Saphnelo is a first-in-class type I interferon receptor antibody
The first patients have been dosed in the IRIS Phase III clinical trial of Saphnelo (anifrolumab) in lupus nephritis (LN).
Up to 60% of patients with lupus develop kidney involvement. In more severe cases, this can develop into LN.1 LN is characterised by kidney inflammation and is one of the most common severe organ manifestations in systemic lupus erythematosus (SLE),2 a chronic and complex autoimmune disease in which the immune system attacks healthy tissue in the body.3 Patients with LN are at a substantial increased risk of dialysis and early mortality.4-6 Patients with LN have been shown to have elevated levels of type I interferons in the blood and kidneys.7,8
Saphnelo is approved for the treatment of moderate to severe SLE in the US, Japan, Europe and Canada, with regulatory reviews ongoing in other countries worldwide. This is the first Phase III trial of Saphnelo in a potential new indication beyond SLE. The IRIS Phase III trial will be conducted in multiple countries involving adult patients with active LN.9
Eduardo Mysler, Medical Director and Rheumatologist at the Organización Médica de Investigación, Buenos Aires, Argentina, and the international coordinating investigator in the Saphnelo clinical development programme for LN, said, “The Phase II results of anifrolumab in lupus nephritis provided important evidence suggesting that blocking type I interferons is a potentially promising strategy for the treatment of lupus nephritis. I look forward to contributing to the next phase of anifrolumab’s development in this severe and often debilitating complication of lupus where new therapeutic options are needed.”
Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca, said: “Lupus nephritis continues to represent a significant burden to patients worldwide. Following the approval of Saphnelo as the first new treatment for systemic lupus erythematosus in over a decade, the start of our IRIS Phase III trial in lupus nephritis is another important step forward in our ambition to bring Saphnelo to more patients with diseases where type I interferon is a central driver.”
Results from the TULIP-LN1 Phase II proof of concept, dose-finding trial of Saphnelo were published in Annals of the Rheumatic Diseases in February 2022.10 The primary endpoint was the change in a measure of kidney function (baseline 24-hour urine protein creatinine ratio) at week 52 for combined anifrolumab versus placebo groups. Although the trial’s primary endpoint was not met (69% versus 70%, p=0.905), the higher dose tested showed clinically meaningful numeric improvements across multiple secondary and exploratory endpoints versus placebo (with all patients also receiving standard therapy).10 The adverse events that were more common (≥5% difference) in the combined Saphnelo versus placebo groups were herpes zoster, urinary tract infection, and influenza.10
Notes
Lupus nephritis
LN is more common in women than in men, and there is a higher prevalence and severity of the disease among African American, Asian and Hispanic women between 15-44, who tend to develop the disease earlier and experience more serious complications.11
IRIS
The IRIS Phase III trial is a two-year, multicentre, multinational, randomised, double-blind, placebo-controlled study expected to enrol up to 360 participants aged 18 to 70.9 The aim of the study is to evaluate the efficacy and safety of Saphnelo versus placebo when added to standard therapy (consisting of mycophenolate mofetil and glucocorticoids) in adults diagnosed with active Class III or IV LN (with or without concomitant Class V).9 Active LN will be confirmed by kidney biopsy during screening visits using the 2003 International Society of Nephrology/Renal Pathology Society criteria, and clinically active kidney disease.9
TULIP-LN1
This Phase II double-blinded TULIP-LN1 study randomised 147 patients to receive monthly intravenous Saphnelo basic regimen (300 mg), intensified regimen (900 mg ×3, 300 mg thereafter) or placebo, alongside standard therapy (oral glucocorticoids, mycophenolate mofetil).12 The primary endpoint was change in baseline 24-hour urine protein–creatinine ratio at week 52 for combined Saphnelo versus placebo groups. The secondary endpoint was complete renal response at week 52.12Exploratory endpoints included more stringent complete renal response definitions and sustained glucocorticoid reductions (≤7.5 mg/day, weeks 24–52). Safety was analysed descriptively.12
Saphnelo
Saphnelo (anifrolumab) is a fully human monoclonal antibody that binds to subunit 1 of the type I IFN receptor, blocking the activity of type I IFN.13 Type I IFNs, such as IFN-alpha, IFN-beta and IFN-kappa, are cytokines involved in regulating the inflammatory pathways implicated in SLE.14-19 The majority of adults with moderate to severe SLE have increased type I IFN signalling, which is associated with increased disease activity and severity.14,20
In SLE, Saphnelo continues to be evaluated in a long-term extension Phase III trial and a Phase III trial assessing subcutaneous delivery.21,22
Additional Phase III trials are planned investigating Saphnelo in diseases where type I IFN plays a key role, including cutaneous lupus erythematosus and myositis.23
AstraZeneca in Respiratory & Immunology
Respiratory & Immunology, part of BioPharmaceuticals, is one of AstraZeneca’s main disease areas and is a key growth driver for the Company.
