Tegoprubart Improves Quality of Life vs Tacrolimus After Kidney Transplant

Tegoprubart, an investigational anti-CD40 ligand (CD40L) antibody, was associated with greater improvements in health-related quality of life (HRQoL) and fewer medication-related symptoms than tacrolimus in adults receiving their first kidney transplant, according to patient-reported outcome (PRO) data from the phase 2 BESTOW trial.1 The findings were presented at ASN Kidney Week 2026 in Denver, Colorado.2

“Treatment today with tacrolimus helps prevent organ rejection but at a high cost to patients, with side effects such as kidney toxicity, hypertension, diabetes, tremors, and brain fog. Tegoprubart, which works by targeting the CD40L pathway that is central to how immune cells communicate, has the potential to replace tacrolimus and become the new standard of care immunosuppression therapy across all transplant types, not just kidney transplantation,” corresponding author Andrew Adams, MD, PhD, of the University of Minnesota Medical School, said in a statement.2 “These latest BESTOW trial results are encouraging that we may soon have a new medication that can prevent rejection without the side effects of tacrolimus and transform the broader transplant immunosuppression treatment landscape.”

BESTOW previously showed tegoprubart preserved kidney function vs tacrolimus as the core of the immunosuppressive regimen, with fewer cases of new-onset diabetes and tremor.3 At 18 months, mean eGFR was 74 mL/min/1.73 m² with tegoprubart compared with 61 mL/min/1.73 m² with tacrolimus.4 The present analysis represents the first report of HRQoL outcomes from the trial.1

How Did Tegoprubart Affect Quality of Life in the BESTOW Trial?

BESTOW was a multicenter, randomized, open-label, active-controlled trial. Patients received intravenous tegoprubart 20 mg/kg on days 1, 3, 7, 14, 21, and 28 and every 21 days thereafter, or oral tacrolimus twice daily. Both groups received rabbit antithymocyte globulin induction and maintenance therapy with mycophenolate and corticosteroids.1

PROs were assessed at baseline and at 25 and 52 weeks post-transplant. Investigators used the Kidney Disease Quality of Life 36-Item Short-Form (KDQOL-SF 36), with higher scores indicating better HRQoL, and the Modified Transplant Symptom Occurrence and Symptom Distress scale (MTSOSD-59R), with lower scores indicating fewer symptoms.1

Of 127 treated patients, 107 completed study treatment through week 52, including 51 receiving tegoprubart and 56 receiving tacrolimus. At week 52, HRQoL improved from baseline across all 5 KDQOL-SF 36 subscales with tegoprubart, compared with 4 of 5 subscales with tacrolimus.1

Improvements were greater with tegoprubart than tacrolimus on the SF-12 mental component summary and the symptoms and problems scale. The investigators concluded the PROs suggest improved HRQoL with tegoprubart versus tacrolimus after kidney transplantation. The KDQOL-SF 36 subscales cover symptoms and problems, effects of kidney disease, burden of kidney disease, and the SF-12 physical and mental component summaries.1

Did Tegoprubart Reduce Transplant Medication Side Effects?

The symptom improvement observed on the KDQOL-SF 36 was also reflected in the MTSOSD-59R. Patients receiving tegoprubart had a numerically greater reduction in total symptom score from baseline vs tacrolimus at week 25, and the difference was more pronounced by week 52.1

The investigators did not report statistical testing for symptom score differences, and the open-label design may have influenced how patients rated their quality of life.1 Earlier BESTOW results also showed a numerically higher rate of the composite of death, graft loss, or biopsy-proven acute rejection with tegoprubart than tacrolimus at 12 months (22% vs 17%).3

Still, the PRO findings add a patient-centered dimension to the kidney function and metabolic safety advantages previously reported with tegoprubart.3,4 Confirmation in larger, blinded trials will be needed to establish whether these quality-of-life gains hold up as tegoprubart advances in development.

References

1. Adams AB, Hovland DN, Habibi S, et al. Patient-reported outcomes in the phase 2 BESTOW trial comparing tegoprubart to tacrolimus in kidney transplant recipients. Presented at: ASN Kidney Week 2026; October 22-25, 2026; Denver, CO. doi:10.1681/ASN.20267zf5wbsg

2. American Society of Nephrology. Phase 2 BESTOW trial generates promising kidney function and quality of life results for tegoprubart versus tacrolimus immunosuppression in kidney transplant recipients. EurekAlert! Published October 23, 2026. Accessed October 25, 2026. https://www.eurekalert.org/news-releases/1148321

3. Johnson V. BESTOW: Tegoprubart showcases safer prevention of kidney transplant rejection over tacrolimus. HCPLive. Published November 6, 2025. Accessed October 25, 2026. https://www.hcplive.com/view/bestow-tegoprubart-showcases-safer-prevention-kidney-transplant-rejection-over-tacrolimus

4. Adams A. Tegoprubart sustains increased eGFR longterm compared to tacrolimus. HCPLive. Published July 13, 2026. Accessed October 25, 2026. https://www.hcplive.com/view/tegoprubart-sustains-increased-longterm-egfr-compared-to-tacrolimus