Anifrolumab

• While taking anifrolumab you must see your rheumatologist regularly to ensure the treatment is working and minimise any possible side effects. 
• You should have regular blood tests as suggested by your rheumatologist 
• If you are worried about any side effects you should contact your rheumatologist as soon as possible. 
• It is important to tell your doctor if you develop any infections including shingles while taking anifrolumab.
• If you are taking anifrolumab and plan to become pregnant you must discuss the timing with your doctor. 

You may notice improvements in skin disease and reduction in joint pain, stiffness, and swelling within the first 12 weeks of starting.  Your doctor may be able to gradually reduce the dose of steroids if you are currently taking this medication.

Continue with your treatment unless advised by your doctor or unless side effects develop (see Side effects). If you stop anifrolumab for any reason you must contact your doctor.

Regular clinical examinations and blood tests will be required during your treatment to monitor your condition and to determine the effectiveness of treatment. If you have an active infection then please see your doctor to have this treated as soon as possible. 

Anifrolumab is given as an intravenous infusion at a dose of 300mg every 4 weeks. The dosage and frequency may change however this will be determined by your rheumatologist.

Anifrolumab can be taken with other lupus medications including steroids. Anifrolumab cannot be used with other bDMARDs.

Anifrolumab has been given for up to 48 weeks in clinical trials. Your response will be regularly monitored by your rheumatologist. 

You might experience side effects with your treatment. Contact your doctor if you have any concerns about possible side effects. Many side effects disappear when anifrolumab is discontinued. 

Most common possible side effects

The most common side effects with anifrolumab include:

• Upper respiratory tract infections
• Nasopharyngitis 
• Infusion-related reaction
• Bronchitis
• Herpes zoster (7.2%)

Clinical trials showed that all cases of herpes zoster presented as skin manifestations and resolved without discontinuation of anifrolumab.   

Less common or rare possible side effects

The serious side effects with anifrolumab include:

• Pneumonia which can lead to death
• Non-opportunistic serious infections (2.8%)
• Worsening of SLE characterised by flares
• Infusion related hypersensitivity reaction (1.1%)

It is still unclear from research if there is an increased risk of cancer from anifrolumab.  

Infections

Anifrolumab will not be given if you have an active infection. Due to the risks associated with infection the following tests may be conducted prior to starting anifrolumab:

• Blood tests for hepatitis B and C, chicken pox, and tuberculosis
• Chest X-ray
• HIV tests for those who are at risk for this infection.

Vaccines

• If you are on anifrolumab it is recommended you should not be immunised with ‘live’ vaccines such as MMR (measles, mumps and rubella), OPV (oral polio virus), BCG (Bacillus Calmette Guerin) or yellow fever vaccine. Talk with your rheumatologist before receiving any vaccines.
• The Zostavax is also another live vaccine given for the prevention of shingles and should not be given while taking anifrolumab. The Shingrix vaccine however is the inactivated version and is safe to be given prior or during anifrolumab therapy.  
• Pneumococcal, the yearly seasonal flu and COVID vaccinations are safe and encouraged whilst on anifrolumab.

More information is available on Vaccinations in Rhematology and COVID-19 vaccination.

Cancer risk

• The impact of anifrolumab on the potential development of cancer is unknown.  Caution should be taken when considering the use of anifrolumab if you have a history of cancer. 
• For general cancer prevention, stopping smoking and taking skin cancer prevention measures are recommended. It is important to use sunscreen and avoid prolonged sun exposure. A yearly skin check is recommended.
• Talk to your doctor if you have any concerns about issues relating to cancer risk.

Use with other medications

• Anifrolumab can interact with other medications. 
• You should tell your doctor (including your general practitioner, rheumatologist, and other health professionals) about all medications you are taking, including herbal and naturopathic medications. This includes over-the-counter medications.

Use with alcohol

• You may drink alcohol while taking anifrolumab. However, if you are also taking other medications such as methotrexate then you need to be cautious with your alcohol intake. 
• To reduce the risk of harm from alcohol related disease the NHMRC recommend consuming no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. 

Use in pregnancy and when breastfeeding

• There is insufficient data about the possible side effects of anifrolumab on the unborn baby. If you plan to become pregnant it is important to discuss this with your doctor and ensure that the SLE is under control. 
• There is limited data on anifrolumab use during breastfeeding, however there is likely to be minimal absorption by the infant. Please speak to your rheumatologist for more information.  
• More information on pregnancy is available here.