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Abstract
Sixty per cent of oncologic patients need radiation therapy for cure or palliation. In fact, in most neoplastic diseases, a better local control positively impacts on disease-free survival and overall survival. The efficacy of radiotherapy depends on several factors: while some are tumor-related, others are host-related. Radiobiological phenomena are also important: ionizing radiation is responsible for cell damage (double rupture of DNA chains), mostly an indirect mechanism with the formation of free radicals. Their toxic action is enhanced by the oxygen partial pressure at the cellular level. A number of studies have confirmed that good tissue oxygenation is a function of a high hemoglobin level in the peripheral blood (Hb≥13g/dL). Unfortunately, these values are rarely present in oncologic patients due to the disease-related toxicosis as well as to the therapy induced hematologic toxicity. The treatment of anemia is free of risk for the recent developments in technology which with gene cloning and the technique of recombinant DNA has allowed the production of human recombinant erythropoietin. Erythropoietin is produced by the interstitial cells of renal tubules in response to hypoxia. It prevents apoptosis and promotes erythroid proliferation and differentiation with consequent reticulocyte release and hemoglobin synthesis. It is not completely understood whether the efficacy of radiotherapy depends on hemoglobin values present at the start of irradiation (often less than 12-13 g/dL) or on the higher ones observed during and at the end of radiotherapy. Therefore, preventive systemic erythropoietin therapy in non anemic patients in terms of costs/benefits is at present non sustainable. To the contrary, in patients undergoing radiotherapy to extended fields or aggressive multimodal treatments, for the higher risk of anemia, the early use of this treatment can be hypothesized in case of initial anemia to improve therapy compliance and prevent negative conditioning of results. Keeping in mind that grade 1 minimum toxicity for red cells, according to the Radiation Therapy Oncology Group (RTOG) is equal to 11gHb/dL we think that this value can be considered as cutoff to start erythropoietin therapy.
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Affiliation(s)
- L Trodella
- Divisione di Radioterapia, Università Cattolica Sacro Cuore, Roma
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152
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Bajetta E, Vercammen E, Reinhardt U, Janmohamed R, da Costa RM, Matulonis U, Guastalla JP. Efficacy of Epoetin Alfa in a Retrospective Non-stratified Subgroup Analysis of a Breast Cancer Cohort Receiving Non-platinum Chemotherapy. Tumori 2018; 90:449-57. [PMID: 15656327 DOI: 10.1177/030089160409000501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background More than 60% of patients with metastatic breast cancer receiving non-platinum-based chemotherapy experience anemia, which is associated with fatigue and impaired quality of life. Epoetin alfa treatment in patients with a variety of malignancies has been shown to decrease transfusion requirements and improve hemoglobin levels and quality-of-life efficacy parameters. Patients Retrospective subgroup analyses were performed in patients with breast cancer who were part of a multinational, randomized (2:1), double-blind, placebo-controlled trial of anemic cancer patients (n = 375) undergoing non-platinum-based chemotherapy. Results In the breast cancer subpopulation (n = 114, 48% with stage IV disease at baseline), the hemoglobin increase was greater for epoetin alfa patients than placebo patients (2.3 versus 0.9 g/dL). Epoetin alfa patients had lower transfusion requirements (28.2% versus 33.3%), improvement or preservation versus deterioration of quality of life, and a higher proportion of responders (patients achieving a ≥2 g/dL increase in hemoglobin levels unrelated to transfusion) (68.0% versus 22.9% for placebo). The results were similar to those observed in the full study cohort, where statistical analyses showed the differences to be significant (P <0.05 for all). Epoetin alfa treatment was well tolerated. Although the study was not designed or powered for survival as an endpoint, Kaplan-Meier estimates for the full cohort showed a trend in overall survival favoring epoetin alfa treatment (P= 0.13, log rank test); a similar benefit was seen in the breast cancer subpopulation. Conclusions In the full study cohort and the breast cancer subpopulation, epoetin alfa effectively treated anemia (increased hemoglobin levels and decreased transfusion requirements) and improved or preserved quality of life. Results concerning potential survival benefits support further study of epoetin alfa in anemic cancer patients.
