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Background outlines the immunologic rationale for combining B-cell depletion with BAFF/APRIL inhibition, addressing limitations of monotherapy and the risk of flare related to B-cell reconstitution. Sequential treatment with obinutuzumab followed by telitacicept is reported to achieve effective remission of lupus activity after recurrent, critically severe flares.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/novel-sequential-therapy-with-obinutuzumab-and-telitacicept-in-severe-lupus-nephritis-with-glucocorticoid-induced-avascular-necrosis-of-the-femoral-head-a-case-report/412872/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/novel-sequential-therapy-with-obinutuzumab-and-telitacicept-in-severe-lupus-nephritis-with-glucocorticoid-induced-avascular-necrosis-of-the-femoral-head-a-case-report/412872.png","ImageObject",300,407,{"name":92,"@type":93},"A glass of water","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the clinical setting described in this case report?","Question",{"text":112,"@type":113},"The report describes a patient with severe lupus nephritis complicated by glucocorticoid-induced avascular necrosis of the femoral head and recurrent lupus flares.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why is a sequential regimen with obinutuzumab followed by telitacicept considered biologically relevant?",{"text":117,"@type":113},"The rationale is that B-cell depletion alone may be followed by disease flare due to B-cell reconstitution and increased BAFF-related stimulation, while BAFF/APRIL inhibition after depletion targets this pathway.",{"name":119,"@type":110,"acceptedAnswer":120},"What outcomes are reported after sequential therapy?",{"text":121,"@type":113},"Sequential treatment resulted in effective remission of lupus activity in the setting of a critically severe lupus flare.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},412872,1790823190,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},962090760832,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","e-ISSN 1941-5923  \n© Am J Case Rep, 2025; 26: e950362 DOI: 10. 12659/AJCR.950362  \nReceived: 2025.06.22  \nAccepted: 2025.10.01  \nAvailable online: 2025.10.14  \nPublished: 2025.12.11  \nAuthors’ Contribution: Study Design A  \nData Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G  \nBCDE  \nBCDE  \nBCD  \nBCF  \nAE  \nAE  \nADE  \nADEF  \nCorresponding Authors:  \nFinancial support: Conflict of interest:  \nNovel Sequential Therapy with Obinutuzumaband Telitacicept in Severe Lupus Nephritis with Glucocorticoid-Induced Avascular Necrosis (AVN) of the Femoral Head: A Case Report  \n1 Yu Zhang*  1 Department of Nephrology, Center of Nephrology and Urology, The Seventh  \n1 Liqi Huang* Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, PR China  \n2 Department of Pharmacy, The Seventh Affiliated Hospital, Sun Yat-sen University, 1 Na Li* Shenzhen, Guangdong, PR China  \n2 Xuelin Zeng   \n1 Zhihua Zheng  \n1 Xiaohua Wang  \n1 Yiqing Zhang  \n1 Chun Tang  \n* Yu Zhang, Liqi Huang, and Na Li contributed equally to this work and share first authorship Chun Tang, e-mail: [tangch28@mail.sysu.edu.cn](tangch28@mail.sysu.edu.cn), Yiqing Zhang, e-mail: [zhangyq85@mail.sysu.edu.cn](zhangyq85@mail.sysu.edu.cn),  \nXiaohua Wang, [e-mail:](e-mail: wangxh95@mail.sysu.edu.cn)[ wangxh95@mail.sysu.edu.cn](e-mail: wangxh95@mail.sysu.edu.cn)  \nFinancial support was provided by Sanming Project of Medicine in Shenzhen (No.SZSM202411016); Shenzhen Municipal Science and Technology Innovation Commission (Grants No. JCYJ20210324123414040 and JCYJ20230807110715030)  \nNone declared  \nPatient: Female, 16-year-old  \nFinal Diagnosis: Severe lupus nephritis with glucocorticoid-induced avascular necrosis of femoral head  \nSymptoms: Cough with white mucus sputum • facial and bilateral lower limb edema • fever •  \npain in left knee and hip joint • proteinuria  \nClinical Procedure: —  \nSpecialty: Nephrology  \nObjective: Unusual clinical course  \nBackground: Systemic lupus erythematosus (SLE) is a common systemic autoimmune disease characterized by immunemediated inflammation. Nearly half of SLE patients develop lupus nephritis (LN). Glucocorticoids are the most widely used foundational medication for SLE, yet their long-term use leads to a series of complications, such as opportunistic infections, diabetes, and femoral head osteonecrosis. Obinutuzumab is a humanized antiCD20 monoclonal antibody, whereas telitacicept is a fusion protein that blocks B-cell activating factor (BAFF) and A proliferation-inducing ligand (APRIL). Since monotherapy with B-cell depletion agents may lead to disease flare due to B-cell reconstitution and elevated levels of B-cell-stimulating factors (eg, BAFF), a new combination therapy involving B-cell depletion and BAFF/APRIL inhibitors could be an alternative to conventional therapies for patients, especially those with severe SLE. This combination has not yet been clinically applied.  \nCase Report: We report the case of a 22-year-old woman with biopsy-proven class V LN 6 years ago, initially managed with prednisone, tacrolimus, and hydroxychloroquine. She developed glucocorticoid-induced femoral head necrosis  \n2 years after diagnosis and experienced recurrent lupus flares requiring multiple hospitalizations. At this admission for a critically severe lupus flare (SLEDAI score: 27), sequential treatment with Obinutuzumab followed by telitacicept resulted in effective remission of lupus activity.  \nConclusions: This is the first reported case of severe SLE treated with sequential therapy involving Obinutuzumab followed by telitacicept. The combination therapy of B-cell depletion plus BAFF/APRIL inhibition could be a promising and rational treatment approach for SLE patients, especially those with severe SLE, which warrants further clinical trials to validate the efficacy and safety of the therapeutic regimen.  \nKeywords: Antibodies, Monoclonal • Glucocorticoids • Lupus Erythemat","cbCaieGO2ZmjHyV9","https://ap.wps.com/l/cbCaieGO2ZmjHyV9","pdf",667874,"English","# Introduction\n## Case Report\n## Conclusions\n## Keywords","[{\"question\":\"What is the clinical setting described in this case report?\",\"answer\":\"The report describes a patient with severe lupus nephritis complicated by glucocorticoid-induced avascular necrosis of the femoral head and recurrent lupus flares.\"},{\"question\":\"Why is a sequential regimen with obinutuzumab followed by telitacicept considered biologically relevant?\",\"answer\":\"The rationale is that B-cell depletion alone may be followed by disease flare due to B-cell reconstitution and increased BAFF-related stimulation, while BAFF/APRIL inhibition after depletion targets this pathway.\"},{\"question\":\"What outcomes are reported after sequential therapy?\",\"answer\":\"Sequential treatment resulted in effective remission of lupus activity in the setting of a critically severe lupus flare.\"}]","Novel Sequential Therapy with Obinutuzumab and Telitacicept in Severe Lupus Nephritis with Glucocorticoid-Induced Avascular Necrosis of the Femoral Head - A Case Report | PDF",1790593091]