CSA dosage after ATG

[pvinod]

Hi All,

My daughter had an H-ATG on Dec-2010. but still she has not response. we have doubt for CSA dose.

Our doctor start CSA at 10th day of ATG after stopping the predinsone and 0.3 ml twice a day as her weight is 11 kg. But after 2 month doctor do the CSA level test and level was only 64. so doctor increase dose 0.5 ml.

we feel she cannot take the advantage of CSA quickly after ATG due to lower dose of CSA.

Please give the advise if my thought is true. If true do we need to try second H-ATG with same day of ATG and with correct dose?

[pvinod]

what could be the good time for starting the CSA after ATG? Early or later start can affect on response?

[Ruth Cuadra]

Hi, pivnod.

You may be right that your daughter did not get the full benefit of her ATG treatment because she was not receiving a therapeutic dose of CSA soon enough. As far as I know CSA is typically started immediately after ATG is given. In fact, I took CSA with prednisone after my ATG, without waiting for the prednisone to be tapered. My CSA level was tested twice a week at first, then once a week for several months and the dosage was adjusted as needed. It's important that they test for the "trough" (lowest) level by doing the blood test in the morning before your daughter's first CSA dose of the day.

It can take up to six months to see a response to ATG, but since your daughter is already about ten months out, it would be reasonable to talk to the doctor about repeating the treatment. Recent studies have should that horse ATG is much more effective than rabbit ATG so doing a second round like the first one may be the way to go.

Hope this helps.

Regards,
Ruth