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Affiliation(s)
- Emilio Bajetta
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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153
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Takasawa K, Takaeda C, Wada T, Ueda N. Optimal Serum Ferritin Levels for Iron Deficiency Anemia during Oral Iron Therapy (OIT) in Japanese Hemodialysis Patients with Minor Inflammation and Benefit of Intravenous Iron Therapy for OIT-Nonresponders. Nutrients 2018; 10:nu10040428. [PMID: 29596361 PMCID: PMC5946213 DOI: 10.3390/nu10040428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background: We determined optimal serum ferritin for oral iron therapy (OIT) in hemodialysis (HD) patients with iron deficiency anemia (IDA)/minor inflammation, and benefit of intravenous iron therapy (IIT) for OIT-nonresponders. Methods: Inclusion criteria were IDA (Hb <120 g/L, serum ferritin <227.4 pmol/L). Exclusion criteria were inflammation (C-reactive protein (CRP) ≥ 5 mg/L), bleeding, or cancer. IIT was withheld >3 months before the study. ΔHb ≥ 20 g/L above baseline or maintaining target Hb (tHB; 120-130 g/L) was considered responsive. Fifty-one patients received OIT (ferrous fumarate, 50 mg/day) for 3 months; this continued in OIT-responders but was switched to IIT (saccharated ferric oxide, 40 mg/week) in OIT-nonresponders for 4 months. All received continuous erythropoietin receptor activator (CERA). Hb, ferritin, hepcidin-25, and CERA dose were measured. Results: Demographics before OIT were similar between OIT-responders and OIT-nonresponders except low Hb and high triglycerides in OIT-nonresponders. Thirty-nine were OIT-responders with reduced CERA dose. Hb rose with a peak at 5 months. Ferritin and hepcidin-25 continuously increased. Hb positively correlated with ferritin in OIT-responders (r = 0.913, p = 0.03) till 5 months after OIT. The correlation equation estimated optimal ferritin of 30-40 ng/mL using tHb (120-130 g/L). Seven OIT-nonresponders were IIT-responders. Conclusions: Optimal serum ferritin for OIT is 67.4-89.9 pmol/L in HD patients with IDA/minor inflammation. IIT may be a second line of treatment for OIT-nonreponders.
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Affiliation(s)
- Kazuya Takasawa
- Department of Internal Medicine, Division of Nephrology, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan.
| | - Chikako Takaeda
- Department of Internal Medicine, Division of Nephrology, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan.
| | - Takashi Wada
- Department of Nephrology, Kanazawa University; Kanazawa, Ishikawa 9208641, Japan.
| | - Norishi Ueda
- Department of Pediatrics, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan.
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154
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Nowicki M, Peczek K. History of Erythropoietin Stimulating Agents use for the treatment of renal anemia in Poland. G Ital Nefrol 2018; 35:87-89. [PMID: 29482281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
| | - Katarzyna Peczek
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
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155
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Di Iorio BR, Di Micco L, Russo L, Nardone L, De Simone E, Sirico ML, Di Natale G, Russo D. A strategy to reduce inflammation and anemia treatment's related costs in dialysis patients. G Ital Nefrol 2018; 35:2018-vol1-10. [PMID: 29390245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This is a post-hoc analysis evaluating erythropoiesis stimulating agents' (ESA) related costs while using an additional ultrafilter (Estorclean PLUS) to produce ultrapure dialysis water located within the fluid pathway after the treatment with reverse osmosis and before the dialysis machine. Twenty-nine patients (19 treated with epoetin alfa and 10 with darboepoetin alfa) were included in the analysis. We showed to gain savings of 210 € per patient (35 € per patient each month) with epoetin alfa during the experimental period of 6 months, compared to the control period and of 545 € per patient (90 € per patient each month) with darboepoetin alfa. Estorclean PLUS had a cost of 600 € (25 € per month per each patient) and was used for 6 months. Intravenous iron therapy with sodium ferrigluconate had a cost of 0,545 €/62,5 mg. In conclusion, during the experimental period with the use of Estorclean, we obtained global savings of 11 € per patient per month with epoetin alfa and 30 € per patient per month with darboepoetin alfa to treat anemia in dialysis patients.
