Anifrolumab in Systemic Lupus Erythematosus (SLE): A Critical Appraisal of Clinical Trials and its Prospects for Elevating Patients' Quality of Life

Systemic Lupus Erythematosus (SLE) presents a complex autoimmune challenge characterized by chronic inflammation and multi-organ involvement. This paper offers a comprehensive analysis of anifrolumab, a promising monoclonal antibody that targets type I interferon signaling, as a potential treatment for SLE. It also compares with existing therapies, namely belimumab and rituximab. Anifrolumab received FDA approval in 2021 based on evidence from clinical trials, such as MUSE and TULIP-2, demonstrating its effectiveness in reducing disease activity, glucocorticoid usage, and flares among SLE patients. However, concerns regarding its safety profile, particularly herpes zoster infections and immunosuppression, should be addressed. Comparative analysis of belimumab and rituximab reveals their distinct mechanisms of action and levels of clinical evidence. Belimumab, focusing on B-cell activity, has a longer history of reducing disease activity and flares. Rituximab, while promising, lacks direct comparative data. Challenges related to the long-term safety and efficacy of anifrolumab emphasize the need for personalized treatment strategies, patient selection, and real-world data integration. The paper discusses the importance of tailoring therapies based on biomarker profiles and clinical characteristics, involving patients in shared decision-making, and monitoring treatment responses over time. The paper highlights ongoing research and clinical trials exploring new therapeutic approaches for SLE, offering hope for improved outcomes. It underscores that anifrolumab, while promising, should be considered within the context of individual patient needs, with further studies necessary to refine treatment choices for SLE patients

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population