Tegoprubart beats tacrolimus on kidney function and quality of life in BESTOW trial

Adults receiving their first kidney transplant fared better on an experimental immunosuppressive drug than on the current standard of care, according to Phase 2 results from the BESTOW clinical trial being presented at ASN Kidney Week 2026 in Denver, October 22–25. Tegoprubart, a novel anti-CD40L antibody therapy, was better at preserving kidney function than tacrolimus, the immunosuppressive drug most transplant patients take today. Kidney graft function stabilized after the first month of treatment and remained higher in the tegoprubart group than in the tacrolimus group at every reported time point, with a statistically significant kidney function benefit at 18 months.

The trial also produced a second, patient-centered finding. A recent analysis of BESTOW data showed that tegoprubart-treated participants reported greater improvements in health-related quality of life than those taking tacrolimus. Of 127 treated patients, 107 completed study treatment to week 52: 51 taking tegoprubart and 56 taking tacrolimus. Among those who completed the year, improvements from baseline were seen at week 52 across all five quality-of-life subscales with tegoprubart, compared with four of five subscales among tacrolimus-treated patients.

The differences between the two drugs were not uniform across every measure, but they favored the experimental agent in several key domains. Improvements were greater with tegoprubart than with tacrolimus on the mental component summary score, and patients on tegoprubart also showed a numerically greater reduction in total symptom score from baseline. The analysis is reported in a study titled “Patient-Reported Outcomes in the Phase 2 BESTOW Trial Comparing Tegoprubart to Tacrolimus in Kidney Transplant Recipients.”

Corresponding author Andrew Adams, MD, PhD, of the University of Minnesota Medical School, framed the results against the well-known burden of current therapy. “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,” Adams said.

Tegoprubart works differently. The antibody targets the CD40L pathway, which is central to how immune cells communicate with one another. “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,” Adams said.

“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,” he said.

The kidney function results follow a consistent pattern across the trial’s reported time points. Graft function stabilized after the first month of treatment in both groups, but the tegoprubart arm maintained higher function throughout, and the advantage reached statistical significance at the 18-month mark.

In the BESTOW analysis, the mental component summary score showed a greater improvement with tegoprubart, and the total symptom score declined more on a numerical basis in that group, although the symptom reduction was described as numerically rather than statistically greater.

The findings were presented at ASN Kidney Week 2026, where more than 12,000 kidney professionals from around the world are gathering in Denver for the annual meeting, which runs from October 22 to 25 following early programs on October 21. The American Society of Nephrology, which has more than 20,000 members representing 138 countries, hosts the meeting as a venue for the latest scientific and medical advances in kidney disease.

Subject of Research: A phase 2 trial comparing tegoprubart with tacrolimus immunosuppression in kidney transplant recipients

Article Title: Phase 2 BESTOW trial generates promising kidney function and quality of life results for tegoprubart versus tacrolimus immunosuppression in kidney transplant recipients

Article References: Phase 2 BESTOW trial generates promising kidney function and quality of life results for tegoprubart versus tacrolimus immunosuppression in kidney transplant recipients. Original publication (Bibliographic details unavailable.)

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Keywords: tegoprubart, tacrolimus, kidney transplant, BESTOW trial, immunosuppression, anti-CD40L antibody, kidney function, quality of life, ASN Kidney Week, transplantation, clinical trial, nephrology