Key points are not available for this paper at this time.
Background IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. However, the lack of direct comparative evidence between the emerging targeted therapies, budesonide enteric-coated (EC) capsule and telitacicept, creates uncertainty in clinical decision-making. This study aimed to conduct a head-to-head comparison of their efficacy in reducing proteinuria and preserving renal function, and to explore efficacy stratification based on baseline characteristics. Methods We conducted a single-center retrospective cohort study at Henan Provincial People’s Hospital, including 95 adults with biopsy-proven IgAN who initiated budesonide EC (n ;= ;46) or telitacicept (n ;= ;49) from January 2022 to December 2025. We assessed 6-month changes in 24-hour proteinuria and eGFR using linear mixed-effects models adjusted for prespecified baseline covariates—age, sex, time from biopsy to treatment, baseline proteinuria and eGFR, comorbidities, and concomitant medications. Findings were evaluated in six sensitivity analyses. Results In this selected cohort of 95 patients with biopsy-proven IgAN, the effect of treatment on proteinuria reduction was modified by baseline proteinuria level (interaction P = 0.003), with greater relative benefit of telitacicept observed at mild-to-moderate baseline proteinuria. This interaction remained significant in a propensity score–matched (PSM) analysis (p = 0.003). Budesonide EC was associated with a higher mean eGFR during follow-up in the primary model (β = 4.090 mL/min/1.73 m²; p = 0.018), though this association attenuated and lost statistical significance in the matched cohort (β = 5.022 mL/min/1.73 m²; p = 0.085). Conclusions The relative antiproteinuric effect of telitacicept versus budesonide EC may be modified by baseline proteinuria, with a possible trend toward greater benefit in patients with mild-to-moderate levels. In contrast, although budesonide EC was associated with higher mean eGFR during follow-up in the primary analysis, this difference attenuated after PSM and likely reflects baseline imbalance rather than a true differential effect on renal trajectory. These observations are limited by the retrospective design and residual confounding, and require confirmation in larger prospective studies.
Zuo et al. (Wed,) studied this question.