Efficacy and Safety of Telitacicept as Add-On Therapy to Oral Glucocorticoids in IgAN: Real-World Retrospective Study

Background: Telitacicept, a dual inhibitor of B cell activating factor and a proliferation-inducing ligand, has been shown to reduce proteinuria in patients with immunoglobulin A nephropathy (IgAN). However, its efficacy and safety when added to traditional oral glucocorticoids remain unclear. Methods: In this single-center retrospective study, patients with IgAN and persistent proteinuria (24-hour urine protein, 24-h UP ≥ 0.5 g/d or UPCR ≥ 0.5 mg/mg) or hematuria (urinary RBC count > 28 cells/μl), despite supportive therapy and with eGFR ≥ 15 ml/min/1.73 m2, were assigned to telitacicept plus oral glucocorticoids (with/without immunosuppressants, T+OG) or oral glucocorticoids (with/without immunosuppressants, OG) using propensity score matching (PSM) in a 1:1 ratio. The primary endpoints were the percentage changes in 24-h UP, UPCR, UACR, and urinary RBC count over the 24-week follow-up. Results: 52 patients were included in each group. At 24 weeks, the T+OG group showed a median reduction in 24-h UP of -65.33% (IQR -84.93 to -49.70), UPCR -66.94% (-81.18 to -51.77), UACR -75.13% (-84.37 to -56.76), and urinary RBC count -82.93% (-94.78 to -46.99), along with an increase in eGFR of 9.40% (0.78 to 26.17). In comparison, the OG group showed a reduction in 24-h UP of -63.11% (-79.22 to -32.61), UPCR -53.20% (-76.03 to -21.45), UACR -59.03% (-82.78 to -24.53), and urinary RBC count -71.13% (-87.91 to -36.14), with eGFR remaining stable. The incidence of adverse events (AEs) was lower in the T+OG group (26/52, 50.0%) compared to the OG group (47/52, 90.4%). No serious AEs were reported in either group. Conclusion: Telitacicept, when used as an add-on to oral glucocorticoids in IgAN, exhibited faster and greater reductions in proteinuria and hematuria, improved eGFR, and a favorable safety profile compared to oral glucocorticoid therapy. Funding: Government Support – Non-U.S.Percentage change in primary outcomes between the two groups during the follow-up period.