Clinical Efficacy of Telitacicept in the Treatment of IgA Nephropathy complicated by Diabetes Mellitus: A Case Report

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Clinical Efficacy of Telitacicept in the Treatment of IgA Nephropathy complicated by Diabetes Mellitus: 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

Immunoglobulin A nephropathy (IgAN) is one of the most prevalent primary glomerulonephritis globally, characterized by mesangial IgA deposition and driven by immune dysregulation. Traditional therapies involving glucocorticoids with or without immunosuppressive increase the risk of infection, osteoporosis, and glucose metabolism disturbances. Telitacicept, a novel biologic targeting both B lymphocyte stimulator(BLyS) and a proliferation-inducing ligand(APRIL), may mitigate disease progression by suppressing pathogenic IgA1 production. This case report from Xiangya Hospital of Central South University demonstrates the potential efficacy of telitacicept monotherapy in managing IgAN with comorbid diabetes mellitus (DM), a population at high risk for steroid-related complications.

Methods

We observed a 49-year-old male with poorly controlled DM(diagnosed over 10 years, complicated by diabetic retinopathy and peripheral neuropathy) presented with massive proteinuria, with the 24-hour urinary protein excretion (24-h UPE) of 9 g. The initial clinical diagnosis was diabetic nephropathy. Initial treatment with renin-angiotensin system inhibitors (allisartan isoproxil), sodium-glucose co-transporter 2 inhibitor (dapagliflozin) and nonsteroidal mineralocorticoid antagonist (finerenone) failed to reduce proteinuria (24-h UPE escalated to 29 g). Renal biopsy confirmed the diagnosis as IgAN (Lee’s classification: Grade III; Oxford classification: M1E1S1T0C1). To avoid glucocorticoid-induced hyperglycemia, telitacicept monotherapy was initiated at 240 mg subcutaneously weekly, later tapered to 160 mg weekly. Proteinuria, serum albumin, and safety markers were monitored monthly.

Results

After 9 months of telitacicept treatment, the patient’s 24-h UPE decreased from 29 g to 0.75 g, and serum albumin normalized from 24.1 g/L to 42.4 g/L. Immunoglobulin G levels remained within normal limits, and no infections, cytopenias, or glycemic exacerbations were observed. Figure 1 Renal biopsy findings. A: Hematoxylin-eosin staining (×40); B: Hematoxylin-eosin staining (×400); C: Immunofluorescence staining for IgA (×400); D: Electron microscopy (×1500). Figure 2 Changes in serum albumin, creatinine and 24-hour urinary protein during treatment.

Conclusion

This case highlights telitacicept’s dual advantages in IgAN with DM: significant proteinuria reduction without compromising glycemic control or increasing infection risk, offering a promising therapeutic option for such patients. Further randomized trials are warranted to validate its role as a steroid-sparing agent in this high-risk population.

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