Efficacy and safety of telitacicept in IgA nephropathy: real-world study outcomes

Immunoglobulin A nephropathy (IgAN) is one of the most common causes of primary glomerulonephritis that lacks a specific treatment option. This study aimed to evaluate the efficacy and safety of telitacicept in patients with IgAN.

We performed a retrospective analysis in 82 biopsy-proven IgAN patients with baseline estimated glomerular filtration rate (eGFR) >20 mL/min/1.73 m² and proteinuria ≥1 g/day. Forty-one patients were treated with telitacicept and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB). They were divided into extended group (treated with telitacicept weekly for the first 6 months, then once every 2 weeks for the next 3-6 months) and short-term group (treated with telitacicept weekly for the first 6 months). The other 41 patients received ACEI/ARB alone and served as the ACEI/ARB group.

The mean percent change in proteinuria from baseline of extended group, short-term group and ACEI/ARB group were -56.8 ± 23.5% (P < .01), -28.6 ± 65.6% (P = .09) and -0.3 ± 57.0% at Month 12. eGFR decline in telitacicept groups were slower compared with the ACEI/ARB group. Univariate logistic regression analysis revealed only extended treatment (odds ratio = 4.3, 95% confidence interval 1.2-15.0, P < .05), but not short-term treatment was significantly associated with proteinuria decrease (defined as reduction in urine protein by more than 50%) at 12 months. This association remained robust after adjusting for age, gender, baseline eGFR or proteinuria. Subgroup analysis showed that the effect of extended treatment on reducing urine protein was more pronounced than that of short-term treatment in patients with higher proteinuria (≥2 g/day), poorer renal function (eGFR<60 mL/min/1.73 m²), or worse pathological changes (M1, E1, T1/T1 and C1/C2). The safety outcomes of telitacicept were similar to ACEI/ARB. No severe adverse events were reported in all groups.

Our study confirms that telitacicept has a definite proteinuria-lowering effect in IgAN. Extending the treatment duration from 6 months to 9-12 months further enhances its ability to reduce proteinuria.