Anti-lymphocyte immunoglobulin (horse)

Published 21st February 2017, updated 4th May 2019

Haematological disordersMedicineNew MedicinesNHS England commissionedPre-registration (UK/EU)
Unassigned

New Medicines

Atgam · Moderate-to-severe aplastic anaemia of known or suspected immunologic aetiology as part of standard immunosuppressive therapy - new dosing regimen from that approved in the US (16 mg/kg/day over 10 days or 20 mg/kg/day over 8 days or 40 mg/kg/day over 4 days)

Information

Atgam
New molecular entity
Pfizer
Pfizer

Development and Regulatory status

Pre-registration (Filed)
Pre-registration (Filed)
Launched

Dec 18: Still pre-registration; a decision on whether to recommend approval is expected shortly [4].

Feb 17: Currently pre-registration in the EU. Has been filed via the EU mutual recognition procedure [2].

Feb 17: Atgam is approved in the US for the management of allograft rejection in renal transplant patients and for the treatment of moderate to severe AA in patients who are unsuitable for bone marrow transplantation. For AA the recommended dose regimen is 10-20 mg/kg daily for 8 to 14 days; additional alternate-day therapy up to a total of 21 doses can be administered. Atgam is currently not licensed in the UK but is available on a named patient basis [3].

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Category

Atgam is composed of antibodies that bind a wide variety of proteins on the surface of lymphocytes. Atgam binds to granulocytes, platelets and bone marrow cells. The mechanism of Atgam-induced immunosuppression has not been determined.
The incidence of acquired AA in Europe and North America is around 2 per million population per year, and it has a biphasic age distribution, with peaks from 10 to 25 years and >60 years [1]. ·
Moderate-to-severe aplastic anaemia of known or suspected immunologic aetiology as part of standard immunosuppressive therapy - new dosing regimen from that approved in the US (16 mg/kg/day over 10 days or 20 mg/kg/day over 8 days or 40 mg/kg/day over 4 days)
Intravenous infusion

Trial or other data

Nov 05: PIII (NCT00260689/060034, 06-H-0034) study starts. 120 treatment-naive patients (60 per arm) aged 2-77 years with moderate to severe were randomized to receive either hATG at 40 mg/kg/day for 4 days or anti t-lymphocyte (rabbit rATG) at 3,5mg/Kg/day for 6 months. Each a arm also included ciclosporin at 10mg/Kg/day (15mg/kg/day for children under 12) given in divided doses every 12 hours from day 1 for at least 6 months in both the hATG and rATG groups, with the dose adjusted to maintain through blood levels of 200 to 400 ng/ml. The observed rate of haematologic response at 6 months was in favour of hATG (68%; 95% confidence interval -CI-, 56 to 80%) as compared with rATG (37%; 95% CI, 24 to 49%; p<0,001). The overall survival rate at 3 years differed significantly between the two regimens: 96% (95% CI, 90 to 100%) in the h ATG group as compared with 76% (95% CI, 61 to 95%) in the rATG group (p=0,004) when data were censored at the time of stem cell transplantation, and 94% (95% CI, 88 to 100%) as compared with 70% (95% CI, 56 to 86%; p=0,008) in the respective groups when stem cell transplantation eventes were not censored [2].

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