What is belatacept?
A biological agent that blocks the co-stimulation necessary for activation of the T-cell (signal 2), Belatacept is associated with less metabolic side effects and nephrotoxicity compared to CNIs and mTOR inhibitors. Drug levels do not need to be checked, allowing for less lab draws. Another advantage is that once loaded, it is typically a once-monthly intravenous infusion, potentially improving patient compliance. Studies comparing Belatacept to CNI (cyclosporine) showed that, though there was improved glomerular filtration rates in the Belatacept arm, this came at the cost of an increased rejection rate. Also, Belatacept was associated with post-transplant lymphoproliferative disease when given in patients who were Epstein-Barr negative. The primary barriers for Belatacept to be a more mainstream agent are the need for the infusion, cost, and the possible higher rate of rejection in high-risk transplant groups.