Telitacicept (APRIL/BLyS Dual Inhibitor — SLE/IgA Nephropathy)

How it works

It is a TACI-Fc fusion protein that binds and neutralises both B-lymphocyte stimulator (BLyS/BAFF) and a proliferation-inducing ligand (APRIL), suppressing the survival and maturation of B cells and plasma cells that drive autoantibody production.

Prescribing in practice

• By suppressing B-cell-mediated immunity it increases the risk of infection, so active serious infection should be treated before starting and patients monitored for infection during therapy.
• Injection-site reactions and hypersensitivity can occur; it is given by subcutaneous injection.
• Avoid live vaccines during treatment and review immunisation status before starting.

Monitoring

Monitor for signs of infection and infusion- or injection-related reactions, along with disease activity and relevant immunological markers.

Counselling the patient

• Report fever or other signs of infection promptly.
• Do not have live vaccines while on treatment and discuss any planned vaccinations with your team.
• Report any rash, swelling or reaction at the injection site or signs of an allergic reaction.

Evidence & guidelines

Benefit in systemic lupus erythematosus and IgA nephropathy has been reported in randomised controlled trials, with evolving regulatory and guideline positions.