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Affiliation(s)
- Biagio R Di Iorio
- Department of Nephrology, A. Landolfi Hospital, Solofra, Avellino, Italy
| | | | - Luigi Russo
- Chair of Nephrology, University of Naples Federico II, Naples, Italy
| | - Luca Nardone
- Department of Nephrology, A. Landolfi Hospital, Solofra, Avellino, Italy
| | | | - M L Sirico
- Department of Nephrology, A. Landolfi Hospital, Solofra, Avellino, Italy
| | | | - Domenico Russo
- Chair of Nephrology, University of Naples Federico II, Naples, Italy
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156
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Kato H, Nangaku M, Hirakata H, Wada T, Hayashi T, Sato H, Yamazaki Y, Masaki T, Kagimura T, Yamamoto H, Hase H, Kamouchi M, Imai E, Mizuno K, Iwasaki M, Akizawa T, Tsubakihara Y, Maruyama S, Narita I. Rationale and design of oBservational clinical Research In chronic kidney disease patients with renal anemia: renal proGnosis in patients with Hyporesponsive anemia To Erythropoiesis-stimulating agents, darbepoetiN alfa (BRIGHTEN Trial). Clin Exp Nephrol 2018; 22:78-84. [PMID: 28660446 PMCID: PMC5805810 DOI: 10.1007/s10157-017-1427-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 06/01/2017] [Indexed: 10/29/2022]
Abstract
BACKGROUND Renal anemia is an important complication in non-dialysis chronic kidney disease (CKD) patients as well as in dialysis patients. Although recombinant human erythropoietin has dramatically improved prognosis and quality of life in these patients, there have been issues among non-dialysis CKD patients who exhibit hyporesponsiveness to erythropoiesis-stimulating agent (ESA). The causes and definition of ESA hyporesponsiveness, as well as the incidence of renal and cardiovascular disease (CVD) events in such patients, are yet to be clarified. METHODS This ongoing trial is a multicenter, prospective, observational study of non-dialysis CKD patients with renal anemia. The primary objective is to survey the current realities of the therapy with ESA in Japan and evaluate the correlation between hyporesponsiveness to darbepoetin alfa and CKD progression. The secondary objective is to investigate relationship between ESA hyporesponsiveness and CVD events based on the clinical situation in Japan, and to explore an ESA response index. RESULTS The subjects consist of CKD patients with estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2 who present renal anemia. The target number of registered cases is 2000 patients, based on estimates of incidences of renal and CVD events from past studies. Renal function and CVD events will be observed for 96 weeks after the initiation of darbepoetin alfa administration. Definitions of ESA hyporesponsiveness will also be investigated. CONCLUSION By clarifying markers and factors involved in ESA hyporesponsiveness and their relationships with renal and CVD events, this ongoing study aims to improve evidence-based therapies for renal anemia in non-dialysis CKD patients.
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Affiliation(s)
- Hideki Kato
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Centre, Sumiyoshi, Osaka, Japan
| | - Hiroshi Sato
- Division of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Faculty of Pharmaceutical Sciences, Sendai, Miyagi, Japan
| | - Yasushi Yamazaki
- Department of Nephrology and Rheumatology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Tatsuo Kagimura
- Translational Research Informatics Center, Foundation Biomedical Research and Innovation, Kobe, Hyogo, Japan
| | - Hiroyasu Yamamoto
- Department of Internal Medicine, Atsugi City Hospital, Atsugi, Kanagawa, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Hyogo, Department of Nephrology, Fujita Health University Toyoake, Toyoake, Aichi, Japan
| | - Kyoichi Mizuno
- Mitsukoshi Health and Welfare Foundation, Shinjuku, Tokyo, Japan
| | - Manabu Iwasaki
- Department of Computer and Information Science, Seikei University, Musashino, Tokyo, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Yoshiharu Tsubakihara
- Course of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Yodogawa, Osaka, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
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157
