What is the difference between Benlysta and Saphnelo?

Both Benlysta and Saphnelo are targeted treatments that may be used to treat systemic lupus erythematosus (SLE) in addition to standard therapy. But their approved indications, recommended target age groups, and the way they work, differ. They are the only two medicines to have been approved to treat SLE since the 1950s.

Benlysta is approved to treat adults and children aged 5 years and older with active SLE including active lupus nephritis, whereas Saphnelo is only approved in adults with moderate to severe SLE without severe active lupus nephritis or CNS lupus.

Benlysta can be given as an intravenous infusion over 1 hour every 4 weeks in a healthcare provider's office or by self-administered subcutaneous injection weekly at home. Saphnelo is only available as an intravenous infusion that is administered over 30 minutes, every 4 weeks.

Benlysta and Saphnelo are both targeted treatments, but they target different parts of the immune system that are particularly overactive in lupus. Benlysta targets and blocks the activity of a type of white blood cell called a B cell, which produces antibodies that attack tissue, causing symptoms of SLE. It is classified as a B-lymphocyte stimulator (BLyS)-specific inhibitor. Saphnelo targets the type I interferon receptor and inhibits the activity of type 1 interferons. Activation of the interferon system is a common underlying characteristic of SLE that leads to the immune system being constantly “switched on”, contributing to SLE symptoms. Saphnelo is classified as a type 1 interferon receptor antagonist. Benlysta was first approved in 2011 and Saphnelo was approved in 2021.

Both Benlysta and Saphnelo can suppress your immune system, which means you should not receive any live vaccines, such as chickenpox and measles, mumps, and rubella (MMR) while receiving these medications.

Neither the IV form of Benlysta nor Saphnelo requires the use of premedications or additional laboratory tests to monitor side effects.

Which is more effective? Benlysta or Saphnelo?

It is difficult to determine if Benlysta or Saphnelo is better for SLE because they have not been compared in head-to-head trials. Both are likely good medications for SLE, and some patients may respond better to one drug than the other.

• Both lower disease activity, pain, and fatigue while improving quality of life.
• Both are well tolerated with few major side effects.
• A Saphnelo trial used the measurement called the BICLA (British Isles lupus assessment group-based Composite Lupus Assessment) tool to measure disease activity in 97 different body areas. Saphnelo decreased inflammation in all organ systems that had moderate to severe involvement.
• There is some evidence that people with low C3, low C4, or a high anti-dsDNA level may do better with Benlysta (Embrace trial), and certain antibodies (anti-Smith, anti-RNP, anti-Ro, anti-SSA, anti-La, anti-SSB) may cause high levels of interferon type 1 that Saphnelo may work better for.
• Saphnelo specifically treats SLE by decreasing the effects of a cytokine called interferon type-1.
• Benlysta has been shown to be safe and effective in 8 clinical trials.
• Benlysta is the only IV drug available to treat SLE in children as young as 5 years.
• Benlysta is the only biologic FDA-approved drug to treat lupus nephritis.
• Both Benlysta and Saphnelo are considered steroid-sparing drugs, meaning that steroid doses can be reduced in people with SLE taking Benlysta or Saphnelo.
• Benlysta has been available longer than Saphnelo and trials have shown it to be safe and effective when taken for at least 13 years.
• Saphnelo tends to be more expensive than IV Benlysta.
• Saphnelo can increase the risk of developing shingles.
• Neither should be used during pregnancy or breastfeeding.

Can you take Saphnelo and Benlysta together?

Benlysta and Saphnelo are both biologics, but because Saphnelo has not been studied in combination with other biologics, it is not recommended to be given with Benlysta.