Telitacicept, a novel fusion protein that targets B lymphocyte stimulator and a proliferation-inducing ligand, has been used in autoimmune diseases. However, the efficacy and safety of telitacicept combined with glucocorticoids (GCs) in the treatment of immunoglobulin A nephropathy (IgAN) remain unclear. We recruited a total of 71 IgAN patients who received telitacicept without concurrent immunosuppressive therapy. Among them, 40 patients who received telitacicept 160 mg weekly and had not received GCs within the previous 3 months were further analyzed. Patients treated with telitacicept alone formed the telitacicept-alone subgroup, while those who received telitacicept plus GCs formed the telitacicept + GC subgroup. The primary outcome was the change in 24-h proteinuria from baseline over time. The telitacicept + GC subgroup showed a greater reduction in mean proteinuria (-84.1%, IQR: -90.4% to -74.4%) compared with the telitacicept-alone subgroup (-71.4%, IQR: -88.5% to -33.5%; p = 0.043) at 6 months. The eGFR slightly increased with no significant difference (8.8% vs. 8.1%; p = 0.91). Both groups showed reductions in serum IgA, IgG levels, and the percentage of patients with hematuria. Urinary soluble CD163, a potential biomarker of disease activity, also significantly decreased following telitacicept treatment (-4.33 ng/mg; p = 0.001). No serious adverse events were reported. In conclusion, telitacicept combined with glucocorticoids may offer a greater reduction in proteinuria than telitacicept monotherapy in IgAN patients, with preserved renal function. These findings support potential benefit of adjunctive GC therapy in selected patients undergoing telitacicept treatment.
Yang et al. (Sat,) studied this question.