Front Immunol. 2026 Sep 16;17:1865753. doi: 10.3389/fimmu.2026.1865753. eCollection 2026.
ABSTRACT
BACKGROUND: Severe abdominal Henoch-Schönlein purpura (HSP) can cause intense abdominal pain and gastrointestinal bleeding. Glucocorticoid therapy has limited efficacy and a high relapse rate after withdrawal. Telitacicept blocks BLyS/APRIL and inhibits the production of pathogenic IgA immune complexes, but its use in HSP has not been reported.
METHODS: This was a single-center retrospective matched cohort study. Children hospitalized with severe abdominal HSP (abdominal pain VAS ≥3, hematochezia, and extensive rash) between January 2025 and December 2025 were included. Patients were divided into a telitacicept plus glucocorticoid group (telitacicept group) and a glucocorticoid-alone group (steroid group). Individual 1:1 matching was performed based on age, sex, and disease severity. The primary outcome was time to abdominal pain relief. Secondary outcomes included time to rash resolution, disease relapse rate within 3 months after treatment, and safety. Intergroup comparisons used Wilcoxon rank-sum test or Fisher's exact test, and relapse-free time was analyzed by Kaplan-Meier curves and the log-rank test.
RESULTS: A total of 26 children (13 per group) were included. Baseline characteristics were balanced between the two groups (age, sex, age strata, all P > 0.05). The median time to abdominal pain relief was 3.0 days (IQR 3.0-4.0) in the telitacicept group, significantly shorter than the 5.0 days (IQR 4.0-6.0) in the steroid group (P = 0.013). Median time to rash resolution was 9.0 days in both groups, with no significant difference (P = 0.113). The 3-month relapse rate was 7.7% (1/13) in the telitacicept group versus 46.2% (6/13) in the steroid group; the log-rank test showed a significant difference in relapse-time distribution (P = 0.022). The number needed to treat (NNT) was 2.6. For safety, mild injection-site redness occurred in 2 patients (15.4%) in the telitacicept group, and transient hyperglycemia occurred in 1 patient (7.7%) in the steroid group. No serious adverse events were observed.
CONCLUSION: In children with severe abdominal HSP, adding telitacicept to glucocorticoid significantly shortens the time to abdominal pain relief and reduces the short-term relapse rate, with a favorable safety profile. This study provides preliminary clinical evidence for telitacicept as an adjunctive therapy to glucocorticoids, which warrants further validation in prospective randomized controlled trials.
PMID:42819322 | PMC:PMC13623866 | DOI:10.3389/fimmu.2026.1865753