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Tian L, Wang M, Liu M, Pang Y, Zhao J, Zheng B, Wang Y, Zhao W. Cardiovascular and renal safety outcomes of hypoxia-inducible factor prolyl-hydroxylase inhibitor roxadustat for anemia patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2024; 46:2313864. [PMID: 38345037 PMCID: PMC10863523 DOI: 10.1080/0886022x.2024.2313864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
This systematic review and meta-analysis were conducted to evaluate the cardiac and kidney-related adverse effects of roxadustat for the treatment of anemia in CKD patients. 18 trials with a total of 8806 participants were identified for analysis. We employed a fixed-effects model for analysis. The pooled result revealed no significant difference in the risk of occurrence of cardiac disorders when comparing CKD patients receiving roxadustat with the placebo (RR = 1.049; CI [0.918 to 1.200]) or ESA (RR = 1.066; CI [0.919 to 1.235]), in both dialysis-dependent (DD) (RR = 1.094; CI [0.925 to 1.293]) or non-dialysis-dependent (NDD) (RR = 1.036; CI [0.916 to 1.171]) CKD patients. No significant difference was observed in the risk of kidney-related adverse events when comparing roxadustat with the placebo (RR = 1.088; CI [0.980 to 1.209]) or ESA (RR = 0.968; CI [0.831 to 1.152]), in DD (RR = 2.649; CI [0.201 to 34.981]) or NDD (RR = 1.053; CI [0.965 to 1.149]) CKD patients. A high risk of hyperkalemia was observed in the roxadustat group in DD (RR = 0.939; CI [0.898 to 0.981]). Incidence of hypertension was higher in the roxadustat for NDD patients (RR = 1.198; CI [1.042 to 1.377]), or compared to the placebo (RR = 1.374; CI [1.153 to 1.638]). In summary, the risk of cardiac or kidney-related events observed in the roxadustat was not significantly increase whether in DD or NDD patients. However, attention must be paid to the occurrence of hyperkalemia for DD patients and hypertension in NDD patients using roxadustat.
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Affiliation(s)
- Lei Tian
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Mengdi Wang
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Mengchao Liu
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yanyu Pang
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jingwen Zhao
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Bingjie Zheng
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yutong Wang
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wenjing Zhao
- Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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Chen N, Xing C, Niu J, Liu B, Fu J, Zhao J, Ni Z, Wang M, Liu W, Zhao J, Zhong L, Wu X, Li W, Chen Y, Shi W, Chen J, Yin A, Fu P, Wang R, Jiang G, Hou F, Ding G, Chen J, Xu G, Kondo Y, Su Y, Mei C. Darbepoetin alfa injection versus epoetin alfa injection for treating anemia of Chinese hemodialysis patients with chronic kidney failure: A randomized, open-label, parallel-group, non-inferiority Phase III trail. Chronic Dis Transl Med 2022; 8:59-70. [PMID: 35620165 PMCID: PMC9128564 DOI: 10.1002/cdt3.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background Erythropoietin is a glycoprotein that mainly regulates erythropoiesis. In patients with chronic renal failure with anemia, darbepoetin alfa can stimulate erythropoiesis, correct anemia, and maintain hemoglobin levels. This study was designed to demonstrate the efficacy and safety of darbepoetin alfa injections as being not inferior to epoetin alfa injections (Recombinant Human Erythropoietin injection, rHuEPO) when maintaining hemoglobin (Hb) levels within the target range (10.0-12.0 g/dL) for the treatment of renal anemia. Methods Ninety-five patients were enrolled in this study from April 15, 2013 to April 10, 2014 at 25 sites. In this study, patients (n = 95) aged 18-70 years were randomized into a once per week intravenous darbepoetin alfa