Efficacy and Safety of Telitacicept for the Treatment of IgA Nephropathy Patients: A Retrospective Real-World Study

Background This real-world study aimed to evaluate the efficacy and safety of telitacicept in the treatment of immunoglobulin A nephropathy (IgAN). Methods Fifty-seven patients with biopsy-confirmed IgAN who received telitacicept between July 2022 and August 2025 were enrolled. Changes in urinary protein excretion, renal function, urinary red blood cell count, and adverse events were assessed from 2 to 12 months post-treatment. Subgroup analyses were performed based on baseline proteinuria levels and estimated glomerular filtration rate (eGFR). Changes in proteinuria and renal function following telitacicept discontinuation were also observed. Results Significant reductions in proteinuria were observed as early as 2 months into therapy, with median decreases in u rine albumin-to-creatinine ratio (UACR), urine protein-to-creatinine ratio (UPCR), and 24-hour urine protein excretion (24hUP) of 42.3%, 48.7%, and 56.2%, respectively (P < 0.0001). These reductions continued to progress, reaching approximately 80% at 12 months. eGFR and serum creatinine levels remained stable throughout the observation period. Concurrently, urinary red blood cell counts (U-RBC) decreased significantly, exhibiting a 92.7% reduction at month 12. Subgroup analysis indicated that patients across various baseline proteinuria levels and eGFR ranges benefited from the treatment, with those having baseline 24hUP between 1 and 3.5 g/day or an eGFR ≥ 45 mL/min/1.73 m² experiencing more pronounced efficacy. The overall adverse event (AE) rate was 7.0%, with no serious adverse events (SAEs) observed. The therapeutic effect persisted for up to 14 months after discontinuation of telitacicept. Conclusions Telitacicept provides a rapid and sustained reduction in proteinuria, stabilizes renal function, and demonstrates a favorable safety profile in patients with IgAN.