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Antithymocyte Globulin Brand Names- Atgam | Thymoglobulin
What is Antithymocyte Globulin
Antithymocyte globulin (ATG) is a polyclonal antibody that is used for organ transplant rejection, transplant rejection prophylaxis, and moderate to severe aplastic anemia in patients unsuitable for bone marrow transplantation.
Two formulations of ATG are available, derived from either horses (Atgam) or rabbits (Thymoglobulin).
Rabbit ATG has demonstrated a significantly higher rejection reversal rate and a decreased incidence of recurrent rejection in kidney transplant patients compared to equine ATG, but the 2 products were not significantly different with regard to graft survival.
When used for rejection prophylaxis, rabbit ATG is associated with a lower incidence of treatment failure (biopsy-proven acute rejection, graft loss, death) in kidney transplant recipients compared to basiliximab.
In the management of moderate to severe aplastic anemia, equine ATG alone or in combination with other immunosuppressive agents may induce partial or complete hematologic response in 42% to 51% of patients.
Due to the presence of animal proteins, there is a risk of serious hypersensitivity reactions, including anaphylaxis or cytokine release syndrome (CRS), with ATG.
Indications
- aplastic anemia
- graft-versus-host disease (GVHD)
- graft-versus-host disease (GVHD) prophylaxis
- heart transplant rejection
- heart transplant rejection prophylaxis
- kidney transplant rejection
- kidney transplant rejection prophylaxis
- myelodysplastic syndrome (MDS)
- stem cell transplant preparation
Side Effects
- abdominal pain
- acute respiratory distress syndrome (ARDS)
- agitation
- anaphylactic shock
- anaphylactoid reactions
- antibody formation
- anxiety
- arthralgia
- bradycardia
- candidiasis
- chest pain (unspecified)
- chills
- diaphoresis
- diarrhea
- dizziness
- dyskinesia
- dyspnea
- elevated hepatic enzymes
- eosinophilia
- fever
- GI bleeding
- GI perforation
- headache
- heart failure
- hemolysis
- hemolytic anemia
- hyperglycemia
- hyperkalemia
- hyperlipidemia
- hyperphosphatemia
- hypertension
- hypokalemia
- hypophosphatemia
- hypotension
- infection
- infusion-related reactions
- injection site reaction
- insomnia
- laryngospasm
- leukopenia
- myalgia
- myocardial infarction
- nausea
- neutropenia
- new primary malignancy
- paresthesias
- phlebitis
- post-transplant lymphoproliferative disorder (PTLD)
- proteinuria
- pruritus
- pulmonary edema
- rash
- renal failure (unspecified)
- seizures
- serious hypersensitivity reactions or anaphylaxis
- serum sickness
- sinus tachycardia
- syncope
- thrombocytopenia
- toxic epidermal necrolysis
- tremor
- urticaria
- vomiting
Monitoring Parameters
- CBC
- LFTs
- serum creatinine/BUN
Contraindications
- acute bronchospasm
- breast-feeding
- contraception requirements
- equine protein hypersensitivity
- fungal infection
- herpes infection
- hypotension
- infection
- leporine protein hypersensitivity
- leukopenia
- lymphoma
- neoplastic disease
- pregnancy
- reproductive risk
- requires an experienced clinician
- serious hypersensitivity reactions or anaphylaxis
- thrombocytopenia
- thromboembolic disease
- vaccination
- varicella
- viral infection
Interactions
- Abatacept
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Adalimumab
- Aldesleukin, IL-2
- Alefacept
- Alpha interferons
- Alteplase
- Altretamine
- Aminosalicylate sodium, Aminosalicylic acid
- Amlodipine; Celecoxib
- Anticoagulants
- Antimetabolites
- Antithrombin III
- Antitumor antibiotics
- Apixaban
- Argatroban
- Arsenic Trioxide
- Asparaginase Erwinia chrysanthemi
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Azelastine; Fluticasone
- Bacillus Calmette-Guerin Vaccine, BCG
- Basiliximab
- Beclomethasone
- Belatacept
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Betamethasone
- Betrixaban
- Bexarotene
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bivalirudin
- Bortezomib
- Budesonide
- Budesonide; Formoterol
- Carmustine, BCNU
- Celecoxib
- Certolizumab pegol
- Chlorambucil
- Choline Salicylate; Magnesium Salicylate
- Ciclesonide
- Cladribine
- Clofarabine
- Corticosteroids
- Corticotropin, ACTH
- Cortisone
- Cyclophosphamide
- Dabigatran
- Dalteparin
- Danaparoid
- Deflazacort
- Denileukin Diftitox
- Desirudin
- Dexamethasone
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Echinacea
- Edoxaban
- Efalizumab
- Enoxaparin
- Esomeprazole; Naproxen
- Estramustine
- Etodolac
- Famotidine; Ibuprofen
- Fenoprofen
- Fludarabine
- Fludrocortisone
- Flunisolide
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Folate analogs
- Fondaparinux
- Formoterol; Mometasone
- Golimumab
- Heparin
- Hydrocodone; Ibuprofen
- Hydrocortisone
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibritumomab Tiuxetan
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Imatinib
- Indomethacin
- Infliximab
- Influenza Virus Vaccine
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Interferon Gamma-1b
- Intranasal Influenza Vaccine
- Ketoprofen
- Ketorolac
- L-Asparaginase Escherichia coli
- Lansoprazole; Naproxen
- Lepirudin
- Live Vaccines
- Magnesium Salicylate
- Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
- Measles/Mumps/Rubella Vaccines, MMR
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Melphalan
- Mercaptopurine, 6-MP
- Methotrexate
- Methylprednisolone
- Mitoxantrone
- Mometasone
- Muromonab-CD3
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nonsteroidal antiinflammatory drugs
- Oxaprozin
- Peginterferon Alfa-2a
- Peginterferon Alfa-2b
- Pemetrexed
- Penicillamine
- Pentosan
- Pentostatin
- Piroxicam
- Platelet Inhibitors
- Pralatrexate
- Prednisolone
- Prednisone
- Purine analogs
- Reteplase, r-PA
- Rilonacept
- Rituximab
- Rituximab; Hyaluronidase
- Rivaroxaban
- Rofecoxib
- Rotavirus Vaccine
- Rubella Virus Vaccine Live
- Salicylates
- Salsalate
- Sipuleucel-T
- Smallpox and Monkeypox Vaccine, Live, Nonreplicating
- Smallpox Vaccine, Vaccinia Vaccine
- Streptokinase
- Sulindac
- Tenecteplase
- Thioguanine, 6-TG
- Thrombolytic Agents
- Tinzaparin
- Tolmetin
- Tositumomab
- Tretinoin, ATRA
- Triamcinolone
- Typhoid Vaccine
- Upadacitinib
- Urokinase
- Valdecoxib
- Varicella-Zoster Virus Vaccine, Live
- Warfarin
- Yellow Fever Vaccine, Live
