Possible reasons for switching a patient between erythropoiesis-stimulating agents
may include patient preference, injection site pain, hypersensitivity to one of the erythropoiesis-stimulating agents
, stability/storage, dosing interval, lack of response to one of the erythropoiesis-stimulating agents
and the support provided by the manufacturer.
Hematide, a novel peptide-based erythropoiesis-stimulating agent
for the treatment of anemia.
Predictors of hyporesponsiveness to erythropoiesis-stimulating agents
in hemodialysis patients.
Hemoglobin (Hb) variability, in which Hb levels fluctuate above and below the target range over short periods of time, frequently occurs in patients with chronic kidney disease (CKD) Stages 1 to 5 and who are receiving erythropoiesis-stimulating agents
Treatment with erythropoiesis-stimulating agents
(ESAs) is the hallmark of anemia management in patients on hemodialysis.
In one analysis of 240 patients with functioning kidney transplants, only 36% of those with Hgb levels below 10 g/dL had reported iron studies, and 60% were not receiving an erythropoiesis-stimulating agent
(Mix et al., 2003).
Table 1 Case Study: Laboratory Results 2007 September October November December ESA dose, U/wk 18,000 21,000 25,000 27,000 IV iron dose, mg/wk 31.25 31.25 31.25 31.25 Hb, g/dL 11.5 10.9 10.7 10.4 Serum ferritin, ng/mL 650 760 840 1025 TSAT, % 28 27 26 24 2008 January February ESA dose, U/wk 15,000 15,000 IV iron dose, mg/wk 125 125 Hb, g/dL 11.3 11.8 Serum ferritin, ng/mL 800 620 TSAT, % 27 30 Note: ESA = erythropoiesis-stimulating agent
; IV = intravenous; Hb = hemoglobin; TSAT = transferrin saturation.
This was an especially timely topic given the new data on the efficacy of IV iron therapy at moderately elevated serum ferritin levels (Coyne et al., 2007) and the controversy erupting from recent studies surrounding erythropoiesis-stimulating agents
Celgene Corporation (CELG) and Acceleron Pharma (XLRN) announced that Celgene has submitted a Marketing Authorization Application to the European Medicines Agency for luspatercept for the treatment of adult patients with very low to intermediate-risk myelodysplastic syndromes-associated anemia who have ring sideroblasts, require red blood cell transfusions and have received or are not eligible for erythropoiesis-stimulating agents
, and for the treatment of adult patients with beta-thalassemia-associated anemia who require RBC transfusions.
"The use of intravenous iron therapy has escalated in the treatment of anemia of CKD in order to optimize hemoglobin outcomes with the use of erythropoiesis-stimulating agents
," Dyer and her colleagues concluded.
The introduction of erythropoiesis-stimulating agents
(ESA) has led to a dramatic reduction in blood transfusion requirements and has been associated with improved quality of life [1, 2].
One approach is to use erythropoiesis-stimulating agents
or intravenous iron for pre-existing anemia (10).