UCSF: Switch Kidney Transplant Drugs

Researchers at UC San Francisco have demonstrated that an immunosuppressive drug leads to better organ survival in patients who have undergone a kidney transplant than the traditional calcineurin inhibitor cyclosporine A.

A study just published in the New England Journal of Medicine has concluded that long-term use of the drug belatacept led to a patient mortality rate or organ loss of 12.7% for the seven years after a transplant. For patients treated with cyclosporine A, the mortality or organ loss rate is 21.7%. A total of 666 kidney transplant patients were examined in the study, which placed them into three groups: Two received belatacept in either an intense or milder regimen, and the other cohort received  cyclosporine A.

“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,” said study lead author Flavio Vincenti, M.D., a UCSF kidney transplant specialist. “In fact, it helps preserve the function of the kidney over the long term and is more effective in suppressing antibodies against the kidney, which are important causes of late graft loss.”

The belatacept regimen is not perfect. Patients who received the drug initially had a higher rate of acute rejection – about double that of patients treated with cyclosporine A. However, that side effect was easily treated with other drugs. Although patients receiving belatacept had about the same risk as other patients of developing serious infections, they had a greater risk of developing some types of cancer.

“We are still learning how best to use belatacept in immunosuppression regimens to balance its long-term benefits with greater safety and efficacy in the short term,” Vincenti said. He added that UCSF would use precision medicine – molecular testing – in order to better optimize usage of  belatacept.