Belatacept improves long-term kidney transplant outcomes

Follow-up from a previous clinical trial shows improvements in kidney graft survival and function in patients receiving belatacept-based immunosuppression compared with those receiving cyclosporin, reports a study in The New England Journal of Medicine.

The researchers presented 7-year follow-up data from the Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial (BENEFIT). Kidney transplant recipients were randomly assigned to primary immunosuppression with a more intensive belatacept-based regimen, a less intensive belatacept regimen, or a cyclosporin regimen. Patient and graft survival and eGFR were assessed at 84 months.

Of 666 randomized patients, 660 received their assigned treatment. Complete follow-up data were available for 153 patients treated with the more intensive belatacept regimen, 163 patients treated with less intensive belatacept, and 131 patients treated with cyclosporin. Both the more and less intensive belatacept regimens were associated with a lower risk of death or graft loss compared with the cyclosporin regimen: hazard ratio of 0.35 in both groups.

Mean eGFR increased with both belatacept regimens but declined in the cyclosporin group. At 84 months, mean eGFR was 70.4 mL/min per 1.73 m2 with more intensive belatacept and 72.1 mL/min per 1.73 m2 with less intensive belatacept compared to 44.9 mL/min per 1.73 m2 with cyclosporin. The three groups had similar cumulative rates of serious adverse events.

Long-term follow-up of patients enrolled in the BENEFIT shows a 43 percent reduction in risk of death or graft loss with belatacept versus cyclosporin immunosuppression. Vincenti et al. (2) note that the survival advantage of belatacept emerged as early as 5 years of follow-up. They point out some important limitations of their study, including the lack of comparison with tacrolimus [Vincenti F, et al. Belatacept and long-term outcomes in kidney transplantation. N Engl J Med 2016; 374:333–343 (Erratum: N Engl J Med 2016; 374:698)].