Treatment outcomes and safety of telitacicept in reducing proteinuria and hematuria for refractory childhood IgA vasculitis nephritis

Abstract

IgA vasculitis nephritis (IgAVN) is one of the most prevalent glomerulopathies in children. However, therapeutic options remain constrained. This study endeavors to elucidate the efficacy and safety of telitacicept in IgAVN children. This study encompassed 19 biopsy-confirmed IgAVN children, who had previously received glucocorticoids with or without a secondary immunosuppressant, but still exhibited proteinuria. Participants received weekly subcutaneous injections of 80 mg. Clinical outcomes were evaluated. The median age telitacicept initiation of the patients was 13.42 years, and 12 (63.2%) were male during the 1-year follow-up. After 6 months of telitacicept treatment, the proteinuria, B lymphocyte count, IgA, and IgM levels were decreased compared to the baseline ( p < 0.05). The median proteinuria decreased from 1.72 g/day (IQR 1.03–4.45) at baseline to 0.63 g/day (IQR 0.22–1.65) at month 1 ( p = 0.01), 0.18 g/day (IQR 0.12–0.65) at month 3 ( p = 0.002), 0.16 g/day (IQR 0.08–0.27) at month 6 ( p < 0.0001), and 0.09 g/day (IQR 0.07–0.33) at month 9 ( p < 0.0001). Median eGFR remained stable. At month 9, serum albumin increased by 8.8 g/L (24.5%). Additionally, all participants demonstrated a significant decline in hematuria. No significant differences were observed in proteinuria and hematuria reductions across the three groups administered varying telitacicept dosages (1–1.5 mg/kg, 1.5–2 mg/kg, 2–2.6 mg/kg). Encouragingly, no serious adverse events were reported. Telitacicept is effective and safety for IgAVN children, suggesting its potential as a treatment option. Further large-scale studies are imperative to validate these findings.