Effects of Telitacicept and Belimumab on Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis

Abstract Objectives B cell-targeted therapies have a wide range of applications in treating systemic lupus erythematosus (SLE). Belimumab is a BLyS-targeting monoclonal antibody, and telitacicept is a BLyS-APRIL dual inhibitor. Both telitacicept and belimumab demonstrated clinical efficacy in patients with SLE. However, benefits and limitations of telitacicept compared to belimumab are unclear. Methods The electronic databases were searched for trials assessing the effects of belimumab and telitacicept on SLE populations. We extracted outcomes and adverse events from the retrieved articles and performed meta-analysis, sensitivity analysis, and meta-regression analysis to summarize the data. Results 11 trials with telitacicept and belimumab involving 3852 participants were included. Compared with the belimumab group, telitacicept significantly increased the SRI4 response rate (relative risk [RR], 2.17, 95%CI, 1.47–3.21), SRI7 response rate (RR, 3.61, 95%CI, 1.57–8.29) and decreased prednisone usage (RR, 2.01, 95%CI, 1.10–3.67). Compared with belimumab, telitacicept exhibited a significant advantage in SRI4 response rate (p for interaction = 0.02), without an increasing risk of adverse events. Conclusion Telitacicept improved SRI4 and SRI7 response rates, controlled disease activity, reduced prednisone dosage, and lowered medication-related side effects. Furthermore, the potent inhibition of APRIL in telitacicept did not significantly increase infection risk and other AEs. The dual inhibitor telitacicept may be an effective choice for reducing SLE activity.