Fang Zeng, Yang Yang, Fei Tan, Yebei Li, Daijin Ren, Chengmin Cai, Jiang Wang, Wenjun Yan, Xiaojie Xie, Yu Wang, Lu Yi, Shizhang Xu, Dehui Liu, Gaosi Xu
Methods This retrospective, multicenter cohort study enrolled patients aged ≥ 18 years with biopsy-proven IgAN who were treated with telitacicept.
Background To investigate the efficacy and safety of telitacicept combined with glucocorticoid/mycophenolate mofetil (GM) versus telitacicept in the treatment of immunoglobulin A nephropathy (IgAN). Methods This retrospective, multicenter cohort study enrolled patients aged ≥ 18 years with biopsy-proven IgAN who were treated with telitacicept. All participants had a baseline eGFR ≥ 30 mL/min/1.73 m² and proteinuria excretion ≥ 0.75 g/day after receiving at least 1 month of optimized supportive treatment. Clinical data were collected over 9 months. Results A total of 256 patients were enrolled in the study, with 125 patients receiving telitacicept monotherapy and 131 patients receiving telitacicept plus GM therapy. The mean age was 39.5 ± 11.6 years, and 100 patients (39.1%) were male. At 9 months, the telitacicept + GM group showed a significantly greater reduction in proteinuria (-1.32 g/day versus -0.94 g/day, P < 0.001) and exhibited better eGFR slope (2.74 mL/min/1.73 m 2 /year versus -0.56 mL/min/1.73 m 2 /year, P = 0.014) compared to the telitacicept group. Similar reductions in urinary red blood cell count were observed in both groups, but the telitacicept + GM group exhibited a significantly greater median change at 9 months (-35.5/µL versus -9.0/µL, P = 0.009). Kaplan-Meier analysis revealed a significant benefit for the telitacicept + GM group over telitacicept monotherapy in both complete (54.2% vs. 40.8%, P = 0.005) and overall (78.6% vs. 70.4%, P = 0.014) remission rates. After adjusting for various factors, multivariable Cox regression analysis indicated a significantly higher likelihood of complete [adjusted HR 2.18 (95% CI 1.46-3.22), P < 0.001] and overall [adjusted HR 1.46 (95% CI 1.08-2.00), P = 0.013] remissions in the telitacicept + GM group at 9 months. Benefits were consistent across subgroups, with no significant interaction effects. Although the telitacicept + GM group was associated with a higher overall incidence of adverse events (28.2% versus 11.2%), no serious adverse events were reported in either group. Conclusion Telitacicept + GM regimen significantly reduced proteinuria and hematuria, maintained stable renal function in patients with IgAN, with no serious adverse events occurring.