Effectiveness and safety of belimumab and telitacicept in active systemic lupus erythematosus: a retrospective cohort study

Direct comparative evidence on the effectiveness of telitacicept versus belimumab in active systemic lupus erythematosus (SLE) remains limited. This study aimed to compare their effectiveness and safety in patients with active SLE.

This retrospective cohort study included 91 patients with active SLE treated at Affiliated Hospital of Nantong University between July 2021 and June 2024. Eligible patients received conventional therapy and were treated with belimumab (n=45) or telitacicept (n=46) for 24 weeks. Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. The primary outcome was the proportion of patients achieving LLDAS at week 24.

Telitacicept was associated with significantly better outcomes than belimumab in achieving LLDAS at week 24 (30.92% vs. 11.35%, P = 0.026) and SRI-4 responses at weeks 12 and 24 (both P < 0.01). The steroid-sparing effect also favored telitacicept, as evidenced by higher proportions of patients achieving prednisone reduction to ≤5 mg/d (40.99% vs. 18.72%, P < 0.05) and ≤7.5 mg/d (52.14% vs. 27.25%, P < 0.05). Additionally, telitacicept led to a significantly greater reduction in SLEDAI-2K score from baseline at both time points. In contrast, no significant between-group differences were observed in serological indicators. In exploratory multivariable analysis, telitacicept treatment (OR 4.975, P = 0.006), higher SLEDAI-2K score (OR 1.316, P = 0.016), and shorter disease duration (OR 0.914, P = 0.031) were independently associated with SRI-4 response at week 24. Both treatments showed numerically low adverse event rates, with no serious events reported.

Telitacicept was associated with higher weighted response rates than belimumab in this single-center retrospective cohort of patients with active SLE after the reported adjustment.