Summary of Use during Lactation

Information from one patient indicates that the drug may be used in nursing mothers; however, more data are needed. Since glycosylated belatacept has a molecular weight of 92,300 Da, it is unlikely to appear in milk. The manufacturer recommends avoiding nursing if belatacept is given. Because the drug's half-life is 8 to 10 days, it may be more than a month after a dose before the drug is absent from breastmilk. Waiting for at least 2 weeks postpartum to resume therapy may minimize transfer to the infant.[1]

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

A mother with a liver transplant was maintained on belatacept 10 mg/kg monthly, slow-release tacrolimus (Envarsus and Veloxis) 2 mg daily, azathioprine 25 mg daily, and prednisone 2.5 mg daily. She breastfed her infant for a year (extent not stated). The infant’s growth and cognitive milestones were normal.[2]

In a case series of women who received belatacept during pregnancy and postpartum, 5 women with kidney transplants breastfeed their 7 children while continuing belatacept infusions with no reports of problems breastfeeding or issues in the children. The duration and extent of breastfeeding was not reported in 4 instances, but in the other 3, the durations were 1 month, 2 months, and 4 weeks exclusive breastfeeding, followed by partial breastfeeding.[3]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Azathioprine, Cyclosporine, Tacrolimus

References

1.

Krysko KM, Dobson R, Alroughani R, et al. Family planning considerations in people with multiple sclerosis. Lancet Neurol. 2023;22:350–66. [PubMed: 36931808]

2.

Klintmalm GB, Gunby RT Jr. Successful pregnancy in a liver transplant recipient on belatacept. Liver Transpl. 2020;26:1193–4. [PubMed: 32337853]

3.

Coscia L, Cohen D, Dube GK, et al. Outcomes with belatacept exposure during pregnancy in kidney transplant recipients: A case series. Transplantation. 2023 [PMC free article: PMC10442140] [PubMed: 37287109]

Substance Name

Belatacept

CAS Registry Number

706808-37-9

Drug Class

Breast Feeding

Lactation

Milk, Human

Immunosuppressive Agents