Telitacicept for IgA nephropathy: a systematic review and meta-analysis of observational studies

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Background Telitacicept, a dual BAFF/APRIL inhibitor, is a potential targeted therapy for IgA nephropathy (IgAN), but its real-world efficacy and safety remain unclear. Methods We systematically searched PubMed, Embase, Cochrane Central, ClinicalTrials.gov , CNKI, Wanfang, VIP, and SinoMed from inception to 2 March 2026 for observational studies of telitacicept in biopsy-confirmed IgAN. Eligible studies compared telitacicept monotherapy or telitacicept-based combination therapy with other immunosuppressive treatments. Outcomes included complete remission (CR), changes in 24-h urinary protein (Δ24hUPQ), estimated glomerular filtration rate (ΔeGFR), serum creatinine (ΔScr), albumin (ΔAlb), and adverse drug reactions (ADRs). Odds ratios (ORs) and mean differences (MDs) were pooled. Results Eight observational studies involving 459 patients were included. Compared with other immunosuppressive therapies, telitacicept monotherapy showed no statistically significant differences in CR, Δ24hUPQ, ΔeGFR, ΔScr, and ΔAlb. Similarly, telitacicept-based combination therapy did not show statistically significant differences in CR, Δ24hUPQ, ΔeGFR, ΔScr, and ΔAlb. In terms of safety, telitacicept monotherapy was associated with a significantly lower incidence of ADRs than control treatments (OR 0.37, 95% CI 0.20–0.67). The certainty of evidence ranged from moderate to very low across outcomes. Conclusions Current observational evidence suggests that telitacicept has a favorable safety profile and may offer clinical benefit in IgAN, particularly as a well-tolerated therapeutic option. Although superiority in efficacy outcomes was not statistically confirmed, the overall direction of effect tended to favor telitacicept in several analyses. Larger high-quality prospective studies are needed to further clarify its therapeutic value. Systematic review registration The study was registered in the PROSPERO database (CRD420261296245), https://www.crd.york.ac.uk/PROSPERO/recorddashboard .