Prospective analysis of B cell subset dynamics following telitacicept treatment in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease marked by B cell activation and autoantibody formation. Telitacicept, a dual inhibitor of the B cell pathway, neutralizes signals from B lymphocyte stimulator and a proliferation-inducing ligand. The aim of this study is to investigate the changes in detailed B cell subsets in SLE patients following Telitacicept treatment. Twenty active SLE patients (SLEDAI-2 K ≥ 6) were enrolled, with B cell subsets analyses and clinical assessments conducted at 0, 4, 12, and 24 weeks after initiating Telitacicept treatment. Additionally, B cell subsets were measured in 21 healthy controls. Flow cytometry was used to quantify B cell subsets. After six months of treatment, a 95% (19/20) SRI-4 response rate and a 35% (7/20) achievement of LLDAS were recorded. Compared to baseline, there were significant reductions in SLEDAI-2 K scores and anti-dsDNA levels (both p < 0.001), along with increases in complement C3 and C4 levels (both p < 0.001). Additionally, there was a significant decrease in 24-h urine protein levels (p = 0.004). B cell subset analysis revealed decreases in total B cells (p < 0.05), transitional B cells, naive B cells, and short-lived plasma cells (all p < 0.01). The proportion of B regulatory (Breg) cell increased (p < 0.05). Combining telitacicept with standard therapy induced significant changes in B cell subsets and clinical markers in SLE patients. The reduction in naive and transitional B cells, along with the restoration of Breg cell, suggests a potential positive influence on immunoregulatory capacity. Chineses Clinical Trials Registry; https://www.chictr.org.cn ; ChiCTR2400086874.