Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This widespread attack can affect various parts of the body, including the skin, joints, kidneys, brain, and other internal organs, leading to unpredictable symptoms. Anifrolumab, marketed as Saphnelo, is a new targeted therapy for managing this complex condition. It provides an additional option for certain adults living with lupus, aiming to reduce disease activity.
How Anifrolumab Works
Anifrolumab is a monoclonal antibody, a laboratory-made protein that mimics natural antibodies. It targets a protein on cell surfaces called the Type I interferon receptor subunit 1 (IFNAR1). Type I interferons are signaling proteins (cytokines) often elevated in lupus, contributing to the inflammation and immune system dysfunction seen in the disease.
By binding to IFNAR1, anifrolumab blocks Type I interferons from attaching to cells and sending inflammatory signals. This prevents the activation of the JAK-STAT pathway, which is normally triggered by interferon binding. Consequently, it reduces the production of interferon-stimulated genes, which contribute to the aberrant immune response in lupus. This targeted blockade lessens inflammatory and autoimmune activity, leading to improvements in disease symptoms and a reduction in immune overactivation.
Who Anifrolumab Is For
Anifrolumab is approved for adults with moderate to severe active systemic lupus erythematosus (SLE) who are already receiving other standard lupus therapies. It is an add-on treatment, used in combination with existing medications like corticosteroids, antimalarials such as hydroxychloroquine, or other immunosuppressants. Its use requires a careful assessment by a healthcare provider, as it is not suitable for all lupus patients.
Anifrolumab has not been studied in patients with severe active lupus affecting the kidneys (lupus nephritis) or central nervous system, and is therefore not recommended for individuals with these specific manifestations. A physician experienced in treating SLE makes the decision to prescribe anifrolumab, considering the individual patient’s disease activity, symptoms, and overall treatment plan.
Receiving Anifrolumab and What to Anticipate
Anifrolumab is administered as an intravenous (IV) infusion. Each infusion takes about 30 minutes. The recommended dose is 300 mg every four weeks. This regular administration helps maintain consistent medication levels to manage disease activity.
During and immediately after the infusion, some patients may experience mild to moderate reactions. Common infusion-related symptoms include headache, nausea, vomiting, fatigue or weakness, and dizziness. Healthcare providers can manage these reactions and may consider pre-medications for patients with a history of such responses. Patients should communicate any discomfort or unusual feelings to their healthcare team during the infusion.
Beyond infusion-related reactions, anifrolumab increases the risk of infections. Upper respiratory tract infections, such as colds or bronchitis, are common. There is also an increased risk of developing herpes zoster, commonly known as shingles. This increased risk is due to anifrolumab’s effect on the immune system, which can reduce its ability to fight off certain infections.
While most herpes zoster events were mild or moderate, serious infections, including rare fatal cases, have occurred. Patients should be vigilant for symptoms of infection, such as fever, cough, or painful blisters, and promptly report them to their doctor.