group (n = 56) and a twice or three times per week intravenous epoetin alfa group (n = 39) for 28 weeks, who had anemia with hemoglobin levels between 6 g/dL and 10 g/dL due to chronic kidney disease (CKD) and were undergoing hemodialysis or hemofiltration with ESA-naive (erythropoiesis stimulating agent-naive). The primary efficacy profile was the mean Hb level (the non-inferiority margin was -1.0 g/dL, week 21-28); the secondary efficacy profiles were the Hb increase rate (week 0-4), the target Hb achievement cumulative rate and time, the change trends of the Hb levels, and the target Hb maintenance ratio. Adverse events (AEs) were observed and compared, and the efficacy and safety were analyzed between the two treatment groups. Additionally, the frequencies of dose adjustments between the darbepoetin alfa and epoetin alfa groups were compared during the treatment period. SAS® software version 9.2 was used to perform all statistical analyses. Descriptive statistics were used for all efficacy, safety, and demographic variable analyses, including for the primary efficacy indicators. Results The mean Hb level was 11.3 g/dL in the darbepoetin alfa group and 10.7 g/dL in the epoetin alfa group, respectively; the difference of the lower limits of the 95% confidence intervals (CI) between the two groups was 0.1 g/dL (>-1.0 g/dL), and non-inferiority was proven; the Hb levels started to increase in the first four weeks at a similar increase rate; no obvious differences were observed between the groups in the target Hb achievement cumulative rates, and the Hb levels as well as the target Hb level maintenance rate changed over time. The incidence of AEs was 62.5% in the darbepoetin alfa group and 76.9% in the epoetin alfa group. All the adverse events observed in the study were those commonly associated with hemodialysis. Conclusion Darbepoetin alfa intravenously once per week can effectively increase Hb levels and maintain the target Hb levels well, which makes it not inferior to epoetin alfa intravenously twice or three times per week. Darbepoetin alfa shows an efficacy and safety comparable to epoetin alfa for the treatment of renal anemia.
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Affiliation(s)
- Nan Chen
- Department of NephrologyRuijin Hospital Shanghai Jiaotong University School of MedicineShanghai200025China
| | - Changying Xing
- Department of NephrologyJiangsu Provincial HospitalNanjingJiangsu210036China
| | - Jianying Niu
- Department of Nephrology, Shanghai Fifth People's HospitalFudan UniversityShanghai200240China
| | - Bicheng Liu
- Department of NephrologyZhongda Hospital Southeast UniversityNanjingJiangsu210009China
| | - Junzhou Fu
- Department of NephrologyGuangzhou First People's HospitalGuangzhouGuangdong510180China
| | - Jiuyang Zhao
- Department of NephrologyThe Second Hospital of Dalian Medical UniversityDalianLiaoning116027China
| | - Zhaohui Ni
- Department of NephrologyRenji Hospital Shanghai Jiaotong University School of MedicineShanghai200001China
| | - Mei Wang
- Department of NephrologyPeking University People's HospitalBeijing100044China
| | - Wenhu Liu
- Department of Nephrology, Beijing Friendship HospitalCapital Medical UniversityBeijing100050China
| | - Jinghong Zhao
- Department of NephrologyXinqiao Hospital of Army Medical UniversityChongqing400037China
| | - Ling Zhong
- Department of NephrologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqing400010China
| | - Xiongfei Wu
- Department of NephrologySouthwest Hospital of Army Medical UniversityChongqing400039China
| | - Wenge Li
- Department of NephrologyChina‐Japan Friendship HospitalBeijing100029China
| | - Yuqing Chen
- Department of NephrologyPeking University First HospitalBeijing100034China
| | - Wei Shi
- Department of NephrologyGuangdong Provincial People's HospitalGuangzhouGuangdong510080China
| | - Jianghua Chen
