Corticosteroids and methotrexate as adjuvants to costimulation blockade in non-human primate renal transplantation.

Journal Article (Journal Article)

Belatacept, the CD28-B7 costimulation pathway inhibitor, has been approved as a calcineurin inhibitor (CNI) alternative in kidney transplantation. Although costimulation blockade (CoB) allows for CNI avoidance, it is associated with increased rates of early rejection, prompting a search for agents to pair with belatacept. Methotrexate (MTX) is an antimetabolite that has been found to be complimentary with abatacept, a lower affinity CD28-B7-specific analogue of belatacept, in the treatment of rheumatoid arthritis (RA). We examined whether this synergy would extend to prevention of kidney allograft rejection. Rhesus macaques underwent kidney transplantation treated with abatacept maintenance therapy with either a steroid taper, MTX, or both. The combination of abatacept maintenance with steroids prolonged graft survival compared to untreated historical controls and previous reports of abatacept monotherapy. The addition of MTX did not provide additional benefit. These data demonstrate that abatacept with adjuvant therapy may delay the onset of acute rejection, but fail to show synergy between abatacept and MTX beyond that of steroids. These findings indicate that MTX is unlikely to be a suitable adjuvant to CoB in kidney transplantation, but also suggest that with further modification, a CoB regimen used for advanced RA may suffice for RA patients requiring kidney transplantation.

Full Text

Duke Authors

Cited Authors

  • Anderson, DJ; Lo, DJ; Leopardi, F; Song, M; Strobert, EA; Jenkins, JB; Larsen, CP; Kirk, AD

Published Date

  • June 2019

Published In

Volume / Issue

  • 33 / 6

Start / End Page

  • e13568 -

PubMed ID

  • 31006146

Pubmed Central ID

  • PMC6597274

Electronic International Standard Serial Number (EISSN)

  • 1399-0012

Digital Object Identifier (DOI)

  • 10.1111/ctr.13568


  • eng

Conference Location

  • Denmark