Efficacy and safety of telitacicept in IgA nephropathy and IgA vasculitis nephropathy in adolescents: a case series.

Background: IgA nephropathy (IgAN) and IgA vasculitis nephritis (IgAVN) are among the most common glomerulopathies in adolescents, yet treatment options remain limited. Telitacicept (TACI), a dual-target fusion protein, has shown therapeutic potential in adult patients. This study aimed to evaluate the efficacy and safety of telitacicept in adolescents with IgAN and IgAVN.

Methods: This retrospective observational study included 15 adolescent patients (11 with IgAN and 4 with IgAVN) who received telitacicept between January 2023 and January 2025. Patients received weekly subcutaneous injections of 80 mg or 160 mg. The primary efficacy outcome was proteinuria from baseline to follow-up. Secondary outcomes included changes in eGFR, serum albumin, and hemoglobin.

Results: The median age of the patients was 16.91 years. After TACI treatment, the median proteinuria decreased from 2.0 g/day at baseline to 1.0 g/day at month 3 (P = 0.074) and further to 0.5 g/day at month 12 (P = 0.015), corresponding to median reductions of 31.2% and 59.0%, respectively. Median eGFR remained stable, showing an 1.1% increase at month 12 (P = 0.912). At month 12, serum albumin and hemoglobin increased by 5.6 g/L (5.8%) and 12.5 g/L (10.6%), respectively. Subgroup analyses showed consistent proteinuria reduction across baseline characteristics. Most patients tolerated telitacicept well, with no serious adverse events or treatment discontinuations reported.

Conclusions: Telitacicept appeared to be well-tolerated and was associated with substantial reductions in proteinuria in adolescent patients with IgAN and IgAVN. Larger studies are needed to validate these findings.