Date of Award

2018

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective Evidence Based Medicine review is to determine whether or not Horse Antithymocyte Globulin (ATG) plus Cyclosporine (CsA) is the most effective first-line therapy for patients with bone marrow failure disorders.

STUDY DESIGN: Review of two randomized control trials (RCTs) and one single-center retrospective study, which were published between 2010 and 2013. All studies were published in the English language.

DATA SOURCES: Two randomized control trials and one single-center retrospective study published in peer-reviewed journals, which were found using PubMed.

OUTCOMES MEASURED: Each of the three trials measured the patient-oriented outcome of overall survival. Shin et al also assessed failure free survival. Survival was measured at different year markers after therapy between all three studies and also implemented the use of the Kaplan Meier curve for overall survival.

RESULTS: Scheinberg et al (2011) was the only study which yielded statistically significant data supporting Horse ATG plus CsA as the superior therapy for patients with bone marrow failure disorders (p-value = 0.04). Both the Passweg et al (2010) and Shin et al (2013) studies demonstrated inconclusive data, as the results in each study did not yield a statistically significant difference between the three treatment modalities: Horse ATG plus CsA, Rabbit ATG plus CsA, or Basic Supportive Care (BSC).

CONCLUSIONS: Results were inconclusive due to only one of the three studies demonstrating data to support Horse Antithymocyte Globulin as the best initial treatment for patients with bone marrow failure disorders.

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