POS1067 RENAL OUTCOMES IN PATIENTS TREATED WITH ANIFROLUMAB FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN THE US: FINDINGS FROM A REAL-WORLD STUDY
Authors: V. Kyttaris, M. Binka, G. Atefi, D. Persons, D. Withrow, S. S. J. Wu, T. Olufade
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Renal disease is a common severe manifestation of systemic lupus erythematosus (SLE), occurring in 50%-60% of patients [1]. Renal function of SLE patients changes dynamically over time, with periods of declining glomerular filtration rate also occurring among patients without nephritis [2]. Treatment of SLE may stabilize renal function from a declining trajectory. Anifrolumab was approved in the US in 2021 for use among adults with moderate to severe SLE; however, limited robust real-world data is currently available on renal outcomes following anifrolumab treatment initiation. <h3>Objectives:</h3> To describe estimated glomerular filtration rate (eGFR) and urine protein-creatinine ratio (UPCR) results among adult patients with SLE before and during anifrolumab treatment. <h3>Methods:</h3> This retrospective, observational cohort study included data from patients in care of the American Rheumatology Network, a consortium of US community rheumatology practices in 124 locations across 27 states. Patients were selected according to the following criteria: ≥18 years of age with SLE diagnosis at the time of anifrolumab initiation (index date), having at least 180 days of clinical history before index, at least 5 anifrolumab infusions in the 180 days following index and adherence to anifrolumab during post-index measurements (average &lt; 42 days between infusions), serum creatinine levels under 2.0 mg/dL and UPCR less than 2.0 mg/mg, and the absence of another biologic for SLE at time of anifrolumab treatment. Clinical outcomes were assessed for patients with scores for two time periods: baseline (-180 to -1 days prior to index), and follow-up (181-360 days after index). Clinical scores (considered within 28 days after last treatment date) were only included if a patient was on active treatment during assessment. If multiple assessments were made during each period, the one closest to initiation of anifrolumab was chosen for baseline and the measurement closest to 360 days post initiation for follow-up. The median (IQR) result was reported for each outcome measure. <h3>Results:</h3> Amongst the 169 SLE patients eligible for this study, 92.9% were female, 54.3% were white, and median age was 53.0 (IQR 44.0, 63.0) years (Table 1). Of these patients, 98 were included, who had eGFR measures at both baseline and follow-up. Median eGFR measures were consistent with normal levels at baseline (93.9, IQR [78.4, 106.7] mL/Min/1.73M<sup>2</sup>) and during follow-up (90.9, IQR [79.5, 103.1] mL/Min/1.73M<sup>2</sup>) (Figure 1A). At baseline, 54/98 (55.1%), 36/98 (36.7%) and 8/98 (8.2%) of patients had eGFR levels greater than 90 (normal or Stage 1 CKD), between 60 and 90 (Stage 2 CKD), and less than 60 mL/Min/1.73M<sup>2</sup> (Stage 3-5 CKD), respectively. Similarly, during follow-up, 51/98 (52.0%), 36/98 (36.7%), and 11/98 (11.2%) of patients had eGFR levels greater than 90, between 60 and 90, and less than 60 mL/Min/1.73M<sup>2</sup>, respectively. Median UPCR results (n= 24) were 0.14 mg/mg (IQR 0.08, 0.19) at baseline and 0.08 mg/mg (IQR 0.06, 0.25) during follow-up (Figure 1B). Two of the 24 patients who had baseline UPCR &gt;1 mg/mg also remained stable (baseline: 1.11 and 1.07, follow-up: 0.44 and 0.72, respectively). <h3>Conclusion:</h3> In this real-world study of SLE patients on anifrolumab, baseline median eGFR was within normal range and exhibited no decline up to one year after treatment initiation. Regardless of baseline proteinuria, median UPCR remained stable up to one year post-initiation of anifrolumab. This is consistent with findings from the randomized clinical trial on the effect of anifrolumab on the kidney [3]. Further real-world studies to determine long-term renal outcomes with anifrolumab therapy are underway. <h3>REFERENCES:</h3> [1] Kim, Y, et al. "Wolves Trapped in the NETs–The Pathogenesis of Lupus Nephritis." <i>Journal of Rheumatic Diseases</i> 25, no. 2 (2018): 81-99. [2] Yip, TCF, et al. "Predictors of the start of declining eGFR in patients with systemic lupus erythematosus." <i>Lupus</i> 30, no. 1 (2021): 15-24. [3] Furie R, et al. "Renal Involvement in Patients with Systemic Lupus Erythematosus Treated with Anifrolumab Compared with Placebo over a 4-Year Period" [abstract]. <i>Arthritis &amp; Rheumatology</i> 75, no. Suppl 9 (2023). <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Vasileios Kyttaris Consultant of: AstraZeneca, Fresenius Kabi, Jannsen, Mawuena Binka Shareholder of: AstraZeneca, Employee of: AstraZeneca, Gelareh Atefi Shareholder of: AstraZeneca, Employee of: AstraZeneca, Dan Persons: None declared, Dana Withrow Grants/research support from: AstraZeneca, Aurinia, Cipher, GlaxoSmithKline, Sandra Sze-jung Wu Employee of: AstraZeneca, Tope Olufade Shareholder of: AstraZeneca, Employee of: AstraZeneca.