Key points are not available for this paper at this time.
Background Immunoglobulin A nephropathy (IgAN) is a common immune-mediated kidney disease. Its pathogenesis involves dysregulated B cell activation, excessive production of galactose-deficient immunoglobulin A1 (Gd-IgA1), and formation of IgA immune complex, which collectively drive glomerular injury. Telitacicept, a fusion protein that blocks B cell activation pathways, may counteract these mechanisms, but observational data and reliable biomarkers of therapeutic response remain limited. Objective This study aimed to evaluate the clinical efficacy and safety of telitacicept and to determine whether changes in circulating B cell activating factor (BAFF), a proliferation-inducing ligand (APRIL), and Poly-IgA immune complex (Poly-IgA) reflect treatment response. Methods In this single-center retrospective cohort study, 38 adult patients with IgAN received telitacicept combined with low-dose glucocorticoids for up to 9 months. Clinical outcomes, renal function, and safety events were monitored longitudinally, and serum biomarkers were analyzed to assess associations with remission. Results Telitacicept treatment resulted in a substantial and sustained reduction in proteinuria while maintaining stable renal function, with over half of patients achieving complete or partial remission at 3 months. All three biomarkers reduced with treatment, and Poly-IgA showed the strongest correlation with clinical remission and the best ability to distinguish remission from non-remission. Conclusion Telitacicept is an effective and well tolerated drug in the treatment of IgAN, with immunomodulatory effects consistent with suppression of pathogenic B cell activity. The lower level of Poly-IgA during treatment is significantly associated with clinical remission.It may serve as a promising biomarker for monitoring treatment response in the future, supporting its potential use in guiding individualized therapy for patients with IgAN.
Fu et al. (Fri,) studied this question.