Imlifidase therapy: exploring its clinical uses
Lionel Rostaing1,2,3, Johan Noble1,2, Paolo Malvezzi1
1Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, Grenoble, France.
Expert Opinion on Pharmacotherapy
|November 20, 2022
Summary
Imlifidase, an enzyme from Streptococcus pyogenes, effectively degrades IgG antibodies, enabling kidney transplants for highly sensitized patients. This breakthrough shows promising 3-year allograft survival rates, though preventing antibody rebound remains a challenge.
Area of Science:
- Immunology
- Nephrology
- Transplantation
Background:
- Imlifidase, derived from Streptococcus pyogenes, is an enzyme that degrades all human IgG subclasses.
- This enzyme temporarily inactivates IgG for 1-2 weeks until new antibodies are synthesized.
Purpose of the Study:
- To evaluate imlifidase for desensitizing highly HLA-sensitized patients for kidney transplantation.
- To assess imlifidase's efficacy in kidney transplant recipients with antibody-mediated rejection (AMR) or anti-GBM disease.
- To review imlifidase's use in deceased-donor kidney transplants with positive crossmatches.
Main Methods:
- A literature search of PubMed identified four single-arm, open-label, phase II studies.
- 39 crossmatched-positive patients received imlifidase prior to kidney transplantation.
- Data from 3-year follow-up was analyzed.
Main Results:
- 84% allograft survival at 3 years was observed.
- 38% of patients experienced acute AMR.
- Mean estimated glomerular filtration rate (eGFR) was 55 mL/min/1.73 m² at 3 years.
Conclusions:
- Imlifidase is a breakthrough for highly HLA-sensitized kidney transplant candidates, especially those with ≥90% panel-reactive antibodies.
- The primary challenge is preventing donor-specific antibody (DSA) rebound within 5-15 days post-transplantation.
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