Effects of telitacicept in SLE patients with antiphospholipid antibody positivity: a retrospective self-controlled case series.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.