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.