Telitacicept + SoC in proliferative LN: A real-world, retrospective study

Results from a real-world, retrospective study evaluating telitacicept, a dual inhibitor of B-cell activating factor (BAFF) and proliferation-inducing ligand (APRIL), combined with standard of care (SoC; n = 56) vs SoC alone (n = 56) as induction therapy in patients with proliferative lupus nephritis (LN) were published in Lupus Science & Medicine by Tian et al. Proliferative LN was defined as International Society of Nephrology/Renal Pathology Society (ISN/RPS) Class III/IV ± Class V. Endpoints included complete renal response (CR) rate, partial renal response (PR) rate, and no renal response (NR) rate. 

Key data: At Week 24, the telitacicept + SoC group achieved significantly higher CR (67.9% vs 39.3%; p = 0.004) and PR (83.9% vs 67.9%; p = 0.023) rates, and significantly lower NR rates (14.3% vs 32.1%; p = 0.044) vs SoC alone; a significant difference in CR (p < 0.001) was observed from Week 12. By Week 52, the CR rates were 84.1% vs 63.0% (p = 0.036), the PR rates were 93.2% vs 81.5%, and the NR rates were 6.8% vs 18.5% (p = 0.134) with telitacicept + SoC vs SoC alone. Multivariate Cox regression identified telitacicept as an independent predictor of CR (hazard ratio [HR], 4.43; 95% confidence interval [CI], 2.25–8.73; p < 0.001). Median glucocorticoid (GC) dose was lower in the telitacicept + SoC vs SoC alone at Week 12 (20 mg/day vs 40 mg/day; p < 0.001), Week 24 (10 mg/day vs 25 mg/day; p < 0.001), and Week 52 (7.5 mg/day vs 10 mg/day; p < 0.001). Overall, 19.6% of patients receiving telitacicept + SoC experienced adverse events (AEs) vs 30.4% receiving SoC alone. 

Key learning: In a real-world study, adding telitacicept to SoC was associated with improved renal response rates and facilitated faster GC tapering during induction therapy in patients with proliferative LN, warranting further investigation.