Antithymocyte Globulin

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

  1. aplastic anemia
  2. graft-versus-host disease (GVHD)
  3. graft-versus-host disease (GVHD) prophylaxis
  4. heart transplant rejection
  5. heart transplant rejection prophylaxis
  6. kidney transplant rejection
  7. kidney transplant rejection prophylaxis
  8. myelodysplastic syndrome (MDS)
  9. stem cell transplant preparation

Side Effects

  1. abdominal pain
  2. acute respiratory distress syndrome (ARDS)
  3. agitation
  4. anaphylactic shock
  5. anaphylactoid reactions
  6. antibody formation
  7. anxiety
  8. arthralgia
  9. bradycardia
  10. candidiasis
  11. chest pain (unspecified)
  12. chills
  13. diaphoresis
  14. diarrhea
  15. dizziness
  16. dyskinesia
  17. dyspnea
  18. elevated hepatic enzymes
  19. eosinophilia
  20. fever
  21. GI bleeding
  22. GI perforation
  23. headache
  24. heart failure
  25. hemolysis
  26. hemolytic anemia
  27. hyperglycemia
  28. hyperkalemia
  29. hyperlipidemia
  30. hyperphosphatemia
  31. hypertension
  32. hypokalemia
  33. hypophosphatemia
  34. hypotension
  35. infection
  36. infusion-related reactions
  37. injection site reaction
  38. insomnia
  39. laryngospasm
  40. leukopenia
  41. myalgia
  42. myocardial infarction
  43. nausea
  44. neutropenia
  45. new primary malignancy
  46. paresthesias
  47. phlebitis
  48. post-transplant lymphoproliferative disorder (PTLD)
  49. proteinuria
  50. pruritus
  51. pulmonary edema
  52. rash
  53. renal failure (unspecified)
  54. seizures
  55. serious hypersensitivity reactions or anaphylaxis
  56. serum sickness
  57. sinus tachycardia
  58. syncope
  59. thrombocytopenia
  60. toxic epidermal necrolysis
  61. tremor
  62. urticaria
  63. 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
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