COMMENTARY

Recalled Efalizumab Effective as Immunosuppressant for Islet Transplantation

Ron Shapiro, MD

Disclosures

October 20, 2010

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Hi, my name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh. Today I want to talk to you about a really interesting study that has almost a wistful quality to it -- kind of a "what if" aspect.

It's a study from the University of California, San Francisco, on patients undergoing islet transplantation.[1] These patients received a cocktail of immunosuppressants that included a drug called efalizumab, an antileukocyte functional antigen-1 antibody that, unfortunately, was withdrawn from the market because of problems with progressive multifocal leukoencephalopathy in psoriasis patients.

This study was interesting in that these patients all did quite well: 8 out of 8 became insulin independent and 4 required only 1 set of islets after complex immunosuppression with antithymocyte globulin and with non-calcineurin inhibitor-based immunosuppression. After efalizumab was withdrawn from the market, these patients were given additional immunosuppression. In many cases, a calcineurin inhibitor was added.

It is, perhaps, too late for this agent. But there certainly is a sense of what could have been a really interesting immunosuppressive agent in combination with other agents to achieve long-term graft survival in difficult cases, such as islet transplantation and perhaps in other scenarios.

I think that this is a very interesting study and it would be nice if, somehow, interest in resurrecting this agent was rekindled.

Thank you.

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