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New Study Finds Imlifidase More Effective Than Plasma Exchange in Kidney Transplant Rejection

In what could have major implecations for people receiving kidney transplants, researchers have found that the investigational enzyme imlifidase outperforms the current standard of care, plasma exchange (PLEX), in reducing donor-specific antibodies (DSAs) in kidney transplant recipients experiencing antibody-mediated rejection. These findings were presented at ASN Kidney Week 2024 and could lead to significant changes in how rejection is managed for kidney transplant patients.


Currently, PLEX is used to remove harmful antibodies from the plasma, a key step in treating antibody-mediated rejection. However, the new trial suggests that imlifidase, which cleaves and inactivates antibodies, achieves better and faster reduction of DSAs.

The phase 2 trial, which was randomized, open-label, and conducted across multiple centers, involved 30 patients. Researchers compared the effectiveness of imlifidase with PLEX in reducing DSAs. The trial showed that after five days, imlifidase had reduced DSAs by 97%, while PLEX achieved only a 42% reduction. Furthermore, imlifidase reached its maximum effect in just 15 hours after a single dose, compared to nine days for PLEX, which required six sessions on average to achieve maximum DSA depletion.

Dr. Stanley Jordan, a corresponding author from Cedars-Sinai Medical Center, emphasized the importance of the study’s findings. “These data further underscore imlifidase’s consistent and efficient ability to reduce antibodies, which is important for patients who require safe and efficient reduction of DSA levels,” he said. He highlighted that this was the first head-to-head comparison between imlifidase and PLEX, the standard treatment.

The study’s results could have wider implications, as Dr. Jordan suggested that imlifidase’s performance could be relevant in other medical conditions where PLEX is the standard of care for managing pathogenic antibodies. “The performance of imlifidase in this patient model was consistent with that observed in other indications,” he added.

Looking forward, researchers are focusing on how to manage the rebound of antibodies after imlifidase treatment. This is a critical factor in ensuring the long-term success of reducing DSAs and preventing antibody rejection in transplant patients. If further studies confirm these findings, imlifidase could represent a significant advancement in the treatment of antibody-mediated rejection, potentially replacing PLEX as the standard of care.


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