AstraZeneca’s Saphnelo (anifrolumab) has been recommended for marketing authorisation in the European Union (EU) as an add-on therapy for the treatment of adult patients with moderate to severe, active autoantibody-positive systemic lupus erythematosus (SLE), despite receiving standard therapy. SLE is a complex autoimmune condition that can affect any organ, and people often experience inadequate disease control, long-term organ damage and poor health-related quality of life. If approved, Saphnelo would be the first new treatment for SLE in Europe in more than a decade.

The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency based its positive opinion on results from the Saphnelo clinical development programme, including the TULIP Phase III trials and the MUSE phase II trial. In these trials, more patients treated with Saphnelo experienced a reduction in overall disease activity across organ systems and achieved sustained reduction in oral corticosteroid (OCS) use compared to placebo, with both groups receiving standard therapy.

Ian Bruce, Professor of Rheumatology at the University of Manchester, UK, and steering committee chair for the Saphnelo SLE clinical development programme, said, “Systemic lupus erythematosus is a complex and heterogeneous disease that can have a debilitating impact on a person’s quality of life. We need new treatments that are effective in reducing underlying disease activity for patients, particularly those who require higher doses of oral corticosteroids, which themselves can be damaging in the long-term. The anifrolumab clinical programme has provided compelling evidence that this medicine has the potential to be an important new option for patients.”

Mene Pangalos, executive vice president, BioPharmaceuticals R&D, AstraZeneca, said: “Saphnelo is a ground-breaking first-in-class medicine and offers physicians and patients a new way of treating systemic lupus erythematosus by targeting the type I interferon receptor, which is known to play a central role in lupus disease pathophysiology. This positive recommendation from the CHMP brings us one step closer to providing a much-needed new treatment option to improve outcomes for patients in Europe.”

The adverse reactions that occurred more frequently in patients who received Saphnelo in the three clinical trials included upper respiratory tract infection, bronchitis, infusion-related reactions and herpes zoster.

Saphnelo was recently approved in the US, Japan and Canada for the treatment of SLE, and regulatory reviews are ongoing in additional countries. The phase III trial in SLE using subcutaneous delivery has been initiated and additional phase III trials are planned for lupus nephritis, cutaneous lupus erythematosus and myositis.

AstraZeneca acquired global rights to Saphnelo through an exclusive license and collaboration agreement with Medarex, Inc. in 2004. The option for Medarex to co-promote the product expired on its acquisition by Bristol-Myers Squibb (BMS) in 2009. Under the agreement, AstraZeneca will pay BMS a low to mid-teens royalty for sales dependent on geography.

SLE is an autoimmune disease in which the immune system attacks healthy tissue in the body. It is a chronic and complex disease with a variety of clinical manifestations that can impact many organs and can cause a range of symptoms, including pain, rashes, fatigue, swelling in joints and fevers. There are approximately 250,000 people with SLE in Europe, and most are women diagnosed between the ages of 15 and 45. More than 50% of patients with SLE develop permanent organ damage, caused by the disease or existing treatments, which exacerbates symptoms and increases the risk of mortality. At least five million people worldwide have a form of lupus.

All three trials for Saphnelo (TULIP-1, TULIP-2 and MUSE) were randomised, double-blinded, placebo-controlled trials in patients with moderate to severe SLE who were receiving standard therapy. Standard therapy included at least one of the following: OCS, antimalarials and immunosuppressants (methotrexate, azathioprine or mycophenolate mofetil).

The pivotal TULIP (Treatment of Uncontrolled Lupus via the Interferon Pathway) phase III programme included two trials, TULIP-1 and TULIP-2, that evaluated the efficacy and safety of Saphnelo versus placebo. TULIP-2 demonstrated superiority across multiple efficacy endpoints versus placebo with both arms receiving standard therapy. In the trial, 362 eligible patients were randomised (1:1) and received a fixed-dose intravenous infusion of 300mg Saphnelo or placebo every four weeks. TULIP-2 assessed the effect of Saphnelo in reducing disease activity as measured by the BILAG-Based Composite Lupus Assessment (BICLA) scale. In TULIP-1, 457 eligible patients were randomised (1:2:2) and received a fixed-dose intravenous infusion of 150mg Saphnelo, 300mg Saphnelo or placebo every four weeks, in addition to standard therapy. The trial did not meet its primary endpoint based on the SLE Responder Index 4 (SRI4) composite measure.

The MUSE phase II trial evaluated the efficacy and safety of two doses of Saphnelo versus placebo. In MUSE, 305 adults were randomised and received a fixed-dose intravenous infusion of 300mg Saphnelo, 1,000mg Saphnelo or placebo every four weeks, in addition to standard therapy, for 48 weeks. The trial showed improvement versus placebo across multiple efficacy endpoints with both arms receiving standard therapy.

Results from the TULIP-2 phase III trial were published in The New England Journal of Medicine in January 2020, results from the TULIP-1 phase III trial were published in The Lancet Rheumatology in December 2019 and results from the MUSE phase II trial were published in Arthritis & Rheumatology in November 2016.

In SLE, along with the pivotal TULIP phase III programme, Saphnelo continues to be evaluated in a long-term extension phase III trial and a phase III trial assessing subcutaneous delivery. In addition, AstraZeneca is exploring the potential of Saphnelo in a variety of diseases in which type I interferon (type I IFN) plays a key role, including lupus nephritis, cutaneous lupus erythematosus and myositis.


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. Type I IFNs, such as IFN-alpha, IFN-beta and IFN-kappa, are cytokines involved in regulating the inflammatory pathways implicated in SLE. The majority of adults with SLE have increased type I IFN signalling, which is associated with increased disease activity and severity.