Real-world effectiveness of telitacicept in ebv-seropositive patients with systemic lupus erythematosus

Epstein-Barr virus (EBV) infection has been implicated in systemic lupus erythematosus (SLE), but its clinical relevance in the context of BAFF/APRIL pathway inhibition remains unclear. We evaluated the real-world effectiveness and laboratory-based tolerability of telitacicept in EBV-Reactivated patients with moderate-to-severe SLE.

In this single-center retrospective cohort study, patients with SLEDAI-2 K > 4 and evidence of EBV infection (EBNA-IgG or VCA-IgG seropositivity, or plasma EBV DNA > 50 IU/mL) received telitacicept or standard-of-care (SOC). Propensity score matching was performed to balance baseline characteristics. The primary outcome was attainment of lupus low disease activity state (LLDAS). Secondary outcomes included time to first LLDAS, cumulative glucocorticoid exposure, and longitudinal laboratory parameters.

A total of 136 patients were included (telitacicept n = 69; SOC n = 67). After matching, 69 telitacicept-treated and 48 SOC-treated patients were analyzed. Overall LLDAS attainment did not differ significantly between groups (37.7% vs 35.4%; P = 0.8). However, telitacicept was associated with a shorter time to first LLDAS ( log-rank P = 0.031) and lower cumulative prednisone-equivalent exposure at endpoint (P < 0.0001). In exploratory analyses, patients with EBV reactivation achieved LLDAS earlier than those with latent infection (log-rank P = 0.005). In multivariable Cox models, EBV DNA positivity and higher interferon-γ levels were independently associated with earlier LLDAS. No clinically meaningful laboratory abnormalities were observed.

In EBV-infected SLE, telitacicept was associated with earlier disease control and reduced glucocorticoid burden without apparent laboratory tolerability concerns. Prospective studies incorporating longitudinal virological monitoring are needed to confirm these findings. Key Points • EBV infection is common in SLE and may promote B‑cell activation, but treatment outcomes in this subgroup are poorly defined. • This study compared telitacicept versus standard care for effectiveness and laboratory tolerability in EBV‑positive moderate‑to‑severe SLE. • Telitacicept shortened time to LLDAS and reduced cumulative glucocorticoid exposure, despite similar LLDAS attainment rates. • EBV reactivation was associated with earlier disease control; no clinically significant laboratory abnormalities were observed.