Telitacicept Versus Mycophenolate Mofetil in IgA Nephropathy: A Real-World Comparative Study of Efficacy, Renal Outcomes, and Safety

Abstract Background This study aimed to evaluate the efficacy and safety of telitacicept versus mycophenolate mofetil (MMF) in high risk progressive IgAN. Methods This retrospective, multicentre cohort study included patients with high-risk progressive IgAN who received telitacicept or MMF therapy, both combined with low-dose steroids. Clinical data were collected from treatment initiation to 12 months. Results A total of 104 patients were included, with 56 receiving MMF and 48 receiving telitacicept. The average age was 36.9 ± 11.8 years. Baseline characteristics were well-balanced between groups, except for serum albumin, uric acid, and tubular pathology based on the Oxford classification, which showed significant differences. At 12 months, telitacicept plus low-dose steroids demonstrated superior proteinuria reduction (−62.5% vs. −52.9%, P = 0.041) and stabilized renal function (4.1% improvement in eGFR vs. 5.3% decline with MMF, P = 0.085). Telitacicept plus low-dose steroids achieved higher complete remission rates (33.3% vs. 16.1%, P = 0.04) and significantly lower non-response rates (29.2% vs. 48.2%, P = 0.048) compared to MMF plus low-dose steroids. Cumulative remission rates (complete + partial) favored telitacicept at all timepoints, with the largest difference at 12 months. Notably, telitacicept required substantially lower cumulative glucocorticoid doses (P 0.001) and exhibited a superior safety profile, with significantly fewer adverse events (22.9% vs. 42.9%, P = 0.032) and no serious complications reported. Multivariable analysis indicated telitacicept was associated with a higher likelihood of achieving 12-month complete remission (adjusted HR = 6, 95%CI:1.41∼25.62). Conclusions Telitacicept may offer preferable efficacy compared to MMF for proteinuria reduction in high-risk IgA nephropathy patients, while reducing combined glucocorticoid requirements and demonstrating a more favorable safety profile. These advantages position it as a promising therapeutic option, warranting further randomized validation.