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Anifrolumab Plus Standard of Care Reduces Long-Term Cardiovascular Damage in Adults With Systemic Lupus
Zahi Touma1,2, Ian N Bruce3,4, Richard A Furie5
1Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Insights
Anifrolumab treatment may reduce long-term cardiovascular damage in systemic lupus erythematosus (SLE) patients. This study found fewer cardiovascular damage index points and a trend towards reduced cardiovascular events with anifrolumab compared to standard care.
Area of Science:
- Rheumatology
- Immunology
- Cardiovascular Medicine
Background:
- Cardiovascular (CV) events are a primary cause of mortality in systemic lupus erythematosus (SLE) patients.
- Anifrolumab effectively manages SLE disease activity and reduces glucocorticoid dependence, but its long-term impact on CV damage is not well-established.
- This research aims to assess the long-term efficacy of anifrolumab in mitigating CV damage in SLE.
Purpose of the Study:
- To evaluate the long-term effect of anifrolumab plus standard of care (SoC) on cardiovascular damage in SLE patients.
- To compare the accrual of CV damage in patients treated with anifrolumab versus real-world external controls receiving SoC.
- To assess the incidence of CV events over a four-year period in both treatment groups.
Main Methods:
- A cohort of 354 patients receiving anifrolumab from the TULIP trials was compared with 561 real-world SLE patients receiving SoC.
- Propensity score weighting was used to balance baseline characteristics between the anifrolumab and SoC cohorts.
- Mean changes in CV-related Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) and time to first CV event were analyzed over four years.
Main Results:
- Patients treated with anifrolumab accrued significantly less CV-SDI points at four years compared to real-world SoC controls (mean difference: -0.046; P=0.008).
- A trend towards a reduction in CV events was observed in the anifrolumab group, with a hazard ratio of 0.257 (P=0.0583) over four years.
- These results indicate a potential benefit of anifrolumab in reducing long-term cardiovascular complications in SLE.
Conclusions:
- Anifrolumab, in addition to standard of care, may offer a protective effect against long-term cardiovascular damage in patients with SLE.
- The findings suggest a potential role for anifrolumab in managing the cardiovascular risk associated with SLE.
- Further research is warranted to confirm these findings and elucidate the mechanisms behind the observed CV benefits.
Objective:
Despite improvements in overall survival, cardiovascular (CV) events remain a leading cause of death in patients with systemic lupus erythematosus (SLE). Anifrolumab controls disease activity while reducing glucocorticoid use and has been associated with reduced organ-damage accrual; however, its long-term efficacy for reducing CV damage is unknown. This study evaluates the effect of anifrolumab plus standard of care (SoC) on long-term CV damage in SLE compared with real-world external controls.
Methods:
We included 354 patients who initiated anifrolumab 300 mg in the Treatment of Uncontrolled Lupus via the Interferon Pathway (TULIP) trials in the cohort of patients who received anifrolumab. The real-world SoC cohort comprised 561 patients from the University of Toronto Lupus Clinic registry, selected using matched eligibility criteria. Baseline characteristics were balanced using propensity score weighting. Mean changes in CV-related Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) from baseline to year 4 were estimated using weighted linear-regression models. Time to first CV event up to four years was assessed using Kaplan-Meier estimators and a Cox regression model.
Results:
Patients receiving anifrolumab accrued, on average, 0.046 fewer CV-SDI points at four years (95% confidence interval [CI] -0.074 to -0.018; P = 0.008) compared with patients with real-world SoC. The hazard ratio for CV events over four years was 0.257 (95% CI 0.0687 to 0.961; P = 0.0583) for patients treated with anifrolumab versus controls with real-world SoC.
Conclusion:
These findings suggest that anifrolumab may reduce long-term CV damage in patients with SLE.
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