Belatacept 250mg powder for solution for infusion vials

Background The novel immunosuppressant belatacept demonstrates a unique mechanism of action that significantly improves renal function and reduces metabolic complications. However, systematic evidence comparing the risk of post-transplant diabetes mellitus (PTDM) and overall safety profiles between belatacept-based regimens and calcineurin inhibitor (CNI)-based protocols remains limited. This meta-analysis aims to synthesize high-quality evidence to determine the comparative efficacy of these two regimens in PTDM prevention and safety outcomes, thereby providing robust guidance for clinical decision-making. Methods We systematically searched PubMed, Cochrane Library, CNKI, and EMBASE for studies published until November 30, 2024, comparing belatacept versus calcineurin inhibitors (CNIs) regarding PTDM risk in kidney transplant recipients. The primary outcome was PTDM incidence. Following data extraction and quality assessment, we performed pairwise meta-analyses to compare PTDM risk between belatacept (either less intensive(LI) or more intensive (MI) regimen) and CNIs. Bayesian network meta-analysis (WinBUGS 1.4.3) was then conducted for indirect comparison between belatacept LI and MI regimens. Results The initial search yielded 3,206 records. After deduplication, title/abstract screening, and full-text evaluation, 6 studies involving 1,737 kidney transplant recipients were included in the final analysis. Compared with CNIs, belatacept demonstrated significant reductions in PTDM risk for both the LI (RR = 0.65, 95% CI 0.52-0.81, p<0.001; I²=30%) and MI (RR = 0.65, 95% CI 0.52-0.81, p<0.001; I²=30%) regimens. Bayesian network meta-analysis revealed no statistically significant difference between the LI and MI regimens. Conclusions This meta-analysis demonstrates that belatacept significantly reduces PTDM risk compared to CNIs, a finding consistent with previous studies. Notably, both LI and MI dosing regimens showed protective effects, suggesting that even low-intensity belatacept therapy could serve as a viable alternative to CNIs, particularly for patients requiring reduced immunosuppressive toxicity. Systematic review registration https://inplasy.com/, identifier INPLASY202540041.

Abstract licence: CC BY

BackgroundPrimary focal segmental glomerulosclerosis (FSGS) frequently recurs after kidney transplantation and remains a major cause of premature allograft failure. Despite multiple proposed preventive strategies, no standardized approach has been established. This review aimed to systematically evaluate and compare the efficacy and safety of prophylactic interventions for preventing recurrent FSGS following kidney transplantation.MethodsWe performed a systematic review and network meta-analysis of randomized and nonrandomized studies including patients with primary FSGS undergoing kidney transplantation. PubMed and Embase were searched through July 2025. Any intervention administered prior to FSGS recurrence-either before or shortly after transplantation-was eligible for inclusion. The primary outcome was posttransplant FSGS recurrence; secondary outcomes included proteinuria, time to recurrence, and treatment-related adverse events.ResultsTwenty-five unique studies evaluating six interventions were included in the systematic review. None of the prophylactic strategies significantly reduced recurrence compared with control. The combination of rituximab and plasma exchange yielded lower effect estimates than either intervention alone, but this difference did not reach statistical significance. Evidence for belatacept and bleselumab was limited to single studies; however, their findings warrant further investigation. Adverse events were infrequently reported.ConclusionsCurrent evidence does not support a definitive prophylactic strategy to prevent recurrent FSGS after kidney transplantation. These findings remain inconclusive, and confirmation of potential benefit-or lack thereof-requires adequately powered randomized trials. Future multicenter studies should standardize recurrence definitions, timing of prophylaxis, and safety reporting.

Abstract licence: CC BY-NC