Belatacept: Good, but not good enough?

Belatacept has brought about a ‘paradigm shift’ in the maintenance immunosuppression after solid organ transplantation, in that it is the first biologic agent approved for use for long-term maintenance immunosuppression for solid organ transplantation. Biologic agents (Basiliximab, thymoglobulin, etc.) already have an established role as induction immunosuppressive agents at the time of kidney transplantation but there are several issues to be tackled before a biologic agent can be accepted as a viable option for long-term maintenance immunosuppression. Such an agent should inhibit the immune system in a nondepleting manner without creating excessive immunodeficiency, should not have initial and prolonged immunogenicity, should not require therapeutic drug monitoring, and should offer an acceptable administration route and interval between doses. Belatacept satisfies all these requirements, except that it requires intravenous (IV) administration.