- Department of NephrologyThe First Affiliated Hospital, Zhejiang University School of MedicineHangzhouZhejiang310003China
| | - Aiping Yin
- Department of NephrologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi710061China
| | - Ping Fu
- Department of Nephrology, West China HospitalSichuan UniversityChengduSichuan610041China
| | - Rong Wang
- Department of NephrologyShandong Provincial HospitalJinanShandong250021China
| | - Gengru Jiang
- Department of NephrologyXinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai200092China
| | - Fanfan Hou
- Department of NephrologyNanfang Hospital Southern Medical UniversityGuangzhouGuangdong510510China
| | - Guohua Ding
- Department of NephrologyRenmin Hospital of Wuhan UniversityWuhanHubei430060China
| | - Jing Chen
- Department of Nephrology, Huashan HospitalFudan UniversityShanghai200040China
| | - Gang Xu
- Department of NephrologyTongji Hospital Tongji Medical College Huazhong University of Science and TechnologyWuhanHubei430030China
| | - Yuichiro Kondo
- R&D Planning DepartmentR&D Division, Kyowa Kirin Co., LtdTokyo520‐5292Japan
| | - Yuliang Su
- D&R office, Kyowa Kirin China Pharmaceutical Co., LtdShanghai201203China
| | - Changlin Mei
- Department of NephrologyShanghai Changzheng HospitalShanghai200003China
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AlKharboush H, Alshehri F, Alatwi I, Al Karni K, Alatawi A, Hamdan AM. The Cost-Effectiveness of Using Epoetin-Beta Versus Darbepoetin-Alfa for the Treatment of Anemia Among Chronic Hemodialysis Patients. Cureus 2020; 12:e11895. [PMID: 33415047 PMCID: PMC7781860 DOI: 10.7759/cureus.11895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective Anemia is a common prognosis of chronic kidney disease (CKD). It is predominantly managed with synthetic erythropoietin. The principal objective of this study was to compare the cost-effectiveness of the use of short-acting erythropoietin with the long-acting one to maintain serum hemoglobin (Hb) concentration within the range of 10.5-12 g/dL. Method This was a retrospective cohort study involving patients diagnosed with stage 5 CKD according to the Saudi Society of Nephrology and Transplantation conducted at eight tertiary care centers in the Tabuk region, Saudi Arabia. We compared the cost-effectiveness of long-acting erythropoietin with the short-acting one. The decision analysis model and Markov model were established to simulate a cohort of 55-year-old patients to estimate the incremental cost and quality-adjusted life-year (QALY) for chronic hemodialysis patients (CHP) treated with either darbepoetin-alfa or epoetin-beta for at least nine months. The incremental cost per QALY was the main outcome marker for using both medications. Serum HB levels were monitored on a monthly basis and costs were calculated. Results A total of 291 CHP met our inclusion criteria; 194 of them were treated with darbepoetin-alfa while 97 were treated with epoetin-beta. The mean age was 56.3 ± 11.2 years for the darbepoetin-alfa group and 55.2 ± 7.8 years for the epoetin-beta cohort. The baseline serum Hb was 10.68 ± 0.98 g/dL for darbepoetin-alfa patients and 11.63 ± 0.32 g/dL for the epoetin-beta group (p=0.003). We observed a significant difference between the percentage of patients successfully treated with epoetin-beta and those managed with darbepoetin-alfa (80.4% vs. 63.92%, p=0.01) with considerably less cardiovascular side effects. The average annual cost per patient was estimated at $919.47 and $12,319.41 for epoetin-beta and darbepoetin-alfa respectively. Also, the average effectiveness was 0.58 for darbepoetin-alfa vs. 0.61 for epoetin-beta. The average cost-effectiveness ratio was $980.25 and $15,023.66 with an incremental cost difference of -$966 in favor of epoetin-beta compared to darbepoetin-alfa. Conclusion Based on our findings, treating anemia in hemodialysis patients using epoetin-beta is very cost-effective compared to managing them with darbepoetin-alfa.
