#5-36E. Targeting Interferon vs. B-Cells: Evaluating Cardiovascular Risk in SLE Patients (Arthritis Rheumatol, 2026)

How should we navigate the heightened cardiovascular risk in our patients with systemic lupus erythematosus when choosing biologic therapies? This emulated target trial utilizing TriNetX electronic health records from 67 healthcare organizations compared 1,084 propensity score-matched pairs of SLE patients initiating either anifrolumab or belimumab. The study demonstrated that anifrolumab was associated with a significantly lower 3-year risk of major adverse cardiovascular events (MACE) compared to belimumab (HR 0.65; 95% CI 0.37-0.89), showing particularly robust risk reductions in heart failure (HR 0.55) and ischemic stroke (HR 0.50). However, as an observational study reliant on retrospective electronic health record data, clinicians must critically consider potential residual confounding and selection biases that are inherent to this design. Nevertheless, these findings offer vital, real-world clinical evidence to guide personalized biologic selection, suggesting that targeting the type I interferon signaling pathway may provide superior cardiovascular protection for our high-risk lupus patients in daily practice.

Citation: Arjun Mahajan, Maureen Whittelsey, Ruth Ann Vleugels, Prashant Rao, Adarsh Ravishankar, Anna Haemel, Avery LaChance, Karen H. Costenbader, Jeffrey A. Sparks. Anifrolumab versus Belimumab for Cardiovascular Disease Risk in Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2026. DOI: 10.1002/art.70293

URL: https://doi.org/10.1002/art.70293

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