Purpose <p>To evaluate efficacy and safety of telitacicept in IgA nephropathy (IgAN) in a real-world setting.</p> Methods <p>This study is a retrospective, single-center study that included 33 IgAN patients from Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Eleven patients received telitacicept treatment for at least 3 months. A control group was matched using propensity score matching. Clinical assessments and laboratory tests were performed at baseline and subsequently every one to three months during the treatment period. Clinical outcomes were assessed at 3 and 6 months.</p> Results <p>At 3 months, 24-hour urinary protein in the telitacicept group decreased by 893.29&#xa0;mg/day (63.90%). The telitacicept group achieved a complete remission rate of 36.36% and a partial remission rate of 36.36%. Similarly, the control group exhibited a complete remission rate of 31.82% and a partial remission rate of 36.36%. At 6 months, although the telitacicept group showed lower 24-hour urinary protein than the control group, the difference was not statistically significant [381.68 (182.52–990.00) mg/day vs. 480.15 (185.28–905.15) mg/day, <i>P</i> = 0.567]. Complete remission rates for the telitacicept and control groups increased to 54.55% and 36.36%, with overall remission rates of 72.73% and 77.27%, respectively. Serum creatinine and eGFR remained stable throughout the study. The most common adverse reactions were pain, redness, or itching at injection site, without signs of local infection.</p> Conclusion <p>Preliminary clinical trials have provided supportive evidence for the efficacy and safety of telitacicept as a viable treatment option for IgAN.</p> Clinical trial number <p>Not applicable.</p>