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Affiliation(s)
- Hanan AlKharboush
- Pharm D Program, Faculty of Pharmacy, University of Tabuk, Tabuk, SAU
| | - Fatimah Alshehri
- Pharm D Program, Faculty of Pharmacy, University of Tabuk, Tabuk, SAU
| | - Ibrahim Alatwi
- Pharmaceutical Care Administration, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Saudi Arabia, Tabuk, SAU
| | - Khaled Al Karni
- Department of Pharmaceutical Care, King Khaled Civil Hospital, Tabuk, SAU
| | - Abdurahman Alatawi
- Pharmaceutical Care Administration, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Saudi Arabia, Tabuk, SAU
| | - Ahmed M Hamdan
- Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, SAU
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Sinha SD, Bandi VK, Bheemareddy BR, Thakur P, Chary S, Mehta K, Pinnamareddy VR, Pandey R, Sreepada S, Durugkar S. Efficacy, tolerability and safety of darbepoetin alfa injection for the treatment of anemia associated with chronic kidney disease (CKD) undergoing dialysis: a randomized, phase-III trial. BMC Nephrol 2019; 20:90. [PMID: 30866856 PMCID: PMC6417108 DOI: 10.1186/s12882-019-1209-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/11/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Darbepoetin alfa (DA-α) is a long-acting erythropoiesis-stimulating glycoprotein which has half-life three-fold longer than that of Erythropoietin alfa (EPO). The objective of this study was to compare the efficacy and safety of DA-α injection versus EPO for treating renal anemia amongst Indian patients with end-stage renal disease (ESRD) undergoing dialysis. METHODS Patients of either gender (aged 18-65 years) with ESRD undergoing dialysis who had hemoglobin (Hb) levels < 10 g/dL after receiving EPO were switched to DA-α (0.45 μg/kg) once weekly subcutaneously or EPO 50 IU/kg thrice weekly subcutaneously (centrally randomized 1:1) for 12-24 weeks (correction phase) followed by 12 weeks maintenance phase (for Hb levels ≥10 g/dL). The primary efficacy endpoint was mean change in Hb level from baseline to end of correction phase. RESULTS In the intention-to-treat population (n = 126), the between group difference in mean Hb change was - 0.01 g/dL (95% CI - 0.68 to - 0.66, p = 0.97). After adjusting for covariates, the difference was - 0.2878 g/dL (95% CI -0.936 to0.360). The lower limit of the two-sided 95% CI of primary endpoint was above the pre-specified non-inferiority margin of - 1.0 g/dL. Similar trend of non-inferiority was observed for per-protocol population. Safety profile of DA-α and EPO were observed to be similar. CONCLUSION Our study results demonstrated that for patients with ESRD undergoing dialysis, administering DA-α at lower dose frequency, is equally effective and well tolerated as EPO for treating renal anemia. TRIAL REGISTRATION CTRI/2012/07/002835 [Registered on: 27/07/2012]; Trial Registered Prospectively.
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Affiliation(s)
- Shubhadeep D. Sinha
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Vamsi Krishna Bandi
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Bala Reddy Bheemareddy
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Pankaj Thakur
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Sreenivasa Chary
- Clinical Development and Medical Affairs, Hetero Group, Hetero Corporate, 7-2-A2, Industrial Estates, Sanath Nagar, Hyderabad, Andhra Pradesh India
| | - Kalpana Mehta
- Department of Nephrology, B.L.Y Nair Hospital, A.L Nair Road, Mumbai, Maharashtra India
| | | | - Rajendra Pandey
- Department of Nephrology, Institute of Post Graduate Medical Education and Research Kolkata, 244 A.J.C Bose Road, Kolkata, West Bengal India
| | - Subhramanyam Sreepada
- Sri Raghavendra Hospital, 1-7-100, Opp. Round Building, Kamala Nagar, ECIL Cross Road, ECIL, Hyderabad, Andhra Pradesh 500062 India
| | - Santosh Durugkar
- Ashwini Hospital and Ramakanth Heart Care Center, Shivaji Nagar, Nanded, Maharashtra India
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Arantes LH, Crawford J, Gascon P, Latymer M, Launay-Vacher V, Rolland C, Scotte F, Wish J. A quick scoping review of efficacy, safety, economic, and health-related quality-of-life outcomes of short- and long-acting erythropoiesis-stimulating agents in the treatment of chemotherapy-induced anemia and chronic kidney disease anemia. Crit Rev Oncol Hematol 2018; 129:79-90. [PMID: 30097240 DOI: 10.1016/j.critrevonc.2018.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
Erythropoiesis-stimulating agents (ESAs) are man-made forms of erythropoietin used in the treatment of anemia. This quick-scoping review of systematic literature reviews (SLRs) was conducted to define the clinical, economic, and health-related quality of life (HRQoL) outcomes for short-acting and long-acting ESAs in patients with chronic kidney disease-induced anemia (CKD-IA) and patients with chemotherapy-induced anemia (CIA). Embase, Medline, and the Cochrane Database of Systematic Reviews were searched from their establishment until October 2017. SLRs related to the use of short-acting and long-acting ESAs in the treatment of CIA and CKD-IA were included. Forty-eight studies met the inclusion criteria. The evidence suggests little difference in efficacy, HRQoL, and safety outcomes among ESA types. Cost-effectiveness and market price are likely to become determining factors driving the choice of agent. Comparative studies and costing models accounting for the utilization of biosimilars are needed to establish which ESAs are more cost-effective.
