Drug may keep transplanted kidneys healthier longer

By Gene Emery

BOSTON (Reuters) – Transplanted kidneys may survive three
or four years longer when treated with an experimental
Bristol-Myers Squibb Co. drug instead of the standard drug
cyclosporine, a study released on Wednesday showed.

A test of 218 transplant recipients at 22 centers in North
America and Europe found that the six-month rejection rate for
kidneys treated with either drug was equally low.

But tests showed that the organs functioned much better
when receiving the experimental drug belatacept, according to
the study published in the New England Journal of Medicine.

Journal editors Julie Ingelfinger and Robert Schwartz
cautioned that doctors “will need much more experience with
belatacept before recommending it as a routine replacement for
cyclosporine.”

Bristol-Myers Squibb paid for the study. Of the 15 named
authors, four are employees of the company and seven have
financial ties to it.

Cyclosporine “gives excellent short-term results. The
problem is that over the long term, over the past 10 years,
despite all the newer drugs that have been approved for
transplantation, we have seen only a modest improvement in
long-term organ survival,” Flavio Vincenti, the chief author of
the study, told Reuters.

The problem is that cyclosporine-type drugs, while
preventing the body from rejecting an organ, “can produce
toxicity within the kidney, and ultimately many kidneys suffer
significant damage. So early on they do an excellent job, but
over the long term they do not provide significant improvement
in the life of the kidney,” he said.

Cyclosporine, sold under the brand names Sandimmune or
Neoral by Novartis, and related drugs also can promote heart
disease.

Newer drugs like belatacept can be used without
cyclosporine, said Vincenti of the University of California,
San Francisco. The kidney function tests of the belatacept
recipients “can be extrapolated to say these kidneys will last
three to four years longer,” he said.

The study did not directly assess long-term kidney
survival. It was only designed to see if belatacept was
inferior to cyclosporine over the short term.

The researchers found that both drugs made patients just as
prone to infection and just as likely to develop cancer. And
even though more cyclosporine recipients were taking blood
pressure or cholesterol medicine, the blood pressures and
cholesterol readings of the belatacept recipients were similar
or slightly lower.

Vincenti said one advantage of belatacept is that it is
given intravenously once a month so patients don’t have to
worry about taking pills every day. Some cyclosporine patients
may skip their pills because of the side effects.

“You get assurance of compliance and the patient doesn’t
have to deal with the daily toxicities of some of the drugs,”
he said. “So this is a big improvement, I think.”