Efficacy and Safety of Telitacicept Combined with Low-Dosage Corticosteroids for IgA Vasculitis Nephropathy in Adults

Background: Telitacicept effectively reduced proteinuria in patients with immunoglobulin A nephropathy(IgAN) by blocking BLyS and APRIL, which are critial for B-cell survival and autoantibody production. Considering the similar pathogenesis between IgAN and IgA vasculitis nephropathy (IgAVN), we explore the efficacy of telitacicept in treating IgAVN in adult patients. Methods: A retrospective study enrolled adult IgAVN patients admitted to the Department of Nephrology at Zhongshan Hospital, Fudan University, between July 2023 and March 2025. All patients received subcutaneous injections of telitacicept (160 mg/week or 240 mg/week) combined with low-dose oral prednisone (starting dose: 0.3–0.5 mg/kg/day, maximum dose: 30 mg/day) for at least 3 months. Results: 10 patients (60% male) with a mean age of 43 were included, with a median follow-up duration of 16 weeks. The median baseline urine protein was 0.95 g/24h and median eGFR was 92.0ml/min/1.73m2. There was a significant reduction of proteinuria at 12weeks and 16weeks, with mean reduction of -77.69% (-87.72, -32.62, p<0.05) and -85.26% (-90.59, -40.98, p<0.05) compared with baseline. Median 24h UP decreased from 0.95g at baseline to 0.24g at 12weeks(p=0.0236) and 0.26g at 16weeks(p=0.045). 6 patients achived complete remission at 12 weeks. Serum albumin was significant improved, with mean increase of 9.09% (2.22,15.15,p=0.0373) at 8weeks and 6.67% (5, 18.18,p=0.0226) at 16 weeks. The median eGFR remain stable between 92ml/min/1.73m2 at baseline and 101ml/min/1.73m2 at 20weeks. No severe adverse events were reported, with treatment-related injection site reactions occurring in 2 patients. Conclusion: Telitacicept combined with low-dose corticosteroids might be a promising treatment option for adult IgAVN patients.