months, 50.0% at 6 months, and 8/12 (66.7%) at 12 months. Using prednisone ≤ 5 mg/day, attainment was 36.8% at 3 months, 50.0% at 6 months, and 66.7% at 12 months. Disease activity components were met earlier than glucocorticoid thresholds. Mixed-effects models showed significant reductions in SLEDAI-2K, PGA, and prednisone dose during follow-up. One patient permanently discontinued anifrolumab due to influenza A, and one temporarily interrupted treatment because of pneumonia.
After anifrolumab initiation, the proportion of evaluable patients meeting the pragmatic composite increased alongside reductions in disease activity and glucocorticoid dose. These exploratory findings suggest a potential role for anifrolumab within T2T strategies and warrant confirmation in larger controlled studies using validated treatment targets.

PMID:
42832020
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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