Weng Qinjie, Ouyang Yan, Chen Zijin, Jin Yuanmeng, Xu Jing, Liu Jian, Wang Zhaohui, Ma Jun, Shi Hao, Shen Pingyan, Li Xiao, Ren Hong, Xie Jingyuan
Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Institute of Nephrology, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Clin Kidney J. 2025 May 19;18(6):sfaf154. doi: 10.1093/ckj/sfaf154. eCollection 2025 Jun.
Immunoglobulin A nephropathy (IgAN) is one of the most common causes of primary glomerulonephritis that lacks a specific treatment option. This study aimed to evaluate the efficacy and safety of telitacicept in patients with IgAN.
We performed a retrospective analysis in 82 biopsy-proven IgAN patients with baseline estimated glomerular filtration rate (eGFR) >20 mL/min/1.73 m and proteinuria ≥1 g/day. Forty-one patients were treated with telitacicept and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB). They were divided into extended group (treated with telitacicept weekly for the first 6 months, then once every 2 weeks for the next 3-6 months) and short-term group (treated with telitacicept weekly for the first 6 months). The other 41 patients received ACEI/ARB alone and served as the ACEI/ARB group.
The mean percent change in proteinuria from baseline of extended group, short-term group and ACEI/ARB group were -56.8 ± 23.5% (< .01), -28.6 ± 65.6% (= .09) and -0.3 ± 57.0% at Month 12. eGFR decline in telitacicept groups were slower compared with the ACEI/ARB group. Univariate logistic regression analysis revealed only extended treatment (odds ratio = 4.3, 95% confidence interval 1.2-15.0, < .05), but not short-term treatment was significantly associated with proteinuria decrease (defined as reduction in urine protein by more than 50%) at 12 months. This association remained robust after adjusting for age, gender, baseline eGFR or proteinuria. Subgroup analysis showed that the effect of extended treatment on reducing urine protein was more pronounced than that of short-term treatment in patients with higher proteinuria (≥2 g/day), poorer renal function (eGFR<60 mL/min/1.73 m), or worse pathological changes (M1, E1, T1/T1 and C1/C2). The safety outcomes of telitacicept were similar to ACEI/ARB. No severe adverse events were reported in all groups.
Our study confirms that telitacicept has a definite proteinuria-lowering effect in IgAN. Extending the treatment duration from 6 months to 9-12 months further enhances its ability to reduce proteinuria.
免疫球蛋白A肾病（IgAN）是原发性肾小球肾炎最常见的病因之一，目前缺乏特异性治疗方案。本研究旨在评估泰它西普治疗IgAN患者的疗效和安全性。
我们对82例经活检证实的IgAN患者进行了回顾性分析，这些患者的基线估计肾小球滤过率（eGFR）>20 mL/min/1.73 m²且蛋白尿≥1 g/天。41例患者接受泰它西普联合血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）治疗。他们被分为延长治疗组（前6个月每周使用泰它西普，接下来3 - 6个月每2周使用一次）和短期治疗组（前6个月每周使用泰它西普）。另外41例患者仅接受ACEI/ARB治疗，作为ACEI/ARB组。
在第12个月时，延长治疗组、短期治疗组和ACEI/ARB组蛋白尿相对于基线的平均变化百分比分别为 -56.8 ± 23.5%（<0.01）、-28.6 ± 65.6%（=0.09）和 -0.3 ± 57.0%。与ACEI/ARB组相比，泰它西普组的eGFR下降更缓慢。单因素逻辑回归分析显示，仅延长治疗（比值比 = 4.3，95%置信区间1.2 - 15.0，<0.05），而非短期治疗，与12个月时蛋白尿减少（定义为尿蛋白减少超过50%）显著相关。在调整年龄、性别、基线eGFR或蛋白尿后，这种关联仍然显著。亚组分析表明，在蛋白尿较高（≥2 g/天）、肾功能较差（eGFR<60 mL/min/1.73 m²）或病理改变较差（M1、E1、T1/T1和C1/C2）患者中，延长治疗降低尿蛋白的效果比短期治疗更明显。泰它西普的安全性结果与ACEI/ARB相似。所有组均未报告严重不良事件。
我们的数据证实泰它西普对IgAN有明确的降低蛋白尿作用。将治疗时间从6个月延长至9 - 12个月可进一步增强其降低蛋白尿的能力。
