Anifrolumab as Rescue Therapy in Life-Threatening, Infection-Complicated SLE: A Biomarker-Guided Case Beyond Trial Criteria

In a case study of a 45-year-old woman with severe, life-threatening systemic lupus erythematosus (SLE) complicated by infections, anifrolumab, an anti-IFNAR1 monoclonal antibody, was used as a rescue therapy. Despite previous treatments with cyclophosphamide and rituximab, her condition worsened, leading to multiple ICU admissions. Anifrolumab was initiated based on elevated CXCL10 levels indicating IFN-driven disease. Within two months, her mucocutaneous disease improved, and her hair fully regrew. Over 18 months, her clinical and serological markers normalized, and she achieved sustained remission without other immunosuppressive agents. This case highlights anifrolumab's potential as a rescue therapy for high-risk, IFN-driven SLE when traditional cytotoxic treatments are unsafe.