Basiliximab is a drug in the immunosuppressant drug class. It is used to prevent rejection after liver or kidney transplantation.
What is basiliximab?
Basiliximab is a drug in the immunosuppressant drug class. It is used to prevent rejection after liver or kidney transplantation. Basiliximab is a drug substance that belongs to the group of chimeric monoclonal antibodies. It was approved in the United States and the European Union in 1998. The antibodies are produced in a cell culture in mouse myeloma cells. Other components of the finished drug are:
- Sodium chloride
- Sucrose
- Mannitol
- Glycine
- Water
- Sodium monohydrogen phosphate
Pharmacological action
Basiliximab is used as an immunosuppressant, so it suppresses the reactions of the immune system. Basiliximab is used to prevent organ transplant rejection. At the same time, the drug should not increase susceptibility to infections. Basiliximab may only be administered in special centers that are technically and personnel equipped to adequately care for patients with hypersensitivity reactions to the drug. Overall, the tolerability of basiliximab can usually be considered good.
Medical application and use
Basiliximab is an antibody. The target of the antibody is activated T cells. These are usually responsible for transplant organ rejections. The immune system recognizes the transplanted organ as foreign and tries to destroy it with the help of immune cells. The T cells form killer cells that migrate into the tissue of the organ and cause inflammation there. Basiliximab blocks the so-called alpha subunit of the interleukin-2 receptor of the T cells. Normally, the T-cell growth factor interleukin-2 binds to this receptor. Interleukin-2 stimulates the growth and differentiation of T-cells. It also stimulates the production of interleukins, interferons, natural killer cells and macrophages. However, because basiliximab blocks the receptor, interleukin-2 cannot reach the T cells. Growth and proliferation of the T cells are thus prevented. The immune response is absent and the immune system is weakened. The transplant rejection reaction is thus effectively stopped. Basiliximab is usually administered together with ciclosporin A and daclizumab. Daclizumab, like basiliximab, blocks interleukin-2 receptors. Ciclosporin additionally prevents the synthesis of new interleukin-2. Basiliximab is used in adults and children to prevent acute graft rejection after kidney or liver transplantation. In adults, the drug can be used in combination with azathioprine, mycophenolate mofetil, ciclosporin, and corticosteroids for long-term treatment. There are studies that confirm basiliximab’s efficacy in the chronic inflammatory bowel disease ulcerative colitis. However, there is currently no approval for this indication. As soon as it is known that the patient will receive a donor organ, basiliximab is used. Adults receive 20 milligrams intravenously two hours prior to transplant. Four days after the transplant, another 20 milligrams is administered. Studies showed that when basiliximab is added to standard immunosuppressive therapy, there are fewer transplant rejections.
Risks and side effects
The drug should not be used in cases of known hypersensitivity to any active ingredient of the drug. Basiliximab should also not be used during pregnancy or while breastfeeding. Basiliximab can cause many side effects. Pain or nausea are very common. Rarely, patients also suffer from skin rash, sneezing, urticaria, spasms of the respiratory tract or wheezing breath. In addition, pulmonary edema may develop while taking basiliximab. In pulmonary edema, fluid collects in the alveoli and connective tissue of the lungs. Typical symptoms of pulmonary edema include shallow breathing, restlessness, coughing, shortness of breath, and a blue discoloration of the skin. In later stages, patients also cough up frothy sputum. Pulmonary edema puts a strain on the heart and must therefore be treated as quickly as possible.Other possible side effects include constipation, urinary tract infections, anemia, hypercholesterolemia, hyperkalemia, and hypertension. Cytokine release syndrome can occur in about one in 10,000 cases. This involves the release of a large number of cytokines from T cells. As a result, fever, breathing difficulties, chills and skin rashes occur. Cytokine release syndrome can be fatal. Although basiliximab is usually well tolerated, it may only be administered in special centers because of the potential for severe side effects. Here, possible hypersensitivity reactions can be treated quickly and professionally.