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Affiliation(s)
| | - Jeffrey Crawford
- Department of Hematology-Oncology, Duke University Medical Center, Durham, NC, USA
| | - Pere Gascon
- Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | | | - Florian Scotte
- Medical Oncology and Supportive Care Department, Hospital Foch, Suresnes, France
| | - Jay Wish
- Indiana University Health, Indianapolis, IN, USA
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Günal MY, Ozansoy M, Kılıç Ü, Keskin İ, Özdemir EM, Aslan İ, Eren Z, Ersavaş C, Kılıç E. Role of erythropoietin and its receptor in the development of endometriosis in rats. J Turk Ger Gynecol Assoc 2018; 20:41-46. [PMID: 29916217 PMCID: PMC6501872 DOI: 10.4274/jtgga.galenos.2018.2018.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: Besides its hematopoietic function, erythropoietin (EPO) may protect tissues from degenerative disorders. As such, EPO and its receptors were revealed in nonhematopoietic cells, including stromal and endometrial epithelial cells. However, the role of EPO in endometrial disorders is still unknown. Here, we aimed to examine the role of EPO and its receptor activation in the development of endometriosis in rats. Material and Methods: Animals were treated with EPO, darbepoietin (the synthetic form of EPO) or EPO’s receptor activator, methoxy polyethylene glycol-epoetin beta (MIRCERA), after development of endometriosis. Endometriosis was induced by estrogen-administration following surgical attachment of endometrial surface on the inner abdominal wall. Treatments were started 3 weeks after induction of endometriosis and continued for the following 3 weeks. For the analysis of recurrence of endometriosis, additional analyses were conducted 3 weeks after cessation of treatments. Results: As compared with vehicle-treated animals, lesion size was reduced significantly and recurrence of endometriosis was not observed in all treatment groups. Histopathologic examination revealed that EPO and darbepoietin were more effective than MIRCERA- and vehicle-treated animals. Conclusion: Here we provide evidence that EPO is a promising candidate for the treatment of endometriosis. Our histopathologic results in particular indicate that EPO is more effective than its receptor activator MIRCERA in the development endometriosis.
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Affiliation(s)
- Mehmet Yalçın Günal
- Department of Physiology, Alanya Alaaddin Keykubat University School of Medicine, Antalya, Turkey,Regenerative and Restorative Medical Research Center (REMER), İstanbul Medipol University, İstanbul, Turkey
| | - Mehmet Ozansoy
- Department of Physiology, İstanbul Medipol University School of Medicine, İstanbul, Turkey,Regenerative and Restorative Medical Research Center (REMER), İstanbul Medipol University, İstanbul, Turkey
| | - Ülkan Kılıç
- Department of Medical Biology, University of Health Sciences School of Medicine, İstanbul, Turkey,Regenerative and Restorative Medical Research Center (REMER), İstanbul Medipol University, İstanbul, Turkey
| | - İlknur Keskin
- Department of Histology and Embryology, İstanbul Medipol University School of Medicine, İstanbul, Turkey,Regenerative and Restorative Medical Research Center (REMER), İstanbul Medipol University, İstanbul, Turkey
| | - Ekrem Musa Özdemir
- Experimental Animal Center, İstanbul Medipol University, İstanbul, Turkey
| | - İsmail Aslan
- Department of Pharmaceutical Technology, Yeditepe University School of Pharmacy, İstanbul, Turkey
| | - Zehra Eren
- Department of Nephrology, Yeditepe University School of Medicine, İstanbul, Turkey
| | - Cenk Ersavaş
- Department of General Surgery, İstanbul Medipol University School of Medicine, İstanbul, Turkey,Regenerative and Restorative Medical Research Center (REMER), İstanbul Medipol University, İstanbul, Turkey
| | - Ertuğrul Kılıç
- Department of Physiology, İstanbul Medipol University School of Medicine, İstanbul, Turkey,Regenerative and Restorative Medical Research Center (REMER), İstanbul Medipol University, İstanbul, Turkey
