Belatacept for kidney transplant recipients

Abstract

Cochrane Database of Systematic Reviews Main results We included five studies that compared belatacept and calcineurin inhibitors (CNI) that reported data from a total of 1535 kidney transplant recipients. Of the five studies, three (478 participants) compared belatacept and cyclosporin and two (43 recipients) compared belatacept and tacrolimus. Co-interventions included basiliximab (4 studies, 1434 recipients); anti-thymocyte globulin (1 study, 89 recipients); alemtuzumab (1 study, 12 recipients); mycophenolate mofetil (MMF, 5 studies, 1509 recipients); sirolimus (1 study, 26 recipients) and prednisone (5 studies, 1535 recipients). Up to three years following transplant, belatacept and CNI-treated recipients were at similar risk of dying (4 studies, 1516 recipients: RR 0.75, 95% CI 0.39 to 1.44), losing their kidney transplant and returning to dialysis (4 studies, 1516 recipients: RR 0.91, 95% CI 0.61 to 1.38), and having an episode of acute rejection (4 studies, 1516 recipients: RR 1.56, 95% CI 0.85 to 2.86). Belatacept-treated kidney transplant recipients were 28% less likely to have chronic kidney scarring (3 studies, 1360 recipients: RR 0.72, 95% CI 0.55 to 0.94) and also had better gra function (measured glomerular filtration rate (GFR) (3 studies 1083 recipients): 10.89 mL/min/1.73 m , 95% CI 4.01 to 17.77; estimated GFR (4 studies, 1083 recipients): MD 9.96 mL/min/1.73 m , 95% CI 3.28 to 16.64) than CNI-treated recipients. Blood pressure was lower (systolic (2 studies, 658 recipients): MD-7.51 mm Hg, 95% CI-10.57 to-4.46; diastolic (2 studies, 658 recipients): MD-3.07 mm Hg, 95% CI-4.83 to-1.31, lipid profile was better (non-HDL (3 studies 1101 recipients): MD-12.25 mg/dL, 95% CI-17.93 to-6.57; triglycerides (3 studies 1101 recipients): MD-24.09 mg/dL, 95% CI-44.55 to-3.64), and incidence of new-onset diabetes a er transplant was reduced by 39% (4 studies (1049 recipients): RR 0.61, 95% CI 0.40 to 0.93) among belatacept-treated versus CNI-treated recipients.

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“…The study also examined the lipid profiles before and after treatment and observed increases in total and LDL-C (but no change in overall lipid profile). However, belatacept, a molecule closely related to abatacept, was associated with lower blood pressure, better lipid profile and reduced diabetes risk when compared with other immune-suppressive agents among patients who underwent kidney transplant 20. To our knowledge, no prior study has examined the association of abatacept with more clinically important outcomes such as AMI.…”

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“…The long-term benefit was still to be reported. 74 In a recent report of registry data by Wen and associates, which compared clinical outcomes between belatacept-and tacrolimus-treated adult RT recipients, 458 patients of 50 244, who had received belatacept alone, experienced a higher risk for 1-year acute rejection, with highest rates associated with nonlymphocyte-depleting induction (RR = 2.65; P < .0001). There were no significant differences in rejection rates between belatacept-tacrolimus and tacrolimus alone.…”

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“…10 yıl süre Belatacept kullanan hastalarda (15 hasta) stabil renal fonksiyonların görüldüğünü, yan etki profili ve kronik allograft nefropati riskinin çok düşük olduğunu bildirmişlerdir (28). Cochrane Database sistemine göre 1535 hastanın verileri değerlendirilmiş, üç yıllık izlemde Belatacept kullanan hastalarla kalsinörin inhibitörü (KNİ) kullanan hastaların akut rejeksiyon, greft kaybı, diyalize dönme ve ölüm oranlarının benzer olduğu, Belatacept kullananlarda kronik allograft nefropati gelişim riskinin daha düşük olduğu, GFH'ların daha iyi korunduğu bulunmuştur (29). Belatacept kullanan hastalarda daha iyi kan basıncı kontrolü ve lipid profili, daha düşük diyabet gelişimi oranları olduğu tesbit edilmiştir (29).…”

“…Cochrane Database sistemine göre 1535 hastanın verileri değerlendirilmiş, üç yıllık izlemde Belatacept kullanan hastalarla kalsinörin inhibitörü (KNİ) kullanan hastaların akut rejeksiyon, greft kaybı, diyalize dönme ve ölüm oranlarının benzer olduğu, Belatacept kullananlarda kronik allograft nefropati gelişim riskinin daha düşük olduğu, GFH'ların daha iyi korunduğu bulunmuştur (29). Belatacept kullanan hastalarda daha iyi kan basıncı kontrolü ve lipid profili, daha düşük diyabet gelişimi oranları olduğu tesbit edilmiştir (29). Talawilla ve Pengel Belatacept ve KNİ kullanan hastaları karşılaştıran altı randomize kontrollü çalışmanın sonuçlarını metaanaliz halinde değerlendirmiş ve akut rejeksiyon oranlarının benzer, Belatacept alan hastalarda 12 ve 24. aylardaki GFH' ların daha iyi, yeni tanı diyabet oranının daha düşük, kan basıncı ve lipid profillerinin daha iyi olduğunu belirtmişlerdir (30).…”