TDM of belatacept
The inter-individual variability in belatacept exposure seems large enough that a potential for optimized treatment by TDM should be considered. Also, although the switch from CNI based immunosuppression to belatacept in renal transplant recipients has been proven non-inferior with respect to long term graft and patient survival, there is still an increased incidence of rejection episodes and the incidence of severe adverse effects is not negligible. So far, none of the reported analyses of a potential association between belatacept concentrations and treatment failure or side effects have found correlations that could indicate a therapeutic range. A weak point in this argumentation, is that studies with the aim to elucidate a PK-PD relationship for belatacept have been hampered since the drug has been unavailable in periods due to manufacturing problems. All considered, the conclusion remains that based on the data currently available, there is not evidence to recommend TDM of belatacept when used in transplantation.