Efficacy and safety of telitacicept as an add-on therapy for relapsing lupus nephritis: a retrospective cohort study

Aim: This study aims to evaluate the efficacy and safety of telitacicept addition to standard therapy in adults with relapsing lupus nephritis (LN). Methods: From 2021 to 2024, patients with relapsing LN were identified and divided into two groups based on telitacicept administration. Laboratory indicators, renal remission status, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores, glucocorticoid dosages, and the incidence of renal flares were evaluated. Multivariate regression was used to assess the baseline predictors of complete renal remission (CRR) and adverse events (AEs) were recorded. Results: Compared to the standard therapy group (n=20), the proportion of patients who achieved a CRR and the primary efficacy renal response were significantly increased in the telitacicept group (n=20) at 6, 9, and 12 months, while the reduction rates of 24-hour urinary protein from baseline at 1, 3, and 9 months were significantly higher. The telitacicept group showed notable improvement in treatment responses in the median SLEDAI-2K score and glucocorticoid dose. Multivariate Cox regression analysis revealed that add-on telitacicept was associated with achieving early CRR. At the end of the follow-up period, the cumulative relapse rate in the telitacicept group was significantly lower than that in the standard treatment group, with no increase in the incidence of AEs. Conclusions: As an add-on therapy, telitacicept is associated with early disease remission in patients with relapsing LN with reduced disease activity, lower glucocorticoid dosage, and fewer relapses. It also showed a favorable safety profile.