Telitacicept Add Glucocorticoids Versus Telitacicept Alone in the Treatment of IgA Nephropathy: A Real-World Study

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.