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Darsonval A, Besson V, Cavalin C. Cost-Minimisation Analysis of Erythropoiesis-Stimulating Agents in the Treatment of Anaemia in Dialysed Patients: A Pilot Study. PHARMACOECONOMICS - OPEN 2017; 1:223-229. [PMID: 29441494 PMCID: PMC5691838 DOI: 10.1007/s41669-017-0016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study aimed to assess the cost impact of administering erythropoiesis-stimulating agents once every 4 weeks instead of one to three times a week to treat anaemia in patients undergoing dialysis. METHODS This was a monocentric retrospective study involving 27 patients who underwent haemodialysis between 2009 and 2013 in a university hospital in Angers, France. The study was a cost-minimisation analysis from the hospital perspective. Only direct medical costs were considered. RESULTS This study demonstrated that therapeutic management of anaemia with methoxy polyethylene glycol-epoetin beta would save medical and nurse time (7 days and 15 days per year, respectively) and reduce costs by €59,960 a year for an active file of 40 patients undergoing haemodialysis, assuming a 100% occupancy rate in the above-mentioned hospital. CONCLUSION This study indicated that treating anaemia by administering erythropoiesis-stimulating agents once every 4 weeks instead of one to three times a week in patients undergoing haemodialysis would be beneficial for the hospital.
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Affiliation(s)
- Astrid Darsonval
- Service Pharmacie, Centre Hospitalier Universitaire, 49100, Angers, France.
| | - Virginie Besson
- Service Hémodialyse, Centre Hospitalier Universitaire, 49100, Angers, France
| | - Claire Cavalin
- Cellule d'évaluation médico économique, GIRCI Grand Ouest, Tours, France
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8
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Maoujoud O, Ahid S, Cherrah Y. The cost-utility of treating anemia with continuous erythropoietin receptor activator or Epoetin versus routine blood transfusions among chronic hemodialysis patients. Int J Nephrol Renovasc Dis 2016; 9:35-43. [PMID: 26966386 PMCID: PMC4771395 DOI: 10.2147/ijnrd.s96027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the cost-utility of treating anemic dialysis patients with continuous erythropoietin receptor activator (CERA) once monthly or Epoetin Beta (EpoB) thrice weekly compared with a reference strategy of managing anemia with red blood cell transfusion (RBCT). METHODS Cost-utility analysis study design. Decision analysis model, National health care payer, over 1 year with the publicly funded health care system. Chronic hemodialysis patients with renal anemia were included. The outcome marker of this study was the incremental cost per quality-adjusted life-year (QALY) gained (incremental cost-utility ratio [ICUR]) of CERA or EpoB relative to RBCT. RESULTS The total cost per patient (in US$) was estimated at $2,176.37, $4,107.01, and $4,356.69 for RBCT, CERA, and EpoB, respectively. The cost-utility ratio was calculated at 4,423.52, 6,955.50, and 7,406.38 $/QALY for RBCT, CERA, and EpoB, with an ICUR of CERA and EpoB in relation to RBCT at 19,606.40 and 22,466.09 $/QALY, respectively. In sensitivity analysis, the model was most sensitive to hospitalization costs, hospital stay, and annual number of RBCT units. Also, assuming utility and survival improvement with erythropoiesis stimulating agents use resulted in a decrease in ICUR at 13,429 $/QALY for CERA and 15,331 $/QALY for EpoB. In probabilistic sensitivity analysis, the main results of our model were unchanged; CERA and EpoB were more costly and more effective than RBCT below a threshold of 19,500 $/QALY. CERA was the best option for a willingness to pay over 19,500 $/QALY. LIMITATIONS Some model parameters were obtained from observational data, the comparator RBCT is not the standard of care. CONCLUSION Our study suggests that managing anemia in dialysis patients with CERA or EpoB may result in better outcomes with higher overall costs. Considering different assumptions, we found substantial variability in the estimates of the cost-utility and incremental of using CERA or EpoB.
