PML: Belatacept vs Mycophenolate

During some recent research on combining MMF/SRL in renal transplant I got curious to see how the progressive multifocal leukoencephalopathy (PML) incidence rate with MMF compared to the incidence rate with Belatacept, the new kid on the block.

I finally made time to find an answer:
Belatacept: 6/(445+359+144) = 0.6% (Source)
MMF: 14.4/100,000 = 0.014% (Source)

Both groups included both EBV(+) and (-) patients so are comparable in that regard. I’m not sure I’ve ever seen anything in transplant pharmacology that could be considered conclusive, other than the fact that all current immunosuppressants suck hyena penises, but at present I think the advantage goes to MMF. Like Belatacept, it isn’t nephrotoxic and improves GFR when substituted for CNI; it also has some beneficial effects on CAN, and from these numbers MMF appears less likely to cause a fatal brain cancer. Good enough for government work as my father often said.

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