II. Indications
- Renal Transplant Rejection prophylaxis
- Belatacept (Nulojix)
- Used in combination with Basiliximab induction, Mycophenolate Mofetil, and Corticosteroids
- Belatacept (Nulojix)
- Rheumatoid Arthritis
III. Contraindications
- Non-immune to Epstein-Barr Virus
- Liver Transplant (higher risk of graft loss)
IV. Mechanism
- Costimulatory T-Cell Receptor
- T-Cells are stimulated via CD3 with co-stimulation via various agents including CD28, CD80, CD86
- Images
- T-Cell Co-Stimulatory Blockers
- CD28 Inhibition
- Increases T-Cell Activation threshold and inhibits T-Cell proliferation
- Abatacept inhibits CD28 to CD80/CD66 binding
- Belatacept is derived from Abatacept, and also binds CD80, CD86
- CD28 Inhibition
V. Medications
VI. Dosing: Belatacept (Nulojix)
- See other references for specific dosing regimens per indication
- Prescribers are typically specialists knowledgeable about the risks and monitoring
- Post-Renal Transplant (combined with other agents, e.g. Basiliximab induction, Mycophenolate Mofetil, and Corticosteroids)
- Initial Post-Transplant dosing 10 mg/kg IV over 30 minutes on days 1, 5, 14, 28, 56 and 84 (12 weeks)
- Maintenance Post-Transplant 5 mg/kg IV over 30 minutes
- Start week 16 (following initial dosing to week 12)
- Administer every 4 weeks (each dose +/- 3 days)
VII. Adverse Effects: Belatacept (Nulojix)
- See Abatacept
- Post-transplant Lymphoproliferative Disorder (PTLD)
- Higher risk if non-immune to Epstein-Barr Virus (Antibody negative)
- Most commonly involves the Central Nervous System (CNS)
- Secondary malignancy
- Progressive Multifocal Leukoencephalopathy (PML)
- Serious Infections
- Includes opportunistic infections; Bacterial, viral, fungal, and Protozoal Infections
- Tuberculosis
- Polyoma virus-associated nephropathy
- Cytomegalovirus (post-transplant prophylaxis recommended)
- Pneumocystis (post-transplant prophylaxis recommended)
- Other common adverse effects
- Cardiovascular
- Gastrointestinal
- Neurologic
- Hematologic
VIII. Safety: Belatacept (Nulojix)
- Unknown safety in pregnancy
- Avoid in Lactation
IX. Drug Interactions
-
Live Vaccines
- Avoid use with Costimulatory T-Cell Receptor Antagonists
X. Resources
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129) |
MSH | C468566 |
English | Belatacept, belatacept, BELATACEPT |
Japanese | ベラタセプト |
Ontology: Costimulatory T-Cell Receptors (C3179048)
Concepts | Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129) |
MSH | D061025 |
English | Costimulatory T Cell Receptors, Receptors, Costimulatory T-Lymphocyte, Receptors, Costimulatory T-Cell, Costimulatory T-Cell Receptors, Receptors, Costimulatory, T-Lymphocyte, Costimulatory T-Lymphocyte Receptors, T-Lymphocyte Receptors, Costimulatory, Costimulatory T Lymphocyte Receptors, T-Cell Receptors, Costimulatory |
French | Récepteurs costimulateurs des lymphocytes T, Récepteurs de costimulation des cellules T, Récepteurs costimulateurs des cellules T, Récepteurs de costimulation des lymphocytes T |
Czech | kostimulační receptory T-lymfocytů, kostimulační receptory T-buněk |
German | Rezeptoren, kostimulatorische, T-Lymphozyt, Kostimulatorische T-Lymphozyten-Rezeptoren, Kostimulatorische T-Zell-Rezeptoren |
Ontology: T Lymphocyte Costimulation Activity Blockade [PE] (C3192216)
Concepts | Physiologic Function (T039) |
English | T Lymphocyte Costimulation Activity Blockade, T Lymphocyte Costimulation Activity Blockade [PE] |