B-cell-targeted therapy for systemic lupus erythematosus-associated warm autoimmune haemolytic anaemia: a real-world comparative cohort study

OBJECTIVES: To compare B-cell-targeted therapy with conventional glucocorticoid-based immunosuppression in first-episode systemic lupus erythematosus (SLE)-associated warm autoimmune haemolytic anaemia (AIHA). METHODS: We conducted a multicampus retrospective cohort study from 1 March 2020 to 1 February 2026. Eligible patients had SLE-associated warm AIHA, baseline haemoglobin <90 g/L and laboratory evidence of haemolysis. Treatment exposure was classified within 14 days of treatment initiation: conventional therapy or B-cell-targeted therapy with rituximab, belimumab or telitacicept. The primary outcome was 6-month overall response rate (ORR; complete or partial response). RESULTS: Of 246 SLE hospitalisation records screened, 70 patients were included; 27 received conventional therapy and 43 received B-cell-targeted therapy. The B-cell-targeted therapy group was younger and had higher baseline SLEDAI-2K scores. Six-month ORR was 89.7% with B-cell-targeted therapy and 85.7% with conventional therapy (OR 1.45, 95% CI 0.19-9.61; P = 0.687), with corresponding complete response rates of 61.5% and 42.9%. At 1 month, prednisone-equivalent dose was lower with B-cell-targeted therapy (40.0 vs 50.0 mg/day; P = 0.023). Twelve-month ORR was 89.3% with B-cell-targeted therapy and 73.7% with conventional therapy, and relapse-free survival did not differ significantly. Within 6 months, 13 inpatient-recorded adverse-event episodes, including fatal events, were documented. In telitacicept-treated patients (n = 7), all evaluable patients achieved ORR at 1, 3 and 6 months. CONCLUSIONS: Six- and 12-month ORR did not differ significantly between treatment strategies. The numerically higher complete response rate, more stable 12-month response and earlier glucocorticoid reduction with B-cell-targeted therapy, together with the telitacicept findings, are exploratory and require prospective validation.