Encouraging Results for Belatacept Immunosuppression in Renal

Home , Belatacept

research highlights transplantation Encouraging results for belatacept immunosuppression in renal transplantation mmunosuppression with belatacept, systolic blood pressure than ciclosporin a fusion human protein that acts as administration. in addition, in patients ia blocker of t-cell costimulation, is receiving belatacept, average serum levels associated with similar patient-survival of triglycerides decreased from baseline, and graft-survival rates as treatment with whereas they increased in patients treated ciclosporin, according to the preliminary with ciclosporin. a trend toward a lower results of two phase iii studies of renal incidence of new-onset diabetes after transplant recipients. these studies also transplantation was also observed in indicate that belatacept treatment is patients receiving belatacept than in those associated with reduced parameters of receiving ciclosporin. Finally, a trend for cardiovascular risk. an increased incidence of post-transplant Cardiovascular disease is the leading lymphoproliferative disorder was noticed cause of 1-year mortality in renal in patients treated with belatacept, transplant recipients. Calcineurin particularly in those with known risk inhibitors, such as ciclosporin or factors for the disease. vincenti, a tacrolimus, exacerbate hypertension, 3 years after transplantation, but results coauthor of both BeneFit and BeneFit- diabetes, and dyslipidemia—which are risk after 1 year have now been published. eXt, therefore suggests that belatacept use factors for cardiovascular morbidity and BeneFit and BeneFit-eXt should be avoided in patients with negative mortality. immunosuppressants that have participants treated with the two serology for epstein–Barr virus, who milder adverse effects than calcineurin belatacept regimens had similar patient- are at increased risk of post-transplant inhibitors and are as effective are therefore survival and graft-survival rates as their lymphoproliferative disorder. very desirable. counterparts treated with ciclosporin. according to the BeneFit researchers, according to Flavio vincenti, Patients in BeneFit treated with the although the 1-year patient-survival and university of California, san Francisco, more-intensive belatacept regimen had graft-survival rates in the belatacept- previous studies demonstrated robust a higher incidence of acute rejection treated group were similar to those of the immunosuppressive effects associated than those treated with ciclosporin (22% ciclosporin-treated group, several studies with the blockade of t-cell costimulation versus 7%). the discrepancy in rates of demonstrated a positive association in rodents and non-human primates. acute rejection did not, however, affect between renal function 1 year after moreover, in a phase ii study of adult the overall rates of patient survival (more- transplantation and long-term outcomes. renal transplant recipients, belatacept was intensive 95%; less-intensive 97%; and the BeneFit-eXt researchers say associated with improved renal function ciclosporin 93%) or graft loss (more- that the decrease in blood pressure and and similar acute rejection rates as intensive 2%; less-intensive 2%; and serum triglyceride levels in patients administration of ciclosporin. ciclosporin, 4%). treated with belatacept compared with the preliminary results of two large, Fewer patients treated with the more- their ciclosporin-treated counterparts randomized, multicenter phase iii trials intensive and the less-intensive belatacept indicates that patients who received that compared two different regimens regimens in BeneFit and with the more- belatacept may be at decreased risk of of belatacept therapy with ciclosporin intensive belatacept regimen in BeneFit- cardiovascular mortality. therapy in adult recipients of renal eXt had renal function impairment the BeneFit researchers aim to assess transplants from living or standard- than patients treated with ciclosporin. these outcomes over the next 2 years. criteria deceased donors (BeneFit) moreover, the average measured or from extended-criteria donors glomerular filtration rate was significantly Baldo Lucchese (BeneFit-eXt) have now been reported. higher in BeneFit participants treated Both BeneFit (n = 686) and BeneFit- with belatacept than in BeneFit Original articles Vincenti, F. et al. A phase III study of eXt (n = 578) randomly assigned participants treated with ciclosporin (by belatacept-based immunosuppression regimens versus 2 renal transplant recipients to receive ~14 ml/min/1.73 m ), and a similar trend cyclosporine in renal transplant recipients (BENEFIT study). a more-intensive belatacept regimen, a was observed in BeneFit-eXt. Am. J. Transplant. 10, 535–546 (2010) | Durrbach, A. less-intensive belatacept regimen, or in both BeneFit and BeneFit- et al. A phase III study of belatacept versus cyclosporine in a ciclosporin regimen. BeneFit and eXt, belatacept administration was kidney transplants from extended criteria donors (BENEFIT- BeneFit-eXt will collect clinical data for associated with lower average diastolic and EXT study). Am. J. Transplant. 10, 547–557 (2010)