ANIFROLUMAB-FNIA

Guidelines for Use

GUIDELINES FOR USE

INITIAL CRITERIA (NOTE: FOR RENEWAL CRITERIA SEE BELOW)

Our guideline named ANIFROLUMAB-FNIA (Saphnelo) requires the following rule(s) be met for approval:

1. You have moderate to severe systemic lupus erythematosus (SLE: a type of immune condition)
2. You are 18 years of age or older
3. You are receiving standard SLE therapy (such as oral corticosteroids, antimalarials, or immunosuppressants)
4. You will NOT use Saphnelo concurrently (at the same time) with another systemic biologic (such as Benlysta [belimumab]) or targeted small molecules (such as JAK [Janus kinase] inhibitor, PDE-4 [phosphodiesterase-4] inhibitor) for the treatment of systemic lupus erythematosus

RENEWAL CRITERIA

Our guideline named ANIFROLUMAB-FNIA (Saphnelo) requires the following rule(s) be met for renewal:

1. You have moderate to severe systemic lupus erythematosus (SLE: a type of immune condition)
2. You have shown clinical improvement while on Saphnelo
3. You will NOT use Saphnelo concurrently (at the same time) with another systemic biologic (such as Benlysta [belimumab]) or targeted small molecules (such as JAK [Janus kinase] inhibitor, PDE-4 [phosphodiesterase-4] inhibitor) for the treatment of systemic lupus erythematosus