Studies comparing horse ATG/CsA and rabbit ATG/CsA as first therapy in SAA
| Study (year) . | Horse ATG, N . | Rabbit ATG, N . | Horse ATG formulation . | Rabbit ATG formulation . | Horse ATG, response, % . | Rabbit ATG, response, % . | Design . | Outcome comparison between ATGs . |
|---|---|---|---|---|---|---|---|---|
| Zheng (2006)77 | 47 | 32 | Lymphoglobulin | Fresenius | 79 | 53 | Prospective, randomized | Comparative statistics not reported |
| Garg (2009)74 | — | 13 | — | Thymoglobulin | — | 92 | Prospective | No comparative statistics, comparison with reported results with horse ATG in the literature |
| Atta (2010)75 | 42 | 29 | Lymphoglobulin | Thymoglobulin | 60 | 35 | Retrospective | Difference at statistical significance (historical comparison) |
| Afable (2011)111 | 67 | 20 | ATGAM | Thymoglobulin | 58 | 45 | Retrospective | Difference not statistically significant (historical comparison) |
| Scheinberg (2011)79 | 60 | 60 | ATGAM | Thymoglobulin | 68 | 37 | Prospective, randomized | Statistically significant difference (direct comparison) |
| Study (year) . | Horse ATG, N . | Rabbit ATG, N . | Horse ATG formulation . | Rabbit ATG formulation . | Horse ATG, response, % . | Rabbit ATG, response, % . | Design . | Outcome comparison between ATGs . |
|---|---|---|---|---|---|---|---|---|
| Zheng (2006)77 | 47 | 32 | Lymphoglobulin | Fresenius | 79 | 53 | Prospective, randomized | Comparative statistics not reported |
| Garg (2009)74 | — | 13 | — | Thymoglobulin | — | 92 | Prospective | No comparative statistics, comparison with reported results with horse ATG in the literature |
| Atta (2010)75 | 42 | 29 | Lymphoglobulin | Thymoglobulin | 60 | 35 | Retrospective | Difference at statistical significance (historical comparison) |
| Afable (2011)111 | 67 | 20 | ATGAM | Thymoglobulin | 58 | 45 | Retrospective | Difference not statistically significant (historical comparison) |
| Scheinberg (2011)79 | 60 | 60 | ATGAM | Thymoglobulin | 68 | 37 | Prospective, randomized | Statistically significant difference (direct comparison) |
Other studies comparing horse and rabbit ATG as first therapy have been reported in abstract form only. A small Russian prospective randomized study (32 patients in total) showed superiority of horse ATG to rabbit ATG.76 A retrospective Spanish study (35 who received horse ATG and 75 rabbit ATG) showed no difference between the ATGs; however, response rates to horse ATG were only 49%, much lower than the historical response rate for this regimen.73 A follow-up from the experience of Garg et al showed a reduction in the response rate of rabbit ATG to 62%, in a single-arm study (N = 21).78 The European Bone Marrow Transplantation Severe Aplastic Anemia Working Party conducted a matched pair analysis comparing horse an rabbit ATG: survival at 2 years was 56% for rabbit compared with 78% for horse ATG; after censoring for stem cell transplantation, survival was 39% for rabbit and 72% for horse ATG.112 In the Polish and Korean pediatric experience (n = 55 and n = 112, respectively), response rate to upfront rabbit ATG was approximately 50% at 6 months, which is lower than the historic response rate to horse ATG in this population (∼ 75%).113,114 For patients of all ages, the German and Korean experience (n = 64 and n = 58, respectively) also showed a 6-month response rate of approximately 50%, which is inferior to that of historical horse ATG as first therapy.115,116
— indicates not applicable.