People who undergo organ transplantation are
always at a risk that their immune system may recognize the transplanted organ
as foreign and launch an attack against it. This may result in graft failure,
thereby making the entire transplantation process futile. To prevent this, following
transplantation, patients are put on medications to suppress immunity. These
medications are called immunosuppressant drugs
. They have their own side
effects, and make the patient prone to repeated and even life-threatening
A commonly used immunosuppressant drug
following kidney transplantation
. Though its benefits have been established, cyclosporine does have side effects like cardiovascular diseases and diabetes.
over time, kidney function could reduce with the medication.
‘Long-term outcomes in kidney transplant patients may improve with a new drug - belatacept.’
Belatacept is a new
immunosuppressant drug that was approved by the FDA and the Europeans Medicines
Agency in 2011 for use in kidney transplant patient
. Available as Nulojix, it appears to several
benefits over cyclosporine, as demonstrated by a 7-year clinical trial recently
published in the New England Journal of
The BENEFIT (Belatacept Evaluation of
Nephroprotection and Efficacy as First-line Immunosuppression Trial) study
compared the efficacy and safety of three regimens, an intensive
belatacept-based regimen, a less intensive belatacept-based regimen, and a
cyclosporine-based regimen taken for 7 years following kidney transplantation.
All the patients in the study also received basiliximab
, mycophenolate mofetil
The researchers found that:
- The risk of death or graft
rejection at 7 years was almost half in patients on belatacept, compared
to those on a cyclosporine-based regimen.
- Kidney function as measured by
eGFR (Estimated Glomerular Filtration Rate) was
found to be reduced in patients taking cyclosporine, but improved slightly
in patients taking belatacept.
- Acute rejection was more common
with the belatacept group as compared to the cyclosporine group.
- The side effect of post-transplant
lymphoproliferative disorder (PTLD) was more common with the belatacept
groups. PTLD is a type of malignant condition where the body produces
excess immune cells called lymphocytes.
Researchers had earlier reported that this side effect may occur in
individuals taking belatacept who had Epstein- Barr virus infection.
- The development of donor-specific
antibodies was less in the belatacept-based regimens as compared to the
cyclosporine-based regimen. These antibodies can result in rejection of
the kidney tissue.
Cyclosporine is taken orally while belatacept
has to be injected by the healthcare provider. Though the injections may be
inconvenient to the patient, the patient is less likely to skip a dose with
this regimen. This will ensure lesser chances of rejection of the donor organ
Though belatacept has been found to be a
better choice than cyclosporine in the maintenance treatment of kidney
transplant, the researchers admit that a comparison with tacrolimus
, another immunosuppressive drug used
in the prevention of kidney rejection, could provide a better picture of the usefulness of this medication. Also, the prohibitive cost of belatacept could
be a deterrent to a large number of patients who could benefit from its use.
1. Vincenti F, Rostaing L, Grinyo J, Rice K, Steinberg S, Gaite L, Moal M, Mondragon-Ramirez GA, Kothari J, Polinsky MS, Meier-Kriesche H, Munier, S, Larsen CP. Belatacept and Long-Term Outcomes in Kidney Transplantation N Engl J Med 2016; 374:333-343 DOI: 10.1056/NEJMoa1506027