Telitacicept

Objective: To evaluate the efficacy of Telitacicept combined with low-dose mycophenolate mofetil (MMF, 1 g/day) in patients with moderate-to-severe systemic lupus erythematosus (SLE). Methods: In this prospective, open-label, randomized controlled trial, 84 patients with active SLE [Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K)≥10] were enrolled at Shanxi Provincial People's Hospital from June 2023 to June 2024. The participants were randomized to 2 groups with block randomization sequence: Telitacicept group (the patients were given subcutaneous Telitacicept 160 mg weekly+MMF 1 g/day+prednisone) and the MMF group (the patients were treated with MMF 2 g/day+prednisone). The primary endpoint was non-inferiority in SLEDAI-2K reduction at week 24 (margin Δ=2.0). The secondary endpoints included British Isles Lupus Assessment Group 2004 (BILAG-2004), Physician's Global Assessment (PGA), complement levels, glucocorticoid-tapering success rate (prednisone≤7.5 mg/d), and adverse events. Results: A total of 84 patients with moderate-to-severe SLE were enrolled, including 75 females (89.29%), with a mean age of (39.39±10.68) years. There were 43 cases in the Telitacicept group and 41 cases in the MMF group. The Telitacicept group demonstrated non-inferior SLEDAI-2K reduction [(14.77±5.28) vs (17.32±5.99) points, 95%CI of between-group difference:-1.92 to 0.43]. Compared to the MMF group, the Telitacicept group showed a significantly higher achievement rate of prednisone reduction to≤7.5 mg/d [83.72% (36/43) vs 63.41% (26/41), P=0.034], a lower incidence of infections [23.26% (10/43) vs 68.29% (28/41), P<0.001], and a lower anti-dsDNA level [(64.87±44.11) vs (111.92±34.08) U/ml, P=0.001]. In the lupus nephritis subgroup, the 12-week urinary protein remission rate (<0.5 g/24 h) was 90.48% (19/21) in the Telitacicept group, it was higher than that in the MMF group [73.91% (17/23)](P=0.042). The Telitacicept group showed a greater improvement in complement C3 level [(1.03±0.35) vs (0.89±0.29) g/L, P=0.063]. No intergroup differences in BILAG-2004, PGA, or joint symptoms improvement was found between the two groups (all P>0.05). Conclusion: Telitacicept plus low-dose MMF shows comparable efficacy to high-dose MMF for moderate-to-severe SLE, with superior glucocorticoid sparing and reduced infection risk.

Neuropsychiatric systemic lupus erythematosus (NPSLE) is a severe SLE complication with limited therapeutic options. While plasma exchange is used, it carries cardiovascular risks and logistical barriers.

We report a 42-year-old East Asian female with SLE who developed progressive edema, dyspnea, and seizures. Imaging and labs revealed cardiorenal dysfunction and neuroinflammatory signs. Peritoneal dialysis (PD) was initiated alongside immunosuppressive therapy (methylprednisolone, telitacicept, cyclophosphamide), leading to resolution of neuropsychiatric symptoms and improvement in renal and hematologic parameters. Proteomic findings: LC-MS/MS analysis of dialysate identified 518 proteins, with functional enrichment pointing to complement activation pathways. By day 4, levels of FCER2 (CD23) and C-reactive protein (CRP), both of which are associated with inflammation, were significantly downregulated, suggesting that PD may facilitate the removal of proinflammatory mediators.

PD may serve as a dual-purpose therapy in NPSLE, offering renal support and modulating complement overactivation.