Zhou Liling, You Yong, Cai Shaozhe, Ye Cong, Dong Lingli
Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China.
Department of Rheumatology, Huanggang Central Hospital, Huanggang, 438000, Hubei, China.
Clin Rheumatol. 2025 May 3. doi: 10.1007/s10067-025-07411-1.
Antiphospholipid antibody (aPL) is closely related to the manifestation of antiphospholipid syndrome (APS) and an increased risk of thrombosis in systemic lupus erythematosus (SLE) patients. Telitacicept is a new dual B cell inhibitor which has been approved in China to treat SLE, but its application in APS or aPL-positive patients is still lacking. This study aimed to observe the effects of telitacicept in SLE patients with aPL positivity.
It is a retrospective self-controlled case series study on SLE patients with aPL positivity who received telitacicept at a Chinese medical center during June 2021 to March 2023. Demographical information, clinical and immunological characteristics, and aPL profiles were gleaned from the electronic medical records system, and response of aPL profiles to telitacicept treatment was analyzed.
Sixteen SLE patients were included. Eight of them were definite APS, and the other eight patients were aPL carriers. After 6 months of telitacicept administration, significant improvements were observed in parameters representing SLE disease activity, including SLEDAI-2 K, anti-dsDNA antibody levels, and complement levels. Meanwhile, we observed significant decreases in aPL levels that had not been previously reported. LAC normalized ratios significantly decreased from baseline after telitacicept treatment for 6 months (dRVVT: 1.86 (1.24, 2.80) vs. 1.44 (1.11, 1.94), P = 007; SCT: 1.76 (1.28, 3.23) vs. 1.36 (1.06, 2.01), P = 0.010). The titer of aCL IgG decreased from 196.6 (54.58, 328.85) to 90.20 (15.6, 202.20) CU, and anti-β2GPI IgG decreased from 828.70 (51.60, 2490.80) to 211.10 (18.40, 422.50) CU after 6 months of telitacicept treatment (P-value 0.005 and 0.013, respectively). Interestingly, a rebound tendency in aPL titers was observed after telitacicept withdrawal. No thrombosis events or pregnancy morbidities occurred, and no serious adverse events or death happened during treatment.
Telitacicept may be an effective and safe option for patients with persistent aPL. Further well-designed prospective cohort studies are needed to confirm these findings. Key Points • Telitacicept is effective to lower aPL titers and promote aPL seroconversion, which may provide potential for the application of telitacicept in APS by reducing aPL-related events. • No thrombosis events and serious adverse events happened in aPL-positive patients during telitacicept treatment.
抗磷脂抗体（aPL）与抗磷脂综合征（APS）的表现以及系统性红斑狼疮（SLE）患者血栓形成风险增加密切相关。泰它西普是一种新型双B细胞抑制剂，已在中国获批用于治疗SLE，但在APS或aPL阳性患者中的应用仍缺乏相关研究。本研究旨在观察泰它西普对aPL阳性SLE患者的影响。
这是一项回顾性自身对照病例系列研究，研究对象为2021年6月至2023年3月在中国某医疗中心接受泰它西普治疗的aPL阳性SLE患者。从电子病历系统中收集人口统计学信息、临床和免疫学特征以及aPL谱，并分析aPL谱对泰它西普治疗的反应。
纳入16例SLE患者。其中8例为确诊APS，另外8例为aPL携带者。泰它西普给药6个月后，代表SLE疾病活动的参数，包括SLEDAI-2K、抗双链DNA抗体水平和补体水平均有显著改善。同时，我们观察到aPL水平显著下降，这是此前未报道过的。泰它西普治疗6个月后，狼疮抗凝物（LAC）标准化比值较基线显著下降（稀释蝰蛇毒时间：1.86（1.24，2.80）对1.44（1.11，1.94），P = 0.007；白陶土部分凝血活酶时间：1.76（1.28，3.23）对1.36（1.06，2.01），P = 0.010）。泰它西普治疗6个月后，抗心磷脂IgG抗体滴度从196.6（54.58，328.85）降至90.20（15.6，202.20）磷脂单位，抗β2糖蛋白I IgG抗体滴度从828.70（51.60，2490.80）降至211.10（18.40，422.50）磷脂单位（P值分别为0.005和0.013）。有趣的是，泰它西普停药后观察到aPL滴度有反弹趋势。治疗期间未发生血栓事件或妊娠并发症，也未发生严重不良事件或死亡。
泰它西普可能是持续性aPL患者的一种有效且安全的选择。需要进一步设计良好的前瞻性队列研究来证实这些发现。要点：• 泰它西普可有效降低aPL滴度并促进aPL血清学转换，这可能通过减少与aPL相关的事件为泰它西普在APS中的应用提供潜力。• aPL阳性患者在泰它西普治疗期间未发生血栓事件和严重不良事件。