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Aoun M, Karam R, Sleilaty G, Antoun L, Ammar W. Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern? PLoS One 2018; 13:e0191541. [PMID: 29357391 PMCID: PMC5777643 DOI: 10.1371/journal.pone.0191541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022] Open
Abstract
In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents’ coverage during a 5-month period. Iron requirement was assessed based on two guidelines’ target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006), 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012). A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8–79.3) years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents’ therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anemia, Iron-Deficiency/complications
- Anemia, Iron-Deficiency/drug therapy
- Anemia, Iron-Deficiency/metabolism
- Female
- Ferritins/blood
- Hematinics/therapeutic use
- Humans
- Iron/blood
- Iron/therapeutic use
- Iron Deficiencies
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/drug therapy
- Kidney Failure, Chronic/metabolism
- Lebanon
- Male
- Middle Aged
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/metabolism
- Sex Factors
- Young Adult
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Saint-Joseph University, Beirut, Lebanon
- Ministry of Public Health, Beirut, Lebanon
- * E-mail:
| | - Rita Karam
- Ministry of Public Health, Beirut, Lebanon
- Faculty of sciences and medical sciences, Lebanese University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Department of Epidemiology and Biostatistics, School of medicine, Saint-Joseph University, Beirut, Lebanon
| | - Leony Antoun
- Department of internal medicine, Holy Spirit University, Kaslik, Lebanon
| | - Walid Ammar
- Ministry of Public Health, Beirut, Lebanon
- Faculty of sciences and medical sciences, Lebanese University, Beirut, Lebanon
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158
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René É, Lazrak HH, Laurin LP, Elftouh N, Vallée M, Lafrance JP. Association of erythropoiesis-stimulating agents and the incidence risk of cancer diagnosis among chronic dialysis patients: a nested case-control study. Nephrol Dial Transplant 2018; 32:1047-1052. [PMID: 27448671 DOI: 10.1093/ndt/gfw268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/04/2016] [Indexed: 11/14/2022] Open
Abstract
Background Erythropoiesis-stimulating agents (ESAs) are the cornerstone of the treatment for anemia in end-stage renal disease (ESRD) patients. Although a correlation has been established between ESAs and increased tumor growth among patients with cancer-related anemia, an association with a higher incidence of cancer among chronic dialysis patients remains relatively unclear. Methods We completed a nested case-control study in a cohort of 4574 patients who began chronic dialysis treatment between 1 January 2001 and 31 December 2007 in Quebec, Canada, utilizing dialysis registry and administrative databases exclusively to extract our data. We excluded patients with a prior diagnosis of cancer. Eligible cases were identified by the time of initial cancer diagnosis obtained from either the hospital's discharge or physician billing form. We then randomly selected up to 10 controls for each case. ESA exposure was evaluated between 6 and 9 months prior to the initial cancer diagnosis. The mean weekly exposure was used to categorize ESA usage as either a low dose (<30 µg/week), moderate dose (30-70 µg/week) or high dose (>70 µg/week). We estimated the association between ESAs and the risk of developing cancer using a multivariable conditional logistic regression. Results We identified 419 cases of cancer and 3895 matched controls during the study period. The use of ESAs was associated with a higher risk of cancer {odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02-1.07]}. Specifically, patients in the high exposure group (>70 µg/week) had an increased risk of developing cancer [OR 1.77 (95% CI 1.18-2.66)] compared with patients in the unexposed group. Conclusion High-dose ESA was associated with an increased incidence risk of new cancer diagnosis among chronic dialysis patients.
