Introduction: The results of the BENEFIT trial led to the FDA approval of the novel anti-rejection agent belatacept (bela) in 2011. In addition to its favorable impact on allograft survival, bela also appears to represent an improvement in many adverse extra-renal effects associated with calcineurin and mammalian target of rapamycin inhibitors (CNI and mTOR).

Administered as a monthly infusion, bela also introduces a novel mode of delivery for maintenance immunosuppression. However, this brings with it logistical issues, requiring increased patient and center coordination to ensure the monthly doses are infused. In this study, we looked at our center's kidney transplant recipients (KTRs) who transitioned from either a CNI or mTOR inhibitor to bela. The purpose was to assess patient understanding of the reasons for their conversion, their tolerability of bela, and perceived improvement in quality of life.

Methods: Our cohort included KTRs converted from CNI or mTOR to bela at Yale New Haven Transplantation Center. The study was based on a phone-administered questionnaire. The patients were asked a set of 7 open-ended questions to assess their understanding of, and experience with, bela. The inquires included: reason for switch, willingness to revert back to their prior therapy, changes in memory/thinking, cosmetic side effects, and an assessment of bela infusion impediments (missed work days and transportation difficulties).

Results: The survey was administered to a total of 64 patients. 47 (73%) were on tacrolimus, 14 (22%) on sirolimus and 3 (5%) on cyclosporine. 57 (89%) reported being switched due to side effects, 1 (2%) for ease of administration, and 6 (9%) did not know the reason. 56 (88%) were unwilling to switch back to their pre-bela therapy, 5 (8%) wanted to revert, and 3 (4%) were indifferent. 30 (47%) felt no change in their memory and thinking. An equal number reported cognitive improvement, whereas only 6% worsened. 8 (13%) patients reported new cosmetic side effects (e.g. new hair loss) on bela. 13 (20%) patients had to miss work (even 1 day counted) to accommodate the infusion visits. And 4 (6%) reported difficulty related to travel for the infusions.

Conclusions: Our results show a trend towards greater patient acceptance and tolerability of bela compared to either CNI or mTOR inhibitors. And, a significant proportion reported a perceived improvement in their cognition following conversion. The logistics of getting monthly infusions were very acceptable to a majority of the patients.

CITATION INFORMATION: Murad H., Malhotra D., Cohen E., Asch W. The Infusion with a Difference: Patient Experiences with Belatacept Am J Transplant. 2017;17 (suppl 3).

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