Kidney Compass: Final 2-Year TELIGAN Data for Telitacicept in IgA Nephropathy

Welcome back to Kidney Compass!

Recording from ASN Kidney Week 2026 in Denver, Colorado, cohosts Brendon Neuen, MBBS, PhD, and Shikha Wadhwani, MD, MS, welcomed back Jicheng Lv, MD, of Peking University First Hospital, after he presented final 2-year results from the phase 3 TELIGAN trial during the late-breaking plenary.

Lv first joined the podcast at ASN Kidney Week 2025 to discuss the trial’s 39-week proteinuria data.³ This time, the conversation covered kidney function outcomes, the trial’s induction and maintenance dosing strategy, and what long-term B-cell modulation could look like in IgA nephropathy.

What Did the 2-Year TELIGAN Trial Show for Telitacicept and eGFR?

TELIGAN randomly assigned 318 adults with IgA nephropathy in China to telitacicept 240 mg or placebo, with all participants receiving ≥ 12 weeks of renin-angiotensin system inhibition before randomization.¹ Lv explained eligible patients had proteinuria of about 1 g/day or higher and an eGFR of ≥ 30 mL/min/1.73 m², with roughly a third receiving an SGLT2 inhibitor at baseline.

A distinctive feature was the dosing strategy. Patients received telitacicept weekly through week 39, then every 2 weeks through week 104.¹ Lv said dose-finding work showed greater proteinuria reduction with 240 mg than 160 mg, but concerns about infection risk with long-term high-dose exposure led investigators to adopt an induction and maintenance approach modeled on lupus nephritis management.

The 2-year annualized eGFR slope, the primary endpoint, was −0.6 mL/min/1.73 m² per year with telitacicept vs −5.7 with placebo (difference, 5.1; 95% CI, 3.5 to 6.7; P < .001).¹ Confirmed eGFR decline of 30% or more occurred in 2.5% versus 16.4% of patients (hazard ratio, 0.11), and decline of 40% or more in 2.5% versus 9.4% (hazard ratio, 0.19). No telitacicept-treated patients experienced a composite kidney failure event, compared with five patients receiving placebo.¹,²

Proteinuria reduction was maintained after the dose step-down. Lv noted the reduction was 55% at 9 months and reached 60.7% compared with placebo at 2 years, with 44.0% of telitacicept-treated patients achieving UPCR < 0.5 g/g versus 8.2% with placebo.¹,² Serum galactose-deficient IgA1 decreased by 47.8% with telitacicept and increased by 19.1% with placebo.

Serious adverse events occurred in 8.2% and 18.2% of patients and serious infections in 1.9% and 4.4%, while overall infection rates were identical at 67.3%.¹ Lv described the results as balancing treatment effect with long-term safety.

Will Patients With IgA Nephropathy Need Lifelong B-Cell Therapy?

Wadhwani raised a question patients often ask: once therapy starts, can it ever stop? Lv noted more than half of patients biopsied in China show active lesions, suggesting immune-driven proteinuria supportive care alone cannot address. Corticosteroids carry too many adverse effects for this population, he said.

Drawing on lupus nephritis, where histologic disease can persist despite clinical remission, Wadhwani and Neuen asked whether repeat biopsies should guide treatment decisions in IgA nephropathy. Lv agreed randomized trials using rebiopsy to inform withdrawal of B-cell therapy are needed.

Histologic subgroup analyses were limited by a roughly 3-year median interval between biopsy and randomization, Lv explained, and showed no differences. However, patients with hematuria derived greater benefit in both proteinuria reduction and kidney function.

Telitacicept received conditional approval in China in June 2026 to reduce proteinuria in adults with primary IgA nephropathy at risk of progression.² Lv said full approval is anticipated following the 2-year data, and he noted the agent’s long-term use in lupus in China has not raised new safety concerns.

Editors’ note: Disclosures for Neuen include AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, and others. Disclosures for Wadhwani include Boehringer Ingelheim, Calliditas Therapeutics, GSK, Otsuka Pharmaceutical Co., Travere Therapeutics, and others. Disclosures for Lv include AstraZeneca, Novartis, Otsuka, and others.

References

1. Lv J, Perkovic V, Zhang H, et al. Telitacicept for IgA nephropathy: final two-year results of the phase 3 TELIGAN trial. Presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract TH-OR111. doi:10.1681/ASN.20265trr83ac

2. Vor Bio. Telitacicept demonstrates durable preservation of kidney function through two years in phase 3 TELIGAN trial in IgA nephropathy. GlobeNewswire. Published October 22, 2026. Accessed October 24, 2026. https://www.globenewswire.com/news-release/2026/10/22/3386893/0/en/telitacicept-demonstrates-durable-preservation-of-kidney-function-through-two-years-in-phase-3-teligan-trial-in-iga-nephropathy.html

3. Neuen B, Wadhwani S. Kidney Compass: phase 3 data on telitacicept in IgA nephropathy at ASN Kidney Week 2025. HCPLive. Published November 21, 2025. Accessed October 24, 2026. https://www.hcplive.com/view/kidney-compass-telitacicept-in-iga-nephropathy-at-asn-kidney-week-2025