Efficacy and Safety of Telitacicept in Refractory IgA Vasculitis Nephritis: A Real-World Retrospective Study

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Efficacy and Safety of Telitacicept in Refractory IgA Vasculitis Nephritis: A Real-World Retrospective Study

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Co-author 1

Jingyi Wu wujingyi0858@163.com Peking University First Hospital Renal Division, Peking University Institute of Nephrology Beijing China *

Co-author 2

Lijun Liu lijun.liu@aliyun.com Peking University First Hospital Renal Division, Peking University Institute of Nephrology Beijing China -

Co-author 3

Sufang Shi shisufang0510@163.com Peking University First Hospital Renal Division, Peking University Institute of Nephrology Beijing China -

Co-author 4

Qian Wang 1269073829@qq.com Affiliated Hospital of Hebei University Department of Nephrology Hebei China -

Co-author 5

Yanjie Liu yanjienoke0909@163.com Zibo Central Hospital Department of Nephrology Shandong China -

Co-author 6

Pei Chen glhrp@163.com Peking University First Hospital Renal Division, Peking University Institute of Nephrology Beijing China -

Co-author 7

Hong Zhang hongzh@bjmu.edu.cn Peking University First Hospital Renal Division, Peking University Institute of Nephrology Beijing China -

Co-author 8

Jicheng Lv jichenglv75@gmail.com Peking University First Hospital Renal Division, Peking University Institute of Nephrology Beijing China -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

IgA Vasculitis Nephritis (IgAVN) is frequent in children but less common in adults, where kidney involvement tends to be more severe. Treatment strategies are largely extrapolated from IgA nephropathy (IgAN) due to limited evidence. Given shared mechanisms, including galactose-deficient IgA1 immune complexes and B-cell activation, telitacicept, a dual BAFF/APRIL inhibitor, may provide therapeutic benefit.

Methods

We retrospectively analyzed 17 patients with biopsy-confirmed refractory IgAVN (11 adults, 6 children) treated with subcutaneous telitacicept between January 2023 and February 2025. All received RAAS inhibitors; some also received corticosteroids and/or immunosuppressants. The primary endpoint was proteinuria change over 12 months; secondary endpoints included eGFR, albumin, and hemoglobin. An exploratory meta-analysis pooled available case series.

Results

Over a median follow-up of 8 months, median proteinuria decreased from 2.3 g/d at baseline to 1.3 g/d at month 6 (P=0.042) and 0.9 g/d at month 12. Median relative reductions were 30.3% (month 3), 48.8% (month 6), and 60.7% (month 12) (all P<0.001). While adult patients had more severe baseline features (higher proteinuria, lower eGFR, more advanced pathology), proteinuria reduction was comparable between adults and children. Kidney function remained stable, and serum albumin, hemoglobin, and hematuria showed improvement. No treatment-related serious adverse events or discontinuations were observed. Meta-analysis (n=33) showed a pooled 6-month proteinuria reduction of 61.9% (P<0.0001). Figure 2. Changes in proteinuria levels from 12 months before to 12 months after baseline. A-B show the absolute values of proteinuria (g/day), while C-D display the percentage changes relative to baseline (month 0). A and C depict the overall population, and B and D show data stratified by age group (adults vs. children). All data are presented as median with interquartile range. Figure 4. Changes in albumin levels from 12 months before to 12 months after baseline. A-B show the absolute values of albumin (g/L), while C-D display the percentage changes relative to baseline (month 0). A and C depict the overall population, and B and D show data stratified by age group (adults vs. children). All data are presented as median with interquartile range. Figure 5. Changes in hemoglobin levels from 12 months before to 12 months after baseline. A-B show the absolute values of hemoglobin (g/L), while C-D display the percentage changes relative to baseline (month 0). A and C depict the overall population, and B and D show data stratified by age group (adults vs. children). All data are presented as median with interquartile range.

Conclusion

Telitacicept reduced proteinuria with good tolerability in both adult and pediatric IgAVN. These findings support its potential but require confirmation in larger prospective studies with long-term kidney outcomes.

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