BAFF/APRIL expression-guided telitacicept therapy demonstrates superior efficacy in systemic lupus erythematosus patients: a real-world comparative study

作者：Li‐Min Huang, Yingzi Huang, Jiamin Zeng, Huhai Zhang, Liping Chen, Yi Li, Hongwen Zhao, Xiaopeng Tang · 发表于：Frontiers in Medicine · 年份：2025 · DOI：10.3389/fmed.2025.1608085 · 被引用次数：2 · 研究领域：Systemic Lupus Erythematosus Research、T-cell and B-cell Immunology、Monoclonal and Polyclonal Antibodies Research

Background Biological agents targeting B-cell pathways represent significant advances in systemic lupus erythematosus (SLE) management, yet optimal patient selection remains challenging. This study evaluated whether BAFF/APRIL expression testing could guide personalized treatment decisions in SLE patients. Methods In this real-world observational study, we compared two treatment strategies in 86 SLE patients: personalized therapy with telitacicept in BAFF/APRIL double-positive patients ( n = 14) versus conventional belimumab therapy without expression testing ( n = 72). Clinical responses, laboratory parameters, and steroid-sparing effects were assessed at 3 and 6 months. Results Despite having significantly higher baseline disease activity (SLEDAI 18.79 ± 9.34 vs. 8.86 ± 4.3) and more severe proliferative lupus nephritis (Class IV/IV + V in 78.6% vs. 52.8%), the BAFF/APRIL-guided telitacicept group achieved higher complete response rates (57.1% vs. 48.6%) and lower non-response rates (7.1% vs. 23.6%) compared to the conventional belimumab group. The BAFF/APRIL-guided group showed more substantial improvements in complement C3 levels (Δ = 0.49 vs. 0.24, p < 0.001) and anti-dsDNA antibody reduction (Δ = −177.07 vs −117.00, p = 0.028) at 6 months. Notably, normalization of immunological parameters was significantly better in the personalized therapy group, with dsDNA abnormalities decreasing from 92.9 to 7.1% (vs 91.7–32.5%) and C3 abnormalities from 100 to 28.6% (vs 91....