Successful Treatment of Steroid-Dependent Mesangial Proliferative Glomerulonephritis with Telitacicept: A Case Report

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Successful Treatment of Steroid-Dependent Mesangial Proliferative Glomerulonephritis with Telitacicept: A Case Report

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Co-author 1

Hanwei Huang 238112215@csu.edu.cn Central South University Department of Nephrology, Xiangya Hospital Changsha China -

Co-author 2

Yuehua He yuehua0601@163.com Central South University Department of Nephrology, Xiangya Hospital Changsha China -

Co-author 3

Qiongjing Yuan yuanqiongjing@csu.edu.cn Central South University Department of Nephrology, Xiangya Hospital Changsha China -

Co-author 4

Lijian Tao taolj@csu.edu.cn Central South University Department of Nephrology, Xiangya Hospital Changsha China -

Co-author 5

Zhangzhe Peng pengzhangzhe@csu.edu.cn Central South University Department of Nephrology, Xiangya Hospital Changsha China *

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Introduction

To evaluate the efficacy of telitacicept combined with corticosteroid therapy for mesangial proliferative glomerulonephritis (MPGN).

Methods

We report a case of a 46-year-old male presenting with nephrotic syndrome. In January 2021, his urine protein-to-creatinine ratio (UPCR) was 5.49 g/g and serum albumin was 26.3g/L. Renal biopsy confirmed MPGN with diffuse mesangial electron-dense deposits and 35% foot process fusion. Sequential immunosuppressive therapies including rituximab(cumulative dose 3.2g), tacrolimus, cyclophosphamide (CTX) (cumulative dose 6.0g) and mycophenolate mofetil (MMF) showed limited efficacy. Full-dose methylprednisolone reduced proteinuria (the lowest UPCR 0.88 g/g) but tapering steroids resulted in proteinuria rebound (UPCR 1.25 g/g), indicating steroid dependence. Additionally, prolonged steroid use led to steroid-induce diabetes. Innovative combination therapy with telitacicept 80 mg weekly and methylprednisolone 20 mg daily was initiated in July 2024. Serial monitoring of proteinuria, serological markers, immunological profiles, and adverse events was performed.

Results

After eight weeks of treatment, the patient's UPCR dropped to 0.08 g/g. Although IgG levels decreased at the initial treatment, they remained within the relatively safe range after dose adjustment. Currently, glucocorticoid was successfully discontinued and the telitacicept dose is subsequently reduced to 80 mg every 4 weeks. The combined therapy achieved a rapid and sustained remission, with UPCR remaining at a low level. Importantly, no serious infections or disease relapses occurred during glucocorticoid tapering. The treatment process received by the patient and changes in indicators

Conclusion

This is the first report of telitacicept combined with glucocorticoid treatment for steroid-dependent MPGN, effectively alleviating clinical symptoms, reducing proteinuria and enabling a rapid glucocorticoid taper with minimal adverse effects. These results highlight telitacicept as a promising treatment option for steroid-dependent MPGN, warranting further randomized trials.

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