Imlifidase therapy: exploring its clinical uses
Issued Date
2023-01-01
Resource Type
ISSN
14656566
eISSN
17447666
Scopus ID
2-s2.0-85142667050
Pubmed ID
36404277
Journal Title
Expert Opinion on Pharmacotherapy
Volume
24
Issue
2
Start Page
259
End Page
265
Rights Holder(s)
SCOPUS
Bibliographic Citation
Expert Opinion on Pharmacotherapy Vol.24 No.2 (2023) , 259-265
Suggested Citation
Rostaing L., Noble J., Malvezzi P., Jouve T. Imlifidase therapy: exploring its clinical uses. Expert Opinion on Pharmacotherapy Vol.24 No.2 (2023) , 259-265. 265. doi:10.1080/14656566.2022.2150965 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/81524
Title
Imlifidase therapy: exploring its clinical uses
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Introduction: Imlifidase, the IgG-degrading enzyme derived from Streptococcus pyogenes, can cleave all four human IgG subclasses with precise specificity. All IgG molecules can be inactivated for ~1-to-2 weeks, until new IgG synthesis is detected. Areas covered: Imlifidase was first studied for the desensitization of highly HLA-sensitized patients to enable kidney transplantation. It is currently being evaluated for kidney transplant recipients who have antibody-mediated rejection (AMR), those with acute kidney injury in the setting of anti-glomerular basement membrane disease, and those with Guillain–Barré syndrome. In 2020, imlifidase received conditional approval from the European Medicines Agency for use to desensitize deceased-donor kidney transplant recipients with a positive crossmatch. Literature search through PubMed revealed that so far, 39 crossmatched-positive patients, i.e. in the presence of donor-specific alloantibodies (DSA) on the transplantation day, have received imlifidase prior to kidney transplantation in four single-arm, open-label, phase II studies. Results at 3-year follow-up are good, i.e. allograft survival is 84%, despite 38% of patients presenting with acute AMR. Mean estimated glomerular filtration rate at 3 years was 55 mL/min/1.73 m2. Expert opinion: The major hurdle now is how to prevent/avoid DSA rebound within days 5–15 post-transplantation. Thus, imlifidase represents a major breakthrough for highly HLA-sensitized kidney transplant candidates, particularly those that have calculated panel-reactive alloantibodies of ≥90%.