AstraZeneca is an established leader in respiratory care with a 50-year heritage. The Company aims to transform the treatment of asthma and chronic obstructive pulmonary disease (COPD) by focusing on earlier biology-led treatment, eliminating preventable asthma attacks and removing COPD as a top-three leading cause of death. The Company’s early respiratory research is focused on emerging science involving immune mechanisms, lung damage and abnormal cell-repair processes in disease and neuronal dysfunction.
With common pathways and underlying disease drivers across respiratory and immunology, AstraZeneca is following the science from chronic lung diseases to immunology-driven disease areas. The Company’s growing presence in immunology is focused on five mid- to late-stage franchises with multi-disease potential, in areas including rheumatology (including SLE), dermatology, gastroenterology, and systemic eosinophilic-driven diseases. AstraZeneca’s ambition in Respiratory & Immunology is to achieve disease modification and durable remission for millions of patients worldwide.
AstraZeneca
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References
1. Lupus Foundation of America. The Expert Series: Kidney health and lupus. Available at: https://www.lupus.org/resources/the-expert-series-kidney-health-and-lupus. [Last accessed: May 2022]
2. Medscape. Lupus nephritis. Available at: https://emedicine.medscape.com/article/330369-overview. [Last accessed: May 2022]
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5. Kostopoulou M, et al. Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations. RMD Open 2020; 6: e001263
6. Arriens C, et al. Increased Risk of Progression to Lupus Nephritis for Lupus Patients with Elevated Interferon Signature [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10)
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8. Ding X, et al. IFN-I Mediates Lupus Nephritis From the Beginning to Renal Fibrosis. Front Immunol. 2021; 12: 676082
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10. Jayne D, et al. Phase II randomised trial of type I interferon inhibitor anifrolumab in patients with active lupus nephritis. Annals of the Rheumatic Diseases Published Online First: 10 February 2022. doi: 10.1136/annrheumdis-2021-221478
11. The Lupus Foundation of America. What is Lupus Nephritis? Available at: https://www.lupus.org/resources/what-is-lupus-nephritis [Last accessed: May 2022]
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18. López de Padilla CM, et al. The Type I Interferons: Basic Concepts and Clinical Relevance in Immune-mediated Inflammatory Diseases. Gene. 2016; 576 (101): 14-21.
19. Rönnblom L, et al. Interferon pathway in SLE: one key to unlocking the mystery of the disease. Lupus Sci Med. 2019; 6 (1): e000270.
20. Crow MK. Type I Interferon in the Pathogenesis of Lupus. J Immunol. 2014; 192 (12): 5459-5468.
21. ClinicalTrials.gov. Long Term Safety of Anifrolumab in Adult Subjects With Active Systemic Lupus Erythematosus (TULIP SLE LTE). https://www.clinicaltrials.gov/ct2/show/NCT02794285 [Last accessed: May 2022].
22. ClinicalTrials.gov. Subcutaneous Anifrolumab in Adult Patients With Systemic Lupus Erythematosus (Tulip SC). Available at: https://clinicaltrials.gov/ct2/show/NCT04877691 [Last accessed: May 2022]
23. AstraZeneca plc. Saphnelo (anifrolumab) approved in the US for moderate to severe systemic lupus erythematosus. Available at: https://www.astrazeneca.com/media-centre/press-releases/2021/saphnelo-approved-in-the-us-for-sle.html [Last accessed: May 2022]
Veeva ID: Z4-42561
Date of preparation: May 2022