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

• Published in: International journal of hematology 2017-05, Vol.105 (5), p.578-586
• Main Authors: Hayakawa, Jin, Kanda, Junya, Akahoshi, Yu, Harada, Naonori, Kameda, Kazuaki, Ugai, Tomotaka, Wada, Hidenori, Ishihara, Yuko, Kawamura, Koji, Sakamoto, Kana, Ashizawa, Masahiro, Sato, Miki, Terasako-Saito, Kiriko, Kimura, Shun-ichi, Kikuchi, Misato, Yamazaki, Rie, Kako, Shinichi, Kanda, Yoshinobu
• Format: Article
• Language: English
• Subjects: Anemia, Aplastic - drug therapy; Anemia, Aplastic - mortality; Animals; Antilymphocyte Serum - administration & dosage; Hematology; Horses; Humans; Immunosuppressive Agents - administration & dosage; Medicine; Medicine & Public Health; Oncology; Original Article; Rabbits; Survival Rate; Treatment Outcome
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-017-2179-3

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.