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  • Belimumab versus anifrolumab in adults with systemic lupus erythematosus: an indirect comparison of clinical response at 52 weeks

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Belimumab versus anifrolumab in adults with systemic lupus erythematosus: an indirect comparison of clinical response at 52 weeks
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  • Published on: 12 October 2023
    Letter to the Editor: belimumab versus anifrolumab in adults with systemic lupus erythematosus: an indirect comparison of clinical response at 52 weeks
    • Ian N. Bruce, Professor of Rheumatology Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester
    • Other Contributors:
      • Kai Wai Lee, Health Economics & Payer Evidence Lead
      • Jenna Ellis, Manager, Biostatistics
      • Anja Haltner, Associate Director, Data Analytics & Evidence Synthesis
      • Jason Steenkamp, Associate Director, Data Analytics & Evidence Synthesis
      • Barnabas Desta, Global Pricing and Market Access Director
      • Raj Tummala, Global Product Lead

    We read with interest the recent manuscript by Neupane et al. (2023) (1) in Lupus Science and Medicine, which compared the efficacy of anifrolumab and belimumab in adults with moderate-to-severe systemic lupus erythematosus (SLE). The study found that anifrolumab and belimumab are comparable in terms of SRI-4 response at 52 weeks using an indirect treatment comparison (ITC) analysis. The authors noted this was different from our ITC (Bruce et al. 2022) (2) findings where patients on anifrolumab were twice as likely to achieve an improvement in SRI-4 as belimumab.

    The difference in the results between Neupane et al. and our study might not be an actual difference but explained by differences in data utilised in the ITC analyses.

    First, different SRI-4 results were used. Neupane et al. utilised the SRI-4 results derived from pre-specified restricted medication rules for TULIP-1 whereas our study used results derived from amended medication rules (3). There was an error in the pre-specified restricted medication rules which were subsequently amended to ensure clinical appropriateness (3). As highlighted in our Letter in reply (6), the SRI-4 results derived from the amended rules were agreed to by the FDA and the EMA, and reported in the US Prescribing Information (5) and Summary of Product Characteristics (7). Regulators were aligned with the prespecified outcome definition used in TULIP-2 as well as the BLISS trials, thus they were the appropriate rules to use...

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    Conflict of Interest:
    IB Received grant support from Genzyme/Sanofi, GSK, Roche, and UCB, consulting fees from AstraZeneca, Lilly, GSK, Merck Serono, UCB, and ILTOO, and was a speaker for AstraZeneca, GSK, and UCB.
    KWL, BD and RT Employee of AstraZeneca
    JE, AH, JS J Ellis, A Haltner, and J Steenkamp are employees of EVERSANA™, which was contracted by AstraZeneca to work on this study.