Anifrolumab versus Belimumab for Cardiovascular Disease Risk in Systemic Lupus Erythematosus

Area of Science:

• Immunology
• Cardiology
• Rheumatology

Background:

• Systemic lupus erythematosus (SLE) patients face elevated cardiovascular disease (CVD) risk.
• Type I interferon (IFN-I) signaling is implicated in SLE pathogenesis and may influence CVD risk.
• Current guidelines offer anifrolumab and belimumab as comparable SLE treatments, but direct comparative CVD risk data is limited.

Purpose of the Study:

• To compare the cardiovascular disease (CVD) risks associated with anifrolumab versus belimumab in patients with systemic lupus erythematosus (SLE).
• To inform treatment selection and patient counseling regarding CVD risk in SLE management.

Main Methods:

• An emulated target trial was conducted using TriNetX electronic health record data (2020-2025).
• Adult SLE patients initiating anifrolumab or belimumab without prior CVD were included and propensity score matched.
• Three-year risks of myocardial infarction (MI), heart failure (HF), ischemic stroke, and major adverse cardiovascular events (MACE) were assessed.

Main Results:

• Matched cohort included 1,084 pairs of patients treated with anifrolumab or belimumab.
• Anifrolumab was associated with significantly lower risks of MI (HR 0.63), HF (HR 0.55), ischemic stroke (HR 0.50), and MACE (HR 0.65) compared to belimumab.
• These findings were consistent across multiple cardiovascular endpoints.

Conclusions:

• Anifrolumab treatment demonstrated a reduced risk of cardiovascular events compared to belimumab in SLE patients.
• Anifrolumab may be a preferred therapeutic option for SLE patients, particularly those with heightened CVD risk.
• Further prospective studies are warranted to confirm causality.