Anifrolumab Plus Standard of Care Reduces Long‐Term Cardiovascular Damage in Adults With Systemic Lupus Erythematosus: Findings From a Real‐World External Control Study

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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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