Abstract
Aims
IgA vasculitis with nephritis (IgAVN), a severe renal manifestation of IgA vasculitis, is rare in adults and associated with high morbidity. Current therapies are suboptimal, highlighting the need for novel approaches. This case study evaluates telitacicept, a dual BAFF/APRIL inhibitor, in a high-risk adult IgAVN patient.Materials and methods
A 45-year-old male with biopsy-confirmed IgAVN, progressive renal impairment (estimated glomerular filtration rate (eGFR): 44 mL/min/1.73m2), and significant proteinuria (1.08 g/day) was treated with weekly subcutaneous telitacicept (160 mg) and oral prednisone. Clinical outcomes were assessed over 6 months.Results
After 6 months, the patient showed rapid and sustained improvement: proteinuria decreased by 78.7% (from 1.08 to 0.23 g/day), and renal function stabilized (serum creatinine: 90.9 μmol/L; eGFR preserved). Prednisone was tapered and discontinued without relapse, demonstrating telitacicept's steroid-sparing effect. No treatment-related adverse events occurred.Conclusion
Telitacicept appeared to reduced proteinuria, stabilized renal function, and allowed corticosteroid withdrawal in refractory IgAVN. These findings suggest dual BAFF/APRIL inhibition as a promising strategy for IgA-mediated diseases, warranting further studies to confirm its role in IgAVN.