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Anifrolumab Versus Belimumab for Cardiovascular Disease Risk in Systemic Lupus Erythematosus

Arjun Mahajan1,2, Maureen Whittelsey1,3, Ruth Ann Vleugels1,2,3

  • 1Harvard Medical School, Boston, Massachusetts.

Arthritis & Rheumatology (Hoboken, N.J.)
|August 7, 2026
PubMed

Insights

Anifrolumab showed lower cardiovascular risks than belimumab for systemic lupus erythematosus (SLE) patients. This finding suggests anifrolumab may be a safer choice, especially for those with high CVD risk.

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.
Abstract

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