Tegoprubart Eases Symptom Burden vs Tacrolimus After Kidney Transplant

Kidney transplant recipients treated with the investigational anti-CD40L antibody tegoprubart reported sustained improvements in quality of life and transplant-related symptom burden through 12 months compared with those receiving standard-of-care tacrolimus, according to phase 2 BESTOW data presented at the American Society of Nephrology (ASN) Kidney Week 2026 Annual Meeting and announced by Eledon Pharmaceuticals.¹

The patient-reported outcomes (PROs) add to earlier results from BESTOW, a 12-month, randomized, head-to-head trial comparing tegoprubart with tacrolimus in kidney transplant recipients across 44 global sites. All patients also received rabbit antithymocyte globulin induction plus maintenance mycophenolate and corticosteroids.²

Symptom Occurrence Fell on Tegoprubart, Rebounded on Tacrolimus

Investigators assessed PROs with 2 validated measures of symptom burden: the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) and the Kidney Disease Quality of Life Short Form (KDQOL-SF) Symptoms and Problems Scale. Baseline scores were similar between treatment groups.¹

On the MTSOSD-59R, patients receiving tegoprubart reported continued reductions in symptom occurrence from baseline at months 6 and 12. In the tacrolimus arm, symptom occurrence declined through month 6 before returning to slightly above baseline at month 12.

Where a differential improvement between arms was observed, tegoprubart showed greater symptom improvement in 22 of 23 domains, spanning neurological, gastrointestinal, metabolic, and physical symptom categories. Tacrolimus, meanwhile, showed greater symptom worsening in all 22 domains where differential worsening was observed.

9-Point KDQOL-SF Gain Cleared the Clinical Significance Threshold

Tegoprubart-treated patients improved from baseline across all 5 KDQOL-SF subscales through month 12. On the symptoms and problems subscale, the mean change from baseline at month 12 was 9.0 points with tegoprubart vs 3.3 points with tacrolimus (P < .05). Because a change of 3 to 5 points on the KDQOL-SF can be considered clinically significant, the company described tegoprubart's advantage on this subscale as both clinically and statistically significant.

Mental health scores moved in the same direction. The SF-12 mental component summary score rose 1.5 points in the tegoprubart arm and fell 1.6 points in the tacrolimus arm, a 3.1-point between-group difference; no P value was reported for this comparison.

Eledon said the consistency across both instruments suggests reduced symptom burden may contribute to the quality-of-life gains seen with tegoprubart.

Earlier BESTOW Data Missed eGFR End Point but Favored Tegoprubart on Toxicities

The PRO findings follow 12-month efficacy and safety results presented at ASN Kidney Week 2025, when BESTOW did not meet its primary end point of estimated glomerular filtration rate (eGFR) at 12 months. Mean eGFR was 69 mL/min/1.73 m² with tegoprubart vs 66 mL/min/1.73 m² with tacrolimus, and acute rejection occurred in 20.6% vs 14.1% of patients, respectively.²

Tegoprubart did show a more favorable profile on several toxicities associated with tacrolimus. Tremor occurred in 1.6% of tegoprubart-treated patients vs 25.0% of tacrolimus-treated patients, and sepsis or bacteremia in 4.8% vs 17.2%. New-onset diabetes after transplant developed in roughly 1 in 47 patients on tegoprubart vs 1 in 6 on tacrolimus.

The new PRO data were reported in an oral presentation at Kidney Week and an accompanying company press release. Presenting author Andrew Adams, MD, PhD, professor of surgery and chief of the Division of Transplantation at the University of Minnesota, framed the findings around a broader definition of transplant success.¹

“Success after kidney transplantation is measured not only by preventing rejection and preserving graft function, but also by how patients feel and function in their everyday lives,” said Adams in a statement. “What is particularly compelling about these BESTOW results is the consistency of the patient-reported benefits when treated with tegoprubart compared with tacrolimus following kidney transplant. We observed broad improvements in quality-of-life measures together with remarkably favorable outcomes in transplant-specific symptom reporting. The extent of separation between treatment groups suggests patients receiving tegoprubart may experience meaningful quality of life advantages while maintaining strong clinical outcomes as previously reported from BESTOW.”

References

1. Eledon Pharmaceuticals presents phase 2 BESTOW trial data showing sustained improvements in quality of life and symptom burden with tegoprubart compared to tacrolimus at American Society of Nephrology Kidney Week 2026 Annual Meeting. News release. Eledon Pharmaceuticals. October 26, 2026. Accessed October 28, 2026. https://ir.eledon.com/news-releases/news-release-details/eledon-pharmaceuticals-presents-phase-2-bestow-trial-data
2. Johnson V. BESTOW: tegoprubart showcases safer prevention of kidney transplant rejection over tacrolimus. HCPLive^®. November 6, 2025. Accessed October 28, 2026. https://www.hcplive.com/view/bestow-tegoprubart-showcases-safer-prevention-kidney-transplant-rejection-over-tacrolimus