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Antithymocyte Globulin

    Brands

    DEA Class; Rx

    Common Brand Names; Atgam, ATG equine

    • Immunosuppressants; 
    • Polyclonal Antibodies

    Immunosuppressant, polyclonal IgG against human T-lymphocytes derived from horses (Atgam) or rabbits (Thymoglobulin)
    Used for kidney organ transplant rejection, organ transplant rejection prophylaxis, and moderate to severe aplastic anemia
    Risk of serious hypersensitivity reactions, including anaphylaxis or cytokine release syndrome (CRS)

    Indicated for the treatment of acute kidney transplant rejection.

    For kidney transplant rejection prophylaxis.
    For the treatment of patients with moderate to severe aplastic anemia who are not candidates for hematopoietic stem cell transplantation.
    For the treatment of heart transplant rejection.
    For heart transplant rejection prophylaxis.
    For stem cell transplant preparation† prior to allogeneic stem hematopoietic stem cell transplantation (SCT).

    Hypersensitivity to antithymocyte globulin, other equine gamma globulins

    • Fever (33-51%)
    • Thrombocytopenia (11-30%)
    • Rash (27%)
    • Chills (14-16%)
    • Leukopenia (14%)
    • Systemic infection (13%)
    • Dermatologic rxns (12%)
    • Arthralgia, clotted AV fistula, hypotension, peripheral thrombophlebitis
    • Headache
    • Diarrhea, nausea or vomiting, stomatitis
    • Chest or back pain
    • Night sweats
    • Pain at the infusion site
    • Dyspnea
    • Edema, hypertension, pulmonary edema, tachycardia
    • Dizziness, malaise, paresthesia, seizures, weakness or faintness
    • Toxic epidermal necrosis, wound dehiscence
    • Epigastric pain, hiccoughs, iliac vein obstruction
    • Myalgia
    • Renal artery thrombosis
    • Herpes simplex reactivation, localized infection, systemic infection, serum sickness
    • Anaphylaxis, hyperglycemia, laryngospasm

    Test for allergic response by intradermal injection before start of treatment

    Discontinue if anaphylaxis, unremitting thrombocytopenia, or unremitting leukopenia occur

    Aplastic anemia patients may need prophylactic platelet transfusion

    Observe patients carefully for previously masked reactions when reducing dose of corticosteroids, other immunosuppressants

    Pregnancy Category: C

    Lactation: not known if excreted in breast milk, use caution

    Adults

    1.5 mg/kg/day IV for Thymoglobulin; 30 mg/kg/day IV for Atgam.

    Elderly

    1.5 mg/kg/day IV for Thymoglobulin; 30 mg/kg/day IV for Atgam.

    Adolescents

    Safe and effective use has not been established for Thymoglobulin; 25 mg/kg/day IV for Atgam.

    Children

    Safe and effective use has not been established for Thymoglobulin; 25 mg/kg/day IV for Atgam.

    Antithymocyte globulin equine

    Lymphocyte immune globulin, anti-thymocyte globulin equine

    injectable solution

    • 50mg/mL