II. Indications
- Renal Transplant Rejection Prophylaxis
- Basiliximab (Simulect)
- Used in combination with Cyclosporine and Corticosteroids
- Daclizumab (off-market, see below)
- Basiliximab (Simulect)
-
Multiple Sclerosis
- Daclizumab (off-market, marginal efficacy, see below)
III. Mechanism
- Interleukin-2 Receptor Alpha (IL-2Ra, CD25)
- Interleukin 2 binds IL-2Ra on Leukocyte surface, triggering immune response
- IL-2Ra binding is involved in cell signaling, immune response, cell proliferation and apoptosis
- IL-2Ra (CD25) is expressed on the surface of Leukocytes, esp. activated T Cells and Regulatory T Cells (Tregs)
- Alpha subunit combines with 2 other subunits (beta and gamma chain) to form a high affinity Interleukin 2 receptor
- Interleukin 2 binds IL-2Ra on Leukocyte surface, triggering immune response
- CD25 Monoclonal Antibody
- Chimeric monoclonal antibodies bind CD25 receptor alpha on Leukocytes (esp. activated T Cells)
- Blocks Interleukin-2 binding, thereby reducing IL-2 mediated immune response
IV. Dosing
- See other references for disease specific dosing protocols
- Prescribers are typically specialists knowledgeable about the risks and monitoring of Voclosporin
V. Medications
- Basiliximab (Simulect)
- Daclizumab (Zinbryta, off-market)
- https://www.fda.gov/drugs/drug-safety-and-availability/fda-working-manufacturers-withdraw-zinbryta-market-united-states
- Voluntarily removed from market 2018 after association with autoimmune Encephalitis, and risk of hepatotoxicity
VI. Adverse Effects: Basiliximab
- Severe acute Hypersensitivity Reaction (including Anaphylaxis)
- Cytokine Release Syndrome
- Gastrointestinal
- Cardiovascular
- Febrile Illness
- Metabolic
- Electrolytes
- Neurologic
- Hematologic
VII. Safety: Basiliximab
- Unknown safety in Lactation
- Unknown safety in pregnancy (although labeled as Pregnancy Category B)
- Use only in pregnancy if benefit outweighs risk