Meta-analysis of treatment with rabbit and horse antithymocyte globulin for aplastic anemia

Jin Hayakawa, Junya Kanda, Yu Akahoshi, Naonori Harada, Kazuaki Kameda, Tomotaka Ugai, Hidenori Wada, Yuko Ishihara, Koji Kawamura, Kana Sakamoto, Masahiro Ashizawa, Miki Sato, Kiriko Terasako-Saito, Shun ichi Kimura, Misato Kikuchi, Rie Yamazaki, Shinichi Kako, Yoshinobu Kanda

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11 Citations (Scopus)

Abstract

Aplastic anemia patients who received rabbit antithymocyte globulin exhibited response and survival rates inferior to those who received horse antithymocyte globulin in several studies. Therefore, we conducted a meta-analysis to compare rabbit and horse antithymocyte globulin as immunosuppressive therapy for aplastic anemia. We searched online databases for studies that compared antithymocyte globulin regimens as first-line treatment for aplastic anemia, including both randomized and non-randomized controlled trials. The early mortality rate at 3 months and overall response rate at 6 months were evaluated. Thirteen studies were included in the analysis. The risk ratio (RR) of early mortality for rabbit vs. horse antithymocyte globulin was 1.33 [95% confidence interval (CI) 0.69–2.57; P = 0.39], with significant heterogeneity. A sensitivity analysis suggested higher early mortality rate in patients who received rabbit antithymocyte globulin. The overall response rate was significantly higher in patients who received horse antithymocyte globulin (RR 1.27; 95% CI 1.05–1.54; P = 0.015). In conclusion, in aplastic anemia patients treated with ATG, early mortality rate was not significantly different in patients receiving horse or rabbit ATG, although a sensitivity analysis showed higher early mortality in the rabbit ATG group. Horse ATG was associated with significantly higher response rate than rabbit ATG.

Original languageEnglish
Pages (from-to)578-586
Number of pages9
JournalInternational Journal of Hematology
Volume105
Issue number5
DOIs
Publication statusPublished - 2017 May 1
Externally publishedYes

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Keywords

  • Aplastic anemia
  • Bone marrow failure
  • Immunosuppressive therapy
  • Meta-analysis

ASJC Scopus subject areas

  • Hematology

Cite this

Hayakawa, J., Kanda, J., Akahoshi, Y., Harada, N., Kameda, K., Ugai, T., Wada, H., Ishihara, Y., Kawamura, K., Sakamoto, K., Ashizawa, M., Sato, M., Terasako-Saito, K., Kimura, S. I., Kikuchi, M., Yamazaki, R., Kako, S., & Kanda, Y. (2017). Meta-analysis of treatment with rabbit and horse antithymocyte globulin for aplastic anemia. International Journal of Hematology, 105(5), 578-586. https://doi.org/10.1007/s12185-017-2179-3