Table.
Anti-thymocyte globulin drugs available worldwide and clinical profile
| Rabbit | Horse | |
|---|---|---|
| Drug (manufacturer) | Thymoglobulin (Sanofi Genzyme, USA)7 Grafalon (Neovii, Switzerland)† |
Atgam (Pfizer, USA)8 Thymogam (Bharat Serum and Vaccines Ltd., India)†† |
| Source of antigen | Thymoglobulin (Human thymocytes) Grafalon (Human leukaemia cell line) |
Human thymocytes |
| Indications and dosinga | Severe aplastic anaemia (in combination with CSA)b: 3.5 mg/kg daily for 5 days | Moderate-to-severe aplastic anaemia: 10-20 mg/kg daily for 8-14 days |
| GVHDb prevention: 2.5-10 mg/kg divided over 3 daily doses | Severe aplastic anaemia (in combination with CSA +/− eltrombopag)b: 40 mg/kg daily for four days | |
| Steroid-refractory acute GVHDb: 2.5 mg/kg daily for 4-6 days | Steroid-refractory acute GVHDb: 30 mg/kg every other day for 6 doses or 15 mg/kg twice daily for 10 doses | |
| Administration | Intravenous infusion through a 0.22 micron in-line filter Central line recommended First dose infused over at least 6 h Subsequent doses may be infused over 4 h | Intravenous infusion through a 0.2-1 micron in-line filter Central line recommended Doses must be administered over at least 4 h |
| Recommended pre-medications | Corticosteroids, acetaminophen and/or antihistamine | Corticosteroids, acetaminophen and/or antihistamine |
| Common and serious adverse effects | Infusion reactions (chills, headache, pruritus, diaphoresis, hypertension, hypotension, fever, dyspnoea and anaphylaxis) Skin rash, peripheral oedema Thrombocytopenia, leucopenia, profound and prolonged lymphopenia Opportunistic infections, viral reactivation Nausea, vomiting, constipation Hyperkalaemia Arthralgia, myalgia Serum sickness |
Infusion reactions (chills, headache, pruritus, diaphoresis, fever, dyspnoea and anaphylaxis) Skin rash Thrombocytopenia, leukopenia, profound and prolonged lymphopenia Opportunistic infections, viral reactivation Chemical phlebitis (if administered peripherally) Serum sickness |