Telitacicept is a drug being investigated in the treatment of high-risk IgA nephropathy, which is a major cause of kidney failure. In a preliminary real-world study, telitacicept was administered as either initial or alternative therapy to patients with persistent proteinuria ≥ 0.75 g/day and eGFR ≥ 30 mL/min/1.73 m². After 3 months of treatment, the initial telitacicept group achieved a median reduction in proteinuria of 1.47 g/day (79% from baseline), which was significantly greater than the alternative treatment group (46%) and comparable to the initial immunosuppressant group (48%). Renal function (eGFR) remained stable in all groups. The renal response rate (complete or partial) was 83.3% in the initial telitacicept group, which was significantly higher than in the other groups. After 6 months, proteinuria continued to decrease in the initial telitacicept group without significant adverse effects. The study suggests that telitacicept is safe and effective in reducing proteinuria and preserving renal function in patients with high-risk IgA nephropathy, with better outcomes than initial therapy[1][4].