The purpose of the SUNFLOWER study is to describe clinical outcomes, including DORIS remission, achieved following the initiation of anifrolumab 120 mg SC once weekly (QW) as add-on therapy to an anti-malarial, with or without GC; in patients not in LLDAS at enrolment. Patients will be naïve to any prior conventional immunosuppressant including prior biologic therapy at enrolment. The study will also employ a tapering protocol for a systematic approach to GC tapering, seeking to understand better the proportion of patients in remission who can successfully withdraw chronic GC completely.
In this study, approximately 275 participants will be enrolled and the study duration will be up to approximately 69 weeks, including: A Screening Period lasting up to 35 days and A 52-week treatment period. Also, participants not continuing treatment with any preparation of anifrolumab after Week 52 will have additional safety follow up 12 weeks after last dose of anifrolumab. Anifrolumab will be administered SC via an aPFS during the 52-week Study. The study population will comprise participants taking antimalarial with or without GCs (there is a recruitment cap of 50% of patients not on GC at baseline) who are IS-naïve and biologic-naïve and are not meeting LLDAS criteria, described by the following cohorts: * Clinical SLEDAI 2K ≥4 points regardless of GC dose and disease duration. * Clinical SLEDAI-2K \< 4 with GC ≥ 7.5 mg/day for \> 5 weeks. After receiving the first dose of anifrolumab (week 0), the participant is allowed to increase the GC dose up until week 4, based on the investigator's recommendation. Between week 5 and week 40, participants taking \>5 mg/day GC dose at study entry will attempt a protocolized taper to 5 mg/day over 12 weeks. Participants achieving DORIS remission for 2 consecutive visits will attempt complete withdrawal of GC following a 12-week tapering regimen. Starting week 41 until the end of the study (week 52), there will be no further reduction of GC dose.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
245
Patients will receive Anifrolumab subcutaneous
Research Site
Anniston, Alabama, United States
WITHDRAWNResearch Site
Birmingham, Alabama, United States
NOT_YET_RECRUITINGResearch Site
Phoenix, Arizona, United States
NOT_YET_RECRUITINGResearch Site
Tucson, Arizona, United States
NOT_YET_RECRUITINGAttainment of DORIS remission
Proportion of participants who are in DORIS remission at Week 52 will be assessed. DORIS remission is defined as Clinical SLEDAI-2K (sum of all SLEDAI-2K items except for increased deoxyribonucleic acid \[DNA\] binding and low complement) = 0; PGA \[0-3\] \< 0.5, prednisone 5 mg/day or less, and stable antimalarials, ISs, and biologics.
Time frame: At Week 52
To assess the attainment of low level disease activity
Proportion of participants who are in LLDAS, or LLDAS-5 at Week 28 and 52 will be assessed. Low level disease activity as measured by LLDAS and LLDAS 5 * LLDAS criteria: SLEDAI 2K ≤ 4 without major organ involvement, no new disease activity, PGA ≤ 1 (0 - 3), prednisone 7.5 mg/day or less, and permitted use of the following medications: antimalarials, standard maintenance doses of ISs including biologics * LLDAS-5 criteria: SLEDAI-2K ≤ 4 without major organ involvement, no new disease activity, PGA ≤ 1 (0 - 3), prednisone 5.0 mg/day or less (this is modified LLDAS to include EULAR 2023 recommendations to lower daily maintenance GC ≤ 5.0 mg/day)
Time frame: At Week 28 and 52
Time spent in DORIS remission, LLDAS or LLDAS-5
Time spent in DORIS remission, LLDAS or LLDAS-5 for participants initiated on anifrolumab will be measured.
Time frame: At Week 52
Sustaining DORIS remission, LLDAS or LLDAS-5
The proportion of participants initiated on anifrolumab, sustaining DORIS remission, LLDAS or LLDAS-5 through to Week 52 will be measured.
Time frame: All subsequent visits including 52 Week
Sustaining DORIS remission, LLDAS or LLDAS-5
The proportion of participants initiated on anifrolumab, sustaining DORIS remission, LLDAS or LLDAS-5 for three or more consecutive visits will be measured. Consecutive visits' are defined as three back-to-back completed visits.
Time frame: At 3 consecutive visits occurring every 4 weeks during the 52 Week study
Time to attain and sustain DORIS, or LLDAS, or LLDAS-5
The time to attain and sustain DORIS, or LLDAS, or LLDAS-5 will be analyzed.
Time frame: Through Week 52
Daily GC dose
The daily GC dose at Week 40 and 52 in participants initiated on anifrolumab alongside a systematic approach to GC tapering and to assess the maintenance of this GC reduction through Week 52 will be assessed.
Time frame: At Week 40 and Week 52
Reduction in GC use
The reduction in GC use from Week 4 to Week 40 in participants initiated on anifrolumab alongside a systematic approach to GC tapering will be assessed
Time frame: From Week 4 to Week 40
Maintenance of reduction in GC dose
Maintenance of this percent reduction in GC dose through Week 52 will be assessed
Time frame: During 52 Week
Cumulative GC dose
The cumulative GC dose from Week 0 to Week 52 in participants initiated on anifrolumab alongside a systematic approach to GC tapering will be assessed.
Time frame: Week 0 to Week 52
Attainment of DORIS-0
Proportion of participants who attain DORIS-0 from baseline over 52 weeks. DORIS-0 is defined as DORIS criteria with prednisone 0 mg daily.
Time frame: From baseline over 52 Weeks
Time to first moderate-to-severe flare
Time to first moderate-to-severe flare through to Week 52 assessed based on MFI. Moderate-to-severe flare is defined as any one criterion present in the moderate or severe flare categories within the MFI will be assessed.
Time frame: Through Week 52
Change in active skin manifestations
The change in active skin manifestations of SLE measured by CLASI activity score in participants initiated on anifrolumab will be assessed.
Time frame: At Week 4, Week 16, and Week 52
Change in joint activity
The average change in number of active joints (swollen and tender joints) in participants initiated on anifrolumab compared to baseline will be assessed
Time frame: At Week 28 and 52
Change in QoL and fatigue
Change in QoL and fatigue in participants initiated on anifrolumab will be assessed using FACIT-F.
Time frame: At 52 Week
Adverse Events
Safety and tolerability of anifrolumab will be assessed.
Time frame: Up to 52 Weeks
Change in QoL and fatigue
Change in QoL and fatigue in participants initiated on anifrolumab will be assessed using PROMIS Lupus.
Time frame: At 52 Week
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Research Site
Fontana, California, United States
NOT_YET_RECRUITINGResearch Site
La Jolla, California, United States
NOT_YET_RECRUITINGResearch Site
La Palma, California, United States
RECRUITINGResearch Site
Menifee, California, United States
RECRUITINGResearch Site
San Leandro, California, United States
RECRUITINGResearch Site
Temecula, California, United States
RECRUITING...and 97 more locations