Antilymphocyte immunoglobulin (horse)



Antilymphocyte immunoglobulin (horse) is a primarily IgG immune globulin used to manage allograft rejection in renal transplant patients.

Brand Names
Generic Name
Antilymphocyte immunoglobulin (horse)
DrugBank Accession Number

Equine anti-thymocyte globulin is composed of purified gamma globulin containing primarily IgG against human thymus lymphocytes. It is formed by inoculating a horse with an antigen (human thymoyctes) which then induces the horse immune system's B-lymphocytes to produce IgG immunoglobulins specific for that antigen. The result is polyclonal IgG that is then purified from the horse's serum to produce a usable drug product that can be used for immunosuppression. Although the exact mechanism of action is unknown, equine anti-thymocyte globulin targets a variety of immune system proteins including lymphocyte surface proteins, granulocytes, platelets, bone marrow cells, and other cell types. Equine ATG is currently indicated for the suppression of the immune system to prevent renal transplant rejection and in the treatment of aplastic anemia. Induction of T cell apoptosis and resulting T-cell lymphopenia found in vivo is credited for its therapeutic effect in these conditions.

There are currently various ATG products available, which differ in the source of inoculated animal (rabbit, horse, or pig) and in the type of antigen product used to produce immunoglobulin (thymocytes, peripheral T cells, etc.).

Approved, Investigational
Biologic Classification
Protein Based Therapies
Monoclonal antibody (mAb)
Protein Chemical Formula
Not Available
Protein Average Weight
Not Available
Not Available
  • Anti-thymocyte Globulin (Equine)
  • Anti-thymocyte globulin equine
  • eATG
  • equine ATG
  • Equine thymocyte immune globulin
  • hATG
  • Horse anti-thymocyte globulin
  • Horse ATG
  • Lymphocyte immune globulin anti-thymocyte globulin (equine)
  • Lymphocyte immune globulin, anti-thymocyte globulin



For prevention of renal transplant rejection and for the treatment of aplastic anemia.

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Management ofGraft-versus-host disease••• •••••
Treatment ofHeart transplant rejection••• •••••
Prophylaxis ofHeart transplant rejection••• •••••
Treatment ofLung transplant rejection••• •••••
Prophylaxis ofLung transplant rejection••• •••••
Contraindications & Blackbox Warnings
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Not Available

Mechanism of action
Not Available

Not Available

Volume of distribution

During infusion of 10 to 15 mg/kg/day, the mean peak value (n = 27 renal transplant patients) was found to be 727 ± 310 μg/mL.

Protein binding

Not Available

Not Available
Route of elimination

Not Available


The half-life of equine immunoglobulin after ATGAM infusion was found to be 5.7 ± 3.0 days in one group of recipients. The range for half-life was 1.5 to 13 days.


Not Available

Adverse Effects
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The most commonly reported adverse reactions (occurring in greater than 10% of patients) are pyrexia, chills, rash, thrombocytopenia, leukopenia and arthralgia.

Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
AbataceptThe risk or severity of adverse effects can be increased when Abatacept is combined with Antilymphocyte immunoglobulin (horse).
AbciximabThe risk or severity of adverse effects can be increased when Abciximab is combined with Antilymphocyte immunoglobulin (horse).
AdalimumabThe risk or severity of adverse effects can be increased when Adalimumab is combined with Antilymphocyte immunoglobulin (horse).
Adenovirus type 7 vaccine liveThe risk or severity of infection can be increased when Adenovirus type 7 vaccine live is combined with Antilymphocyte immunoglobulin (horse).
AducanumabThe risk or severity of adverse effects can be increased when Antilymphocyte immunoglobulin (horse) is combined with Aducanumab.
Food Interactions
No interactions found.


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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
AtgamSolution50 mgIntravenousPfizer1998-12-04Not applicableCanada flag
AtgamInjection, solution50 mg/1mLIntravenousPharmacia & Upjohn Company LLC1981-11-17Not applicableUS flag
Atgam Sterile Solution IV 50mg/mlLiquid50 mgIntravenousPharmacia & Upjohn Inc1985-12-311999-08-12Canada flag


ATC Codes
L04AA03 — Antilymphocyte immunoglobulin (horse)
Drug Categories
Chemical TaxonomyProvided by Classyfire
Not Available
Organic Compounds
Super Class
Organic Acids
Carboxylic Acids and Derivatives
Sub Class
Amino Acids, Peptides, and Analogues
Direct Parent
Alternative Parents
Not Available
Not Available
Molecular Framework
Not Available
External Descriptors
Not Available
Affected organisms
Not Available

Chemical Identifiers

CAS number
Not Available


General References
  1. Feng X, Scheinberg P, Biancotto A, Rios O, Donaldson S, Wu C, Zheng H, Sato K, Townsley DM, McCoy JP, Young NS: In vivo effects of horse and rabbit antithymocyte globulin in patients with severe aplastic anemia. Haematologica. 2014 Sep;99(9):1433-40. doi: 10.3324/haematol.2014.106542. Epub 2014 Jun 6. [Article]
  2. Vallejo C, Montesinos P, Polo M, Cuevas B, Morado M, Rosell A, Xicoy B, Diez JL, Salamero O, Cedillo A, Martinez P, Rayon C: Rabbit antithymocyte globulin versus horse antithymocyte globulin for treatment of acquired aplastic anemia: a retrospective analysis. Ann Hematol. 2015 Jun;94(6):947-54. doi: 10.1007/s00277-015-2305-3. Epub 2015 Feb 13. [Article]
  3. Hagen P, Wagner JE, DeFor TE, Dolan M, Arora M, Warlick E, Weisdorf D, Brunstein CG: The effect of equine antithymocyte globulin on the outcomes of reduced intensity conditioning for AML. Bone Marrow Transplant. 2014 Dec;49(12):1498-504. doi: 10.1038/bmt.2014.183. Epub 2014 Sep 22. [Article]
  4. Dubey S, Nityanand S: Involvement of Fas and TNF pathways in the induction of apoptosis of T cells by antithymocyte globulin. Ann Hematol. 2003 Aug;82(8):496-9. Epub 2003 May 29. [Article]
PubChem Substance
RxList Drug Page
FDA label
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Clinical Trials

Clinical Trials
4CompletedTreatmentKidney Diseases1
3CompletedTreatmentAplastic Anemia1
3CompletedTreatmentSevere Aplastic Anemia (SAA)1
3RecruitingTreatmentSevere Aplastic Anemia (SAA)1
2Active Not RecruitingTreatmentAplastic Anemia1


Not Available
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Dosage Forms
Injection, solutionIntravenous50 mg/1mL
SolutionIntravenous50 mg
Injection, solutionIntravenous
InjectionIntravenous50 mg/ml
LiquidIntravenous50 mg
Injection, solution, concentrateIntravenous50 MG/ML
Injection, solution, concentrateIntravenous20 MG/ML
Not Available
Not Available


Experimental Properties
Not Available

Drug created at November 16, 2015 22:18 / Updated at February 24, 2024 22:00