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Affiliation(s)
- Omar Maoujoud
- Research Team of Pharmacoepidemiology and Pharmacoeconomics, Medical and Pharmacy School, Mohammed V University, Rabat, Morocco
- Department of Nephrology and Dialysis, Military Hospital, Agadir, Morocco
| | - Samir Ahid
- Research Team of Pharmacoepidemiology and Pharmacoeconomics, Medical and Pharmacy School, Mohammed V University, Rabat, Morocco
| | - Yahia Cherrah
- Research Team of Pharmacoepidemiology and Pharmacoeconomics, Medical and Pharmacy School, Mohammed V University, Rabat, Morocco
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9
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The Cost-Effectiveness of Continuous Erythropoiesis Receptor Activator Once Monthly versus Epoetin Thrice Weekly for Anaemia Management in Chronic Haemodialysis Patients. Anemia 2016; 2015:189404. [PMID: 26843983 PMCID: PMC4710935 DOI: 10.1155/2015/189404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/06/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. The aim of this study was to compare the cost-effectiveness of continuous erythropoietin receptor activator (CERA) once monthly to epoetin beta (EpoB) thrice weekly to maintain haemoglobin (Hb) within the range 10.5–12 g/dL. Methods. Prospective cohort study and cost-effectiveness analysis. Chronic haemodialysis patients (CHP), being treated with EpoB, were selected for two periods of follow-up: period 1, maintaining prior treatment with EpoB, and period 2, conversion to CERA once monthly. Hb concentrations and costs were measured monthly. Health care payer perspective for one year was adopted. Results. 75 CHP completed the study, with a mean age of 52.9 ± 14.3 years. Baseline Hb was 11.14 ± 1.18 g/dL in EpoB phase and 11.46 ± 0.79 g/dL in CERA phase; we observed a significant increase in the proportion of patients successfully treated (Hb within the recommended range), 65.3% versus 70.7%, p: 0.008, and in the average effectiveness by 4% (0.55 versus 0.59). Average cost-effectiveness ratios were 6013.86 and 5173.64$, with an ICER CERA to EpoB at −6457.5$. Conclusion. Our health economic evaluation of ESA use in haemodialysis patients suggests that the use of CERA is cost-effective compared with EpoB.
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Schmid H. Methoxy polyethylene glycol-epoetin beta for the treatment of anemia associated with chronic renal failure. Expert Rev Hematol 2015; 9:5-20. [PMID: 26573694 DOI: 10.1586/17474086.2016.1112734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since more than two decades erythropoiesis-stimulating agents are the main pillar for treatment of anemia associated with chronic kidney disease. Methoxy polyethylene glycol-epoetin beta (MPG-EPO), also called continuous erythropoietin receptor activator, is the longest acting erythropoiesis-stimulating agent currently available. MPG-EPO is characterized by an elimination half-life of approximately 137 h and offers extended dosing intervals up to 4 weeks. Numerous phase I/II studies and a comprehensive clinical phase III program demonstrated the feasibility of MPG-EPO therapy for anemia correction and maintenance of stable hemoglobin levels in adult chronic kidney disease patients. Due to patent disputes MPG-EPO was only available outside the US market so far. In view of a prevailing US market introduction, this review focuses on efficacy and safety data from pivotal trials, summarizes recent clinical research and finally tries to substantiate potential benefits associated with the use of this anti-anemic drug.
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Affiliation(s)
- Holger Schmid
- a Clinic and Policlinic IV, Section of Nephrology , Munich University Hospital , Munich , Germany.,b KFH Nierenzentrum Muenchen Laim , Munich , Germany
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