| Renal transplant rejection
Astagraf XL vs Thymoglobulin
Side-by-side clinical, coverage, and cost comparison for renal transplant rejection.Deep comparison between: Astagraf Xl vs Thymoglobulin with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsThymoglobulin has a higher rate of injection site reactions vs Astagraf Xl based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Thymoglobulin but not Astagraf Xl, including UnitedHealthcare
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Category
Astagraf Xl
Thymoglobulin
At A Glance
Oral
Daily
Calcineurin inhibitor
IV infusion
Daily
Polyclonal anti-thymocyte globulin
Indications
- Renal transplant rejection
- Renal transplant rejection
Dosing
Renal transplant rejection - adult (with basiliximab induction) 0.15 to 0.2 mg/kg once daily prior to reperfusion or within 48 hours of completion of transplant, with MMF and steroids; taken orally every morning on an empty stomach.
Renal transplant rejection - adult (without basiliximab induction) Pre-operative: 0.1 mg/kg within 12 hours prior to reperfusion; post-operative: 0.2 mg/kg once daily at least 4 hours after pre-operative dose and within 12 hours after reperfusion, with MMF and steroids.
Renal transplant rejection - pediatric (with basiliximab induction) 0.3 mg/kg once daily administered within 24 hours following reperfusion, with MMF and steroids.
Renal transplant rejection (prophylaxis) 1.5 mg/kg IV daily for 4 to 7 days; first dose infused over at least 6 hours, subsequent doses over at least 4 hours; premedicate with corticosteroids, acetaminophen, and/or antihistamine 1 hour prior to each infusion.
Renal transplant rejection (treatment) 1.5 mg/kg IV daily for 7 to 14 days; first dose infused over at least 6 hours, subsequent doses over at least 4 hours; premedicate with corticosteroids, acetaminophen, and/or antihistamine 1 hour prior to each infusion.
Contraindications
- Known hypersensitivity to tacrolimus
- History of allergy or anaphylactic reaction to rabbit proteins or to any product excipients
- Active acute or chronic infections that contraindicate additional immunosuppression
Adverse Reactions
Most common (>=30%) Diarrhea, constipation, nausea, peripheral edema, tremor, anemia
Serious Lymphoma and other malignancies, serious infections, new onset diabetes after transplant, nephrotoxicity, neurotoxicity, hyperkalemia, hypertension, QT prolongation, pure red cell aplasia, thrombotic microangiopathy including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura
Postmarketing Agranulocytosis, pancytopenia, cardiac arrest, myocardial infarction, Torsades de pointes, Stevens-Johnson syndrome, toxic epidermal necrolysis, progressive multifocal leukoencephalopathy, posterior reversible encephalopathy syndrome, hepatic failure, graft versus host disease
Most common (>5% higher than comparator) Urinary tract infection, abdominal pain, hypertension, nausea, dyspnea, fever, headache, anxiety, chills, hyperkalemia, leukopenia, thrombocytopenia
Serious Malignancies (including PTLD and lymphoma), anaphylactic shock, serum sickness, severe infections including sepsis
Postmarketing Hepatic dysfunction, hepatic failure, hyperbilirubinemia, febrile neutropenia, coagulopathy, disseminated intravascular coagulopathy, hemolytic anemia, thrombotic microangiopathy, anaphylaxis, cytokine release syndrome
Pharmacology
Calcineurin inhibitor; tacrolimus binds the intracellular protein FKBP-12 to form a complex that inhibits calcineurin phosphatase activity, blocking dephosphorylation and translocation of NF-AT and NF-kB and thereby suppressing T-lymphocyte activation, proliferation, and T-helper-cell-dependent B-cell responses.
Polyclonal anti-thymocyte immunoglobulin G derived from rabbit immunization with human thymocytes; suppresses immune responses via T-cell clearance and modulation of T-cell activation, homing, and cytotoxic activities through antibodies targeting CD2, CD3, CD4, CD8, CD11a, CD18, CD25, CD44, CD45, HLA-DR, HLA Class I heavy chains, and beta2-microglobulin.
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Most Common Insurance
Anthem BCBS
Astagraf Xl
- Covered on 5 commercial plans
- PA (4/12) · Step Therapy (0/12) · Qty limit (0/12)
Thymoglobulin
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Astagraf Xl
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Thymoglobulin
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Astagraf Xl
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (0/3) · Qty limit (0/3)
Thymoglobulin
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: AutoImmune - Medicare Access
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
Final cost depends on formulary coverage
Cost estimate not availableHealthWell: Immunosuppressive Treatment for Solid Organ Transplant Recipients - Medicare Access
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Astagraf XlView full Astagraf Xl profile
ThymoglobulinView full Thymoglobulin profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.