25 Jul Basiliximab vs Thymoglobulin: Who wins in Induction Immunosuppressive Therapy after Kidney Transplantation?

In every organ transplantation, there will be chances of getting side effects like transplant rejection. This is why there are many types of induction immunosuppressive therapy such as methylprednisolone, atgam, thymoglobulin, muromonab-CD3 (OKT3), daclizumab and many more to reduce the risk of organ rejection (Transplant Living, 2019). In this article, we will be looking at the differences between basiliximab and thymoglobulin in the effect of acute transplant rejection and delayed graft survival and safety to see which one is better as an immunosuppressant after kidney transplantation.

What is Basiliximab?

Basiliximab is a chimeric monoclonal antibody that binds selectively to the alpha-chain subunit of the interleukin-2 (IL-2) receptors of T-lymphocyte cells (Ponticelli, 2014). It is derived from a distinct parental mouse monoclonal antibody that is genetically engineered to express plasmids that contain human constant region genes and mouse variable region genes using DNA recombinant technology (Sollinger, et al., 2001). It inhibits the proliferation of T-lymphocytes driven by IL-2 by antagonising IL-2 competitively (Onrust and Wiseman, 1999).

What is Thymoglobulin?

Thymoglobulin, on the other hand, also known as rabbit antithymocyte globulin (rATG), is a polyclonal antibody that serves a variety of antibody specificities such as immune response antigens, adhesion and cell trafficking molecules and molecules involved in heterogeneous pathways (Gaber, et al., 2010). Its IgG fraction is purified and pasteurised from rabbits that have been immunized with human thymocytes (Deeks and Keating, 2009). The mechanism of action of thymoglobulin is still unclear. However, scientists believe that its main role is T-cell depletion (Gaber, et al., 2010). Just like basiliximab, it is anti-IL-2 (Swiatecka-Urban, 2003).

Acute Transplant Rejection Incidence Rate

Acute transplant rejection is one of the two consequences that will follow after kidney transplantation (Martinez, et al., 2008). According to a study that was carried out on patients who have undergone kidney transplantation, thymoglobulin gave a lower incidence of acute transplant rejection risk after the transplantation (Haririan, et al., 2005; Bazerbachi, et al., 2011). Acute rejection rate of basiliximab group was 13.5% higher than thymoglobulin group (30.3% vs 16.8%) (Chen, et al., 2013).

Delayed Graft Function Incidence Rate

Delayed graft function is the other condition that will occur followed by kidney transplantation (Martínez, et al., 2008). The delayed graft function and serum creatinine levels were not statistically different between basiliximab and thymoglobulin (Fernández-Burgos, et al., 2015). They both can reduce the delayed graft function risk. Serum creatinine level is used to measure renal function (Favi, et al., 2010). In 1, 3 and 5 years of follow-up of the patients after organ transplantation, Bazerbachi, et al. (2011) have observed serum creatinine levels (mmol/L) of both basiliximab and thymoglobulin group of 114±31 vs. 112±20, 114±34 vs. 112±21, and 125±42 vs. 131±48 respectively.

Safety

By using all the measuring parameters like acute transplant rejection rate, delayed graft function, graft survival and patient death, an analysis that was done by Martin, et al. (2011) has concluded that patients will have decreased risk if they use thymoglobulin as their induction immunosuppressive therapy than basiliximab. Despite the delayed graft function and serum creatinine levels of the two drugs provided similar results, the fact that thymoglobulin is much safer for the sake of patients’ health than basiliximab is still very convincing (Martin, et al., 2011).

Conclusion

In conclusion, it is very obvious that in this comparison, thymoglobulin served a better function than basiliximab due to its reduced risk of acute rejection rate. So far, there has not been any studies that could prove the reason for the difference between the mechanism of action of basiliximab and thymoglobulin in acute transplant rejection. Hence, Solmeglas is always willing to provide any kinds of biological services and products to aid research like this with honour.

