Targeting BLyS and APRIL with Telitacicept versus Conventional Immunotherapy in Generalized Myasthenia Gravis: A Comparative Study.

BACKGROUND

Telitacicept is approved for acetylcholine receptor antibody-positive generalized myasthenia gravis (AChR-Ab+ gMG) in China. Although clinical trials have demonstrated its efficacy, real-world outcomes and safety require validation. This study compared telitacicept with conventional immunotherapy in a broader AChR-Ab+ GMG population, bridging the gap between RCT data and real-world practice.

METHODS

This retrospective real-world study (ChiCTR2500109279) included 215 patients with AChR-Ab+ gMG, with 43 receiving telitacicept and 172 undergoing conventional immunotherapy. Propensity score matching (1:1) yielded 35 patients per group. Treatment response was assessed by changes in Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis Activities of Daily Living (ADL) scores, time to minimal symptom expression (MSE), and prednisone use.

RESULTS

At week 4, the telitacicept group showed greater improvements than the control group in both QMG and ADL scores (QMG: 3.63±1.48 vs 0.37±2.76, p<0.001; ADL: 2.80±1.13 vs 0.46±2.44, p<0.001). These benefits were more pronounced at week 24 and sustained throughout follow-up (QMG: 10.30±4.19 vs 2.86±3.21, p<0.001; ADL: 8.06±3.37 vs 2.63±2.07, p<0.001). The telitacicept group also reached MSE earlier (median 5 months) and had more patients achieving MSE by week 24 (57.1% vs 11.4%, p<0.001), with lower cumulative prednisone doses over 24 weeks (2325 mg vs 6525 mg, p<0.001). A progressive decrease in IgM/IgG ratio was observed during treatment. Telitacicept was well-tolerated with no serious adverse events.

CONCLUSION

This real-world study demonstrates that telitacicept effectively improves symptoms and maintains stability in AChR Ab+ gMG patients, with faster onset, reduced corticosteroid dependence, and favorable safety versus conventional immunotherapy.