The Efficacy of Telitacicept in Lupus Nephritis: A Single-Center Retrospective Cohort Study

 

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The Efficacy of Telitacicept in Lupus Nephritis: A Single-Center Retrospective Cohort Study

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Yanna
Dou
Xiaojing Li 15896818790@163.com the First Affiliated Hospital of Zhengzhou University Department of Nephrology Zhengzhou China -
Yuanhe Li 15896818790@163.com the First Affiliated Hospital of Zhengzhou University Department of Nephrology Zhengzhou China -
Xiaoyang Wang 15896818790@163.com the First Affiliated Hospital of Zhengzhou University Department of Nephrology Zhengzhou China -
Yanna Dou douyanna1982@126.com the First Affiliated Hospital of Zhengzhou University Department of Nephrology Zhengzhou China *
Zhanzheng Zhao 15896818790@163.com the First Affiliated Hospital of Zhengzhou University Department of Nephrology Zhengzhou China -
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Telitacicept has shown potential effect in the treatment of lupus nephritis (LN). It reduces corticosteroid dosage, improves renal response rates, and preserves renal function. These effects lead to better kidney outcomes. However, most existing studies on telitacicept for LN, both domestically and internationally, are small-scale, short-duration, non-comparative observational studies or case reports.

The patients with telitacicept using (80/160 mg, once weekly, subcutaneously) plus standard therapy (glucocorticoids, hydroxychloroquine, with or without immunosuppressants) were enrolled in the telitacicept group. The control group included patients receiving standard therapy alone. Clinical data were collected at 1, 3, 6, 12, 18, and 24 months. Renal response rates and adverse events were compared between the groups.

A total of 128 patients with lupus nephritis participated in this study. In the Telitacicept group [n=64; 12 (18.2%) male; mean age 35.3 ± 11.8 years; mean follow-up 15.8 ± 6.4 months; 55 patients (86%) underwent renal biopsy, with histological classifications as follows: Type II n=1 (2%), Type III n=9 (16%), Type IV n=20 (36%), Type V n=2 (4%), Type III+IV n=2 (4%), Type IV+V n=16 (29%), Type III+V n= (9%)]. And in the standard therapy group [n=64; 15 (23.4%) male; mean age 35.0 ± 11.9 years; mean follow-up 17.7 ± 6.5 months; 62 patients (97%) underwent renal biopsy, with classifications as follows: Type II n=2 (3%), Type IV n=20 (32%), Type V n=8 (13%), Type IV+V n=24 (39%), Type III+V n=8 (13%)] completed at least 6 months of treatment. The Baseline characteristics, including age, sex, follow-up time, 24-hour proteinuria, glucocorticoid dose, white blood cell count, hemoglobin, platelet count, complement C3, complement C4, albumin, creatinine, estimated glomerular filtration rate (eGFR), positivity rate for anti-dsDNA antibody, and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, were well balanced between the two groups (p > 0.05). At the final follow-up, the telitacicept group showed higher rates of complete renal response (35.9% vs. 26.6%, p >0.05) and overall renal response (56.3% vs. 37.5%, p<0.05) compared to the standard therapy group. A significant reduction in 24-hour proteinuria from baseline was observed in the telitacicept group as early as 3 months (p<0.05), whereas this reduction in the control group occurred at 6 months. At the final follow-up, 24-hour proteinuria decreased from 2.64 g [IQR 1.12–4.05] to 0.31 g [IQR 0.13–0.95] (p =0.033) in the telitacicept group, and from 2.32 g [IQR 1.19–4.35] to 0.34 g [IQR 0.13–0.92] (p =0.013) in the standard therapy group. The eGFR remained stable in the telitacicept group (baseline: 91.30 ± 56.70 mL/min/1.73 m²; 12 months: 114.68 ± 29.09 mL/min/1.73 m²; 24 months: 113.75 ± 23.91 mL/min/1.73 m²), with no statistically significant difference compared to the standard therapy group (p>0.05). Glucocorticoid dosage was significantly reduced in both groups over time (p <0.05). Levels of complement C3 and C4 increased from baseline (p <0.05), while erythrocyte sedimentation rate decreased (p <0.05) in both groups. Renal relapse occurred in 4 patients (6%) in the telitacicept group and 10 patients (16%) in the standard therapy group (p>0.05). The incidence of adverse events was 26.56% in the telitacicept group and 53.13% in the control group, with infections—mainly respiratory and skin infections—being the most common. No serious adverse events, including deaths, were reported.

The Telitacicept combined with standard therapy improves renal response rates and helps maintain stable renal function in patients with LN, demonstrating an advantage in reducing proteinuria.

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