New Kidney Transplant Rx Shows Promise

Belatacept may improve organ survival in kidney transplant patients

/ Author:  / Reviewed by: Jennifer Gershman, PharmD, CPh

(RxWiki News) Keeping transplanted kidneys working properly can be a tough job — and one that may have just gotten a little easier.

In a head-to-head trial, researchers from the University of California at San Francisco (UCSF) compared the medication belatacept (brand name Nulojix) to the current standard of care for kidney transplant patients. For the first time, an immunosupressive drug (belatacept) achieved better survival rates than a calcineurin inhibitor (current standard).

Lead study author Flavio Vincenti, MD, a kidney transplant specialist at UCSF, said in a press release, "Belatacept is potentially a transformational drug in kidney transplantation because unlike the currently used calcineurin inhibitor drugs cyclosporine and tacrolimus, it is not toxic to the kidney. In fact, it helps preserve the function of the kidney over the long term and is more effective in suppressing antibodies."

David J. Scott, PharmD, told RxWiki News a little more about the potential benefits of belatacept.

"Knowing that organs (and organ donors) are always in short supply, any drug shown to improve the longevity of an organ post-transplant is definitely worth it given the high alternative cost of dialysis and the high cost of the oral anti-rejection drug therapies post-transplant," Dr. Scott said.

When a patient receives a kidney transplant, the body's natural immune response must be suppressed. If not, the body will see the new kidney as foreign tissue and try to reject it.

Medications used to prevent these rejections carry the risk of potentially serious side effects, however. Calcineurin inhibitors can damage the new kidney and increase the risk of heart disease and diabetes.

For this study, Dr. Vincenti and team looked at more than 600 kidney transplant patients over the span of seven years.

These patients were placed in one of three groups. The first two groups both received belatacept, but at different dosages. The third group received cyclosporine A (CsA). All three groups also received other anti-rejection medications.

The risk of death or kidney loss for patients on belatacept was 12.7 percent for the higher dose and 12.8 percent for the lower dose compared to 21.7 percent for patients on CsA. The belatacept patients also showed slightly greater improvements in kidney function than the CsA patients.

Patients treated with belatacept were more likely to experience immediate transplant rejection, however. In most cases, these patients were successfully treated and the kidney ultimately recovered.

Researchers noted that belatacept may boost the risk of developing a rare type of cancer sometimes found in transplant patients. Belatacept is also more expensive and must be given by injection in a doctor's office. Calcineurin inhibitors are available as pills.

Dr. Scott said patients shouldn't be deterred by this, however.

"A drug that can be injected or infused once a month is a lot more reliable than the patient's adherence with daily oral drug therapy," Dr. Scott said. "This monthly infusion also means a huge advantage to the patient(s) as far as quality of life post-transplant with reduced daily pill burden."

This study was published in Jan. 27 in the New England Journal of Medicine.

Bristol-Myers Squibb, which manufactures belatacept, funded this research. Information on conflicts of interest was not available at the time of publication.

Review Date: 
January 26, 2016
Last Updated:
January 28, 2016