rabbit anti-human thymocyte immunoglobulin: clinical use

Prescribing considerations

• Restrict prescribing and administration to experienced transplant teams in a hospital with immediate resuscitation facilities.
• Assess previous rabbit exposure, animal allergy and earlier reactions to rabbit-derived immunoglobulins.
• Use appropriate premedication and consider infection prophylaxis according to the patient's overall immunosuppressive regimen.
• Avoid assuming interchangeability with other anti-thymocyte globulin products; compositions and concentrations differ.
• Record the product name and batch number for biological traceability.

Contraindications and cautions

• Hypersensitivity to rabbit proteins or any product excipient.
• Active acute or chronic infection that contraindicates further immunosuppression.

Monitoring

• Observe closely for anaphylaxis, cytokine-release syndrome and haemodynamic or respiratory instability during and after infusion.
• Monitor full blood count, including differential white-cell and platelet counts, during and after treatment.
• Assess for bacterial, fungal, viral and protozoal infection, including reactivation such as cytomegalovirus.
• Monitor liver function; in hepatic disease, also monitor platelets and coagulation because pre-existing clotting abnormalities may worsen.
• Maintain awareness of delayed infection, lymphoma, lymphoproliferative disorders and other malignancies associated with combined immunosuppression.

Clinical pharmacology

A polyclonal rabbit IgG preparation that binds multiple lymphocyte epitopes. Its principal immunosuppressive effect is central and peripheral T-cell depletion, supplemented by effects on B cells, dendritic cells and leucocyte adhesion pathways.

Formulation and product differences

• The selected product is a single-use powder for intravenous infusion that requires reconstitution and dilution before administration.
• It contains glycine, sodium chloride and mannitol and may contain residual polysorbate from manufacture.
• Dilution is supported with sodium chloride or glucose infusion solution, with administration through an in-line filter.
• It must not be mixed with other medicines in the same infusion without established compatibility.

Solution for infusion

Route: Intravenous

Strengths: 25 mg