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Affiliation(s)
- Émilie René
- Maisonneuve-Rosemont HospitalResearch Center, Montreal, QC, Canada
| | - Hind H Lazrak
- Maisonneuve-Rosemont HospitalResearch Center, Montreal, QC, Canada
| | - Louis-Philippe Laurin
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de l'Assomption, Montreal, QC H1T 2M4, Canada
| | - Naoual Elftouh
- Maisonneuve-Rosemont HospitalResearch Center, Montreal, QC, Canada
| | - Michel Vallée
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de l'Assomption, Montreal, QC H1T 2M4, Canada
| | - Jean-Philippe Lafrance
- Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada
- Department of Medicine, University of Montreal, Montreal, QC, Canada
- Division of Nephrology, Maisonneuve-Rosemont Hospital, 5415, boul. de l'Assomption, Montreal, QC H1T 2M4, Canada
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159
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Naqash A, Ara R, Bader GN. Effectiveness and safety of ferric carboxymaltose compared to iron sucrose in women with iron deficiency anemia: phase IV clinical trials. BMC Womens Health 2018; 18:6. [PMID: 29304848 PMCID: PMC5755312 DOI: 10.1186/s12905-017-0506-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/27/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a significant problem worldwide particularly in women. The aim of the study was to evaluate the effectiveness and safety of intravenous ferric carboxymaltose (FCM) in comparison to iron sucrose (IS) in women with IDA. METHOD Two hundred patients at Department of Obstetrics and Gynaecology, Sher-i-Kashmir Institute of Medical Sciences Medical College and Hospital, Jammu & Kashmir, India identified with IDA were enrolled for the study. Intravenous FCM and IS were both given as per the protocol. Change in the laboratory parameters such as hemoglobin (Hb), mean corpuscular value, and serum ferritin levels at two weeks and four weeks interval after the treatment was recorded. RESULT A significant increase in the mean Hb was observed from 7.76 ± 0.709 to 13.25 ± 0.606 in patients treated with FCM and 7.64 ± 0.710 to 11.59 ± 0.733 g/dL (P < 0.001) in patients treated with IS after four weeks of therapy. The rise in mean corpuscular volume was from 66.82 ± 5.24 to 86.76 ± 3.765 and 68.05 ± 5.56 to 93.80 ± 3.80 and rise in serum ferritin levels were from 8.32 ± 1.787 to 38.94 ± 6.095 μg/L and 8.16 ± 1.540 to 27 ± 8.175 μg/L in patients treated with FCM and IS respectively after four weeks of therapy. No serious adverse effects were reported. CONCLUSION Parenteral therapy is effective in IDA, but FCM elevates hemoglobin level and restored iron stores faster than IS with minimum adverse drug reactions. TRIAL REGISTRATION NUMBER ISRCTN14484575 Dated: 15-12-2017 retrospectively registered. https://doi.org/10.1186/ISRCTN14484575.
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Affiliation(s)
- Amreen Naqash
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, J&K 190006 India
| | - Rifat Ara
- Department of Obstetrics and Gynecology, SKIMS Medical College and Hospital, Srinagar, J&K 190017 India
| | - Ghulam N. Bader
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, J&K 190006 India
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160
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Mishra V, Roy P, Gandhi K, Choudhary S, Aggarwal R, Sokabaj S. Safety and Efficacy of Intravenous Ferric Carboxy Maltose in Iron Deficiency Anaemia During Post-partum Period. J Nepal Health Res Counc 2018; 15:208-211. [PMID: 29353890 DOI: 10.3126/jnhrc.v15i3.18841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND Iron deficiency is the commonest treatable cause of postpartum anaemia. Parenteral iron therapy results in faster and higher replenishment of iron stores and correction of haemoglobin levels with better compliance. Ferric Carboxy Maltose is an effective and a safe option which can be administered intravenously in single total correction dose without any serious adverse effects.The study was done to evaluate the efficacy and safety of Ferric Carboxy Maltose in the treatment of iron deficiency anaemia in post-natal patients. METHODS It was an open, single arm study including 615 women with diagnosis of Iron deficiency anaemia and haemoglobin (Hb) levels between 4gm% and 11gm% from January 2013 to December 2016. Intravenous Ferric Carboxy Maltose(500-1500mg) was administered and the improvement in haemoglobin levels and iron stores were assessed after three weeks of total dose infusion. RESULTS Out of the 615 women, 595 women were included in the analysis. Most of the women were in the age group of 27-30 years. Most of the women had mild anaemia as per World Health Organisation guidelines. Mean hemoglobin levels significantly increased over a period of three weeks after Ferric Carboxy Maltose administration. Other parameters like total iron binding capacity, Ferritin and Iron also had a significant improvement after Ferric Carboxy Maltose administration. No serious adverse events were observed after Ferric Carboxy Maltose. CONCLUSIONS Intravenous Ferric Carboxy Maltose was an effective and a safe treatment option for iron deficiency anaemia and has an advantