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TOPLINE
In patients with systemic lupus erythematosus (SLE), anifrolumab was associated with a lower risk for major adverse cardiovascular events (MACE) than belimumab, as well as lower risks for myocardial infarction, heart failure, and ischemic stroke.
METHODOLOGY
- Researchers conducted an emulated target trial using electronic health record data from 67 healthcare organizations in the US within the TriNetX network (2020-2025) to compare the risk for MACE between anifrolumab — a type 1 interferon receptor antagonist — and belimumab — a B-lymphocyte stimulator inhibitor.
- A total of 1084 matched pairs of adults with SLE who initiated anifrolumab or belimumab within 1 year of diagnosis were included, with mean ages of 45.6 and 46.0 years, respectively. Patients with lupus nephritis or prior cardiovascular disease (CVD) were excluded.
- The median follow-up duration was 2.2 and 2.8 years for the anifrolumab and belimumab cohorts, respectively.
- The primary outcome was the 3-year risk for MACE, defined as cardiovascular death, ischemic or hemorrhagic stroke, and myocardial infarction.
- Secondary outcomes were 3-year risks for heart failure, myocardial infarction, ischemic or hemorrhagic stroke, venous thromboembolism, and all-cause mortality.
TAKEAWAY
- Compared with belimumab treatment, anifrolumab treatment was associated with lower risks for myocardial infarction (hazard ratio [HR], 0.63; 95% CI, 0.40-0.91), heart failure (HR, 0.55; 95% CI, 0.39-0.75), ischemic stroke (HR, 0.50; 95% CI, 0.26-0.94), and MACE (HR, 0.65; 95% CI, 0.37-0.89).
- In the emulated target trial, 26 vs 57 MACE occurred among anifrolumab-treated patients vs belimumab-treated patients; heart failure events were 20 vs 59, myocardial infarction events were 12 vs 23, and ischemic stroke events were 12 vs 27.
- No significant risk differences were noted between the two groups in terms of negative control outcomes (lipoma and laceration diagnoses) and all-cause mortality.
IN PRACTICE
“[The study] findings suggest a decreased CVD risk with anifrolumab treatment compared to belimumab in patients with SLE, which may support anifrolumab’s consideration as a safe therapeutic option, particularly for patient populations with increased CVD risk,” the authors of the study wrote.
SOURCE
The study was led by Arjun Mahajan, MS, Harvard Medical School, Boston. It was published online on August 7, 2026, as a brief report in Arthritis & Rheumatology.
LIMITATIONS
The 3-year follow-up period may not be long enough to identify incident cardiovascular events. The differences in follow-up time between treatment groups could reflect remaining unmeasured differences. Outcomes of combination therapy could not be assessed.
DISCLOSURES
The study received support from the Rheumatology Research Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Some authors reported receiving consulting fees, grants, and contracts and/or participation on boards from various companies unrelated to the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
