Table of Contents  
Year : 2012  |  Volume : 3  |  Issue : 1  |  Page : 83-84  

Authors' reply

1 Division of Clinical Pharmacology, JIPMER, Puducherry, India
2 Department of Pharmacology, JIPMER, Puducherry, India

Date of Web Publication3-Feb-2012

Correspondence Address:
George Melvin
Division of Clinical Pharmacology, JIPMER, Puducherry
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Source of Support: None, Conflict of Interest: None

PMID: 22368435

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How to cite this article:
Melvin G, Sandhiya S, Subraja K. Authors' reply. J Pharmacol Pharmacother 2012;3:83-4

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Melvin G, Sandhiya S, Subraja K. Authors' reply. J Pharmacol Pharmacother [serial online] 2012 [cited 2020 Sep 23];3:83-4. Available from:

We thank Parameswaran et al for their interest and cogent comments [1] on our article on belatacept. We have already mentioned in our paper [2] that a major limitation of belatacept is its intravenous route of administration. In developing countries like India patients invariably end up making frequent visits to the hospital to receive medication. A once monthly injection of belatacept should rather reduce the frequency of his/her hospital visits and ensure better compliance. We do agree with him that tacrolimus would have been a better comparator in the trial as it is the first-line drug for maintenance immunosuppression in postrenal transplant patients. However considering the fact that tacrolimus was not approved for coadministration with mycophenolate mofetil at the time of commencement of the BENEFIT trial in 2008 by the US FDA, [3] cyclosporine was preferred instead. Tacrolimus being a CYP3A4 substrate is known to have drug interactions with several drugs. The incidence of nephrotoxicity matches with that of cyclosporine, and there is an increased frequency of insulin-dependent diabetes mellitus. [4],[5] These disadvantages of tacrolimus may be circumvented to a certain extent with belatacept. A study is now underway that compares belatacept over tacrolimus or cyclosporine. [6] The results of this study would be able to answer the question of belatacept's superiority over tacrolimus.

   References Top

1.Parameswaran S & R.P. Swaminathan Belatacept: Good, but not good enough? J Pharmacol Pharmacother 2012;3:81-2.  Back to cited text no. 1
2.George M, Selvarajan S, Kumaresan S. Belatacept: A worthy alternative to cyclosporine? J Pharmacother 2012.  Back to cited text no. 2
3.Medscape family medicine. FDA Approves Tacrolimus for Use With MMF in Kidney Transplant Recipients. Available from [last cited 1 November, 2009]  Back to cited text no. 3
4.Krensky AM, Bennett WM, Vincenti F. Immunosuppressants, Tolerogens and Immunostimulants. In: Brunton LL, Chabner BA, Knollmann B, editors. Goodman and Gilman′s The Pharmacological Basis of Therapeutics. 12 th ed. New York: McGraw-Hill Professional; 2011. p. 1005-29.  Back to cited text no. 4
5.Webster AC, Taylor RR, Chapman JR, Craig JC. Tacrolimus versus cyclosporine as primary immunosuppression for kidney transplant recipients. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003961. DOI: 10.1002/14651858.CD003961.pub2  Back to cited text no. 5 A study of BMS 224818 (Belatacept) in patients who have undergone a kidney transplant and are currently on stable cyclosporine or tacrolimus regimen with or without corticosteroids. Available from [last cited 1 November, 2011]  Back to cited text no. 6


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