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Subcutaneous anifrolumab improves BICLA response by 15.5% in moderate to severe SLEAnifrolumab injection improves lupus outcomes in trial

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Key Takeaway
Consider subcutaneous anifrolumab as an add-on therapy for moderate to severe SLE based on improved BICLA response and remission rates.

This phase 3 randomized, placebo-controlled trial evaluated subcutaneous anifrolumab 120 mg once weekly added to standard therapy in adults with moderate to severe SLE. The study included a preplanned interim analysis (220 patients) and a full analysis (367 patients). The primary outcome was BICLA response at 52 weeks. In the interim analysis, anifrolumab achieved a 59.4% response rate vs 43.9% for placebo (difference 15.5%, 95% CI 2.3-28.6, P=0.0211). In the full analysis, BICLA response while maintaining low/reduced glucocorticoid doses through week 52 was 56.2% vs 34.0% (difference 22.3%, 95% CI 12.3-32.2, P<0.0001). Time to first sustained BICLA response favored anifrolumab (HR 2.2, 95% CI 1.5-3.2, P<0.0001). DORIS remission at week 52 showed a 14.2% difference (95% CI 5.6-22.8, P=0.0012), and Low Lupus Disease Activity State attainment showed a 14.1% difference (95% CI 4.6-23.6, P=0.0038). Safety: herpes zoster occurred in 3.8% of anifrolumab vs 1.1% of placebo patients; serious adverse events were 11.9% vs 10.4%, with an acceptable safety profile. Limitations include lack of reported discontinuation rates and funding details. Clinically, subcutaneous anifrolumab offers a significant benefit for patients with moderate to severe SLE inadequately controlled on standard therapy.

A new phase 3 clinical trial found that a weekly injection of anifrolumab, added to standard therapy, helped more adults with moderate to severe lupus achieve better disease control compared to placebo.

The study included 367 adults with systemic lupus erythematosus (SLE) who still had active disease despite standard treatments. Participants were randomly assigned to receive either a 120 mg subcutaneous injection of anifrolumab once weekly or a placebo. The main goal was to see how many people had a BICLA response at 52 weeks, which measures improvement in lupus symptoms.

Results showed that 59.4% of those on anifrolumab achieved a BICLA response at the interim analysis, compared to 43.9% on placebo. In the full analysis, more people on anifrolumab also maintained low or reduced steroid doses while achieving response. The drug also led to higher rates of remission and low disease activity. However, herpes zoster infections were more common with anifrolumab (3.8% vs 1.1%). Serious side effects were similar between groups.

This is a randomized controlled trial, so the results are reliable. But the study was funded by the drugmaker, and long-term safety data are still needed. For people with lupus that is not well controlled, this treatment may offer a new option, but it is not yet approved for this use.

What this means for you:
Anifrolumab injections improved lupus control in a trial, but herpes zoster risk was higher.

Study Details

Study typeRct
Sample sizen = 220
EvidenceLevel 2
PublishedJun 2026
View Original Abstract ↓
OBJECTIVE: The multinational, phase 3, double-blind, placebo-controlled TULIP-SC trial evaluated the efficacy and safety of subcutaneous anifrolumab in adults who have moderate to severe systemic lupus erythematosus (SLE) activity, despite receiving standard therapy. METHODS: Adults with SLE received subcutaneous anifrolumab 120 mg or placebo once weekly for 52 weeks (1:1 randomization). Only the primary endpoint (treatment difference in BILAG-based Composite Lupus Assessment [BICLA] response at 52 weeks) was formally tested in a preplanned interim analysis; key secondary and other endpoints were tested in the full analysis. RESULTS: At the interim analysis (220 patients, anifrolumab: n = 109; placebo: n = 111), the primary endpoint was met (anifrolumab vs placebo: 59.4% vs 43.9%; BICLA response difference 15.5%, 95% confidence interval [95% CI] 2.3-28.6; P = 0.0211). The full analysis included 367 patients (anifrolumab: n = 184; placebo: n = 183). Versus placebo, more patients treated with anifrolumab attained a BICLA response while maintaining low/reduced oral glucocorticoid doses through week 52 (56.2% vs 34.0%; difference 22.3%, 95% CI 12.3-32.2; P < 0.0001), and the time to first sustained BICLA response was reduced (hazard ratio 2.2, 95% CI 1.5-3.2; P < 0.0001). Treatment differences in week 52 DORIS remission and Low Lupus Disease Activity State attainment rates favored anifrolumab over placebo (14.2%, 95% CI 5.6-22.8; P = 0.0012, and 14.1%, 95% CI 4.6-23.6; P = 0.0038). The frequencies of serious adverse events were 11.9% with anifrolumab and 10.4% with placebo; the frequencies of herpes zoster were 3.8% and 1.1%, respectively. CONCLUSION: Consistent with the well-established profile of intravenous anifrolumab, subcutaneous anifrolumab demonstrated significant, clinically meaningful treatment benefits when added to standard therapy, and an acceptable safety profile in patients with moderate to severe SLE.
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