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Bortezomib in Chronic Kidney Transplant Rejection

By: Sarah Campen, PharmD
Posted: Friday, January 5, 2018

Using bortezomib for the treatment of late donor-specific antibody (DSA)-positive antibody-mediated kidney transplant rejection does not seem to be effective in preserving the function of transplanted kidneys or preventing immunologic tissue injury, according to findings published in the Journal of the American Society of Nephrology. Additionally, the compound, a proteasome inhibitor, was associated with significant toxicity.

"This trial may argue against the use of bortezomib in transplant rejection and underscores that, even today, we have no adequate treatment for chronic rejection," said lead study author Georg A. Böhmig, MD, of the Medical University of Vienna, Austria, in a recent press release.

In the randomized, placebo-controlled trial, 44 DSA-positive kidney transplant recipients with late antibody-mediated rejection were given either bortezomib (n=21) or placebo (n=23). The bortezomib arm received two cycles of the compound (each cycle: 1.3 mg/m2 intravenously on days 1, 4, 8, and 11). The study failed to find a significant difference in the estimated glomerular filtration rate slope between the two groups. Bortezomib was also associated with increased gastrointestinal and hematologic toxicities.

Dr. Böhmig emphasized that future trials exploring promising treatments “will have to be designed to clarify the efficiency of new treatment strategies that are currently in the pipeline.”