PO:14:202 | Use of anifrolumab in the treatment of the hematological manifestations of systemic lupus erythematosus: a single-centre case series

Gaia Ferracane^1|2, Jessika Dichiara^1|2, Elena Manna^1|2, Lorenzo Mattia Bianchessi^1|2, Giovanni Zanframundo^1|2, Serena Bugatti^1|2, Veronica Codullo^1|2, Lorenzo Cavagna^1|2, Francesca Bottazzi^1|2 | ¹Department of Internal Medicine and Therapeutics, Università di Pavia; ²Division of Rheumatology, IRCCS Policlinico San Matteo, Pavia, Italy

Abstract

Background. The efficacy of anifrolumab has been documented in several studies (1,2), however data regarding its use in the haematological domain of SLE remain limited (3). The aim of this case series is to describe a single-centre experience with anifrolumab in patients with SLE predominantly affecting the haematological domain, particularly thrombocytopenia and haemolytic anaemia.

Materials and Methods. We retrospectively evaluated data from six patients with haematological involvement treated with intravenous anifrolumab at a dosage of 300 mg every four weeks. Assessments were performed at baseline (T0) and after one (T1), three (T3), and six months (T6) of therapy. Changes in complete blood counts and corticosteroid dosages were analysed.

Results. Among the six patients, five had thrombocytopenia and one had haemolytic anaemia. All patients were corticosteroid-dependent at baseline. The epidemiological and clinical characteristics of the cohort are detailed in Tables 1 and 2. Four patients with thrombocytopenia received anifrolumab therapy for at least six months. In these cases, an increase in platelet counts was observed, allowing a reduction in corticosteroid therapy — in two cases to a prednisone dose below 5 mg/day, and in one case complete discontinuation was achieved. At the time of reporting, one patient has been treated for three months, showing an improvement in platelet count after the first infusion and a reduction in corticosteroid dosage after the third one (Figure 1). A single patient was treated with anifrolumab for haemolytic anaemia and lymphopenia. At six months after treatment initiation, improvements were observed in lymphocyte counts, haemoglobin levels and haptoglobin values, previously undetectable, allowing a reduction in corticosteroid dosage (Figure 2). No significant adverse events occurred during treatment. In one case, therapy was discontinued after twelve months due to loss of efficacy and diagnosis of colon cancer. In this instance, a paraneoplastic aetiology as a contributing factor to the worsening and refractoriness of thrombocytopenia could not be entirely excluded.

Conclusions. Based on our data, haematological involvement in SLE may represent a potential therapeutic target for anifrolumab. However, the small number of cases precludes any definitive conclusions. Expanding data collection to a larger, multicentre cohort would be valuable to explore potential predictors of response, which could account for the observed variability in both the magnitude and timing of clinical responses.

Keywords

• thrombocytopenia
• anifrolumab
• haemoglobin levels