References

Bazerbachi, F., Selzner, M., Boehnert, M.U., Marquez, M.A., Norgate, A., McGilvray, I.D., Schiff, J. and Cattral, M.S., 2011. Thymoglobulin versus basiliximab induction therapy for simultaneous kidney-pancreas transplantation: impact on rejection, graft function, and long-term outcome. Transplantation, 92(9), pp.1039-1043.

Chen, G., Gu, J., Qiu, J., Wang, C., Fei, J., Deng, S., Li, J., Huang, G., Fu, Q. and Chen, L., 2013. Efficacy and safety of thymoglobulin and basiliximab in kidney transplant patients at high risk for acute rejection and delayed graft function. Exp Clin Transplant, 11(4), pp.310-314.

Deeks, E.D. and Keating, G.M., 2009. Rabbit Antithymocyte Globulin (Thymoglobulin®). Drugs, 69(11), pp.1483-1512.

Favi, E., Gargiulo, A., Spagnoletti, G., Salerno, M.P., Silvestrini, N., Valente, I. and Citterio, F., 2010, May. Induction with basiliximab plus thymoglobulin is effective and safe in old-for-old renal transplantation: six-month results of a prospective clinical study. In Transplantation proceedings (Vol. 42, No. 4, pp. 1114-1117). Elsevier.

Fernández-Burgos, I., Casado, M.M., Pérez-Daga, J.A., Aranda-Narváez, J.M., Sánchez-Pérez, B., León-Díaz, F.J., Cabello-Díaz, M., Rodríguez-Burgos, D., Hernández-Marrero, D. and Santoyo-Santoyo, J., 2015, January. Induction therapy in simultaneous pancreas-kidney transplantation: thymoglobulin versus basiliximab. In Transplantation proceedings (Vol. 47, No. 1, pp. 120-122). Elsevier.

Gaber, A.O., Monaco, A.P., Russell, J.A., Lebranchu, Y. and Mohty, M., 2010. Rabbit antithymocyte globulin (Thymoglobulin®). Drugs, 70(6), pp.691-732.

Haririan, A., Morawski, K., Sillix, D.H., El-Amm, J.M., Garnick, J., West, M.S., Granger, D.K., Migdal, S.D. and Gruber, S.A., 2005. Induction therapy with basiliximab versus Thymoglobulin in African-American kidney transplant recipients. Transplantation, 79(6), pp.716-721.

Martin, S.T., Roberts, K.L., Malek, S.K., Tullius, S.G., Vadivel, N., De Serres, S., Grafals, M., Elsanjak, A., Filkins, B.A., Chandraker, A. and Gabardi, S., 2011. Induction treatment with rabbit antithymocyte globulin versus basiliximab in renal transplant recipients with planned early steroid withdrawal. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 31(6), pp.566-573.

Martínez, E.G., Calabuig, A.S., Quesada, V.E., Bernabeu, A.Á., Catalán, S.B., García, A.M., Albiach, J.C. and Mateu, L.P., 2008, November. Induction treatment with low-dose thymoglobulin or basiliximab in renal transplants from older donors. In Transplantation proceedings (Vol. 40, No. 9, pp. 2900-2902). Elsevier.

Onrust, S.V. and Wiseman, L.R., 1999. Basiliximab. Drugs, 57(2), pp.207-213.

Ponticelli, C., 2014. Basiliximab: efficacy and safety evaluation in kidney transplantation. Expert opinion on drug safety, 13(3), pp.373-381.

Sollinger, H., Kaplan, B., Pescovitz, M.D., Philosophe, B., Roza, A., Brayman, K. and Somberg, K., 2001. Basiliximab versus antithymocyte globulin for prevention of acute renal allograft rejection1, 2. Transplantation, 72(12), pp.1915-1919.

Swiatecka-Urban, A., 2003. Anti-Interleukin-2 Receptor Antibodies for the Prevention of Rejection in Pediatric Renal Transplant Patients. Pediatric Drugs, 5(10), pp.699-716.

Transplant Living, 2019. Types of Immunosuppressants. [online] Available at: <https://transplantliving.org/after-the-transplant/preventing-rejection/types-of-immunosuppressants/>