Blood and kidney problems are common complications of systemic lupus erythematosus (SLE) [1]. For patients with SLE and liver cirrhosis, traditional immunosuppressants and long-term glucocorticoids are not ideal choices, because these drugs may damage the liver and bring many treatment difficulties [2].

Zhou Y, Cheng X, Li 1X, Ying Z (2026) Successful Treatment of Refractory Systemic Lupus Erythematosus with Pancytopenia and Liver Cir rhosis Using Telitacicept. J Clin Nephrol Res 13(1): 1129.

Blood and kidney problems are common complications of systemic lupus erythematosus (SLE) [1]. For patients with SLE and liver cirrhosis, traditional immunosuppressants and long-term glucocorticoids are not ideal choices, because these drugs may damage the liver and bring many treatment difficulties [2]. Telitacicept is a novel dual-target fusion protein that binds to B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL), thereby suppressing aberrant B cell activation. It has been officially approved for the treatment of active SLE [3,4]. Herein, we report a refractory SLE patient who achieved remarkable clinical improvement after receiving telitacicept treatment.

The patient was a 60-year-old woman. She had suffered from SLE for 20 years and always had low blood cell counts. She also had liver cirrhosis for 10 years and took ursodeoxycholic acid regularly. Due to high blood sugar, her methylprednisolone was gradually reduced to 4 mg every other day. One month before admission, her condition worsened. Her white blood cell count dropped to 1.5×10?/L and platelet count fell to 35×10?/L. She felt tired, had rash on the face and large bruises on both lower legs. After examination, she was diagnosed with SLE, lupus nephritis, pancytopenia and renal anemia.

Considering her low blood cells and poor liver function, we gave her subcutaneous injection of telitacicept (160 mg qw) starting on September 3, 2025, while keeping all basic treatments. Repeated tests showed that her CD19? B cell count decreased from 21×10?/L to about 2.6×10?/L, which meant B cell activity was well controlled². Her routine blood tests gradually returned to normal, and blood uric acid also recovered (Figure 1A), showing the body’s inflammation was relieved. Liver elasticity tests proved obvious improvement of liver fibrosis. The initial liver stiffness was 10.38 kPa (F4 cirrhosis). After three months of treatment, the value dropped to 8.48 kPa (F2–F3 stage), and stayed at 8.36 kPa after seven months (Figure 1B). Liver fat level remained normal all the time. Imaging tests showed no worsening of portal vein thrombosis and no new fluid in the abdominal cavity. During follow-up, we did not find liver damage, infection or severe bleeding caused by the drug.

Figure 1: Laboratory and hepatic changes following telitacicept therapy. (A) CD19? B cells, uric acid, and IgG levels normalized during treatment. (B) Liver stiffness decreased progressively from 10.38 kPa to 8.36 kPa, corresponding to reduced hepatic fibrosis

Long-term use of glucocorticoids cannot treat pancytopenia caused by SLE. Most traditional immunosuppressants will also damage the liver [2-5]. Telitacicept is a targeted drug. It works on the key pathogenesis of SLE and is safe for the liver [6]. In this case, telitacicept controlled overactive B cells, improved blood indicators and clinical symptoms, and even improved liver fibrosis. This treatment also helped reduce the dose of glucocorticoids and lower the risk of hormone-related side effects. Many studies have confirmed that telitacicept works well for pancytopenia [7,8]. However, there are few studies focusing on long-term SLE patients who have both refractory pancytopenia and liver cirrhosis. This case provides a reliable treatment choice for such patients. More large-scale clinical studies are still needed to confirm its long-term effects.

1. Morand EF, Fernandez-Ruiz R, Blazer A, Niewold TB. Advances in the management of systemic lupus erythematosus. BMJ. 2023; 383: e073980.
2. Zhang L, Yin L, Lv W, Wang Y, Liu Y. Clinical analysis of patients with systemic lupus erythematosus complicated with liver failure. Clin Rheumatol. 2023; 42: 1545-1553.
3. Dhillon S. Telitacicept: First Approval. Drugs. 2021; 81: 1671-1675.
4. Van Vollenhoven RF, Wang L, Merrill JT, Liu Y, Bao C. 18C010 Trial Investigators. A Phase 3 Trial of Telitacicept for Systemic Lupus Erythematosus. N Engl J Med. 2025; 393: 1475-1485.
5. Bechman K, Song K, Abhishek A, Adas M, Ahmed. The 2025 British Society for Rheumatology guideline for the prescription and monitoring of conventional synthetic disease-modifying anti-rheumatic drugs. Rheumatology (Oxford). 2026; 65: keaf522
6. Yang Y, Chen Y, Xu X, Jin S, Shen Z, Meng Y, et al. Telitacicept Add Glucocorticoids Versus Telitacicept Alone in the Treatment of IgA Nephropathy: A Real-World Study. FASEB J. 2026; 40: e71778.
7. Jin HZ, Li YJ, Wang X, Li Z, Ma B, Niu L, et al. Efficacy and safety of telitacicept in patients with systemic lupus erythematosus: a multicentre, retrospective, real-world study. Lupus Sci Med. 2023; 10: e001074
8. Cheng J, Peng Y, Wu Q, Wu Q, He J, Yuan G. Efficacy and safety of telitacicept therapy in systemic lupus erythematosus with hematological involvement. Clin Rheumatol. 2024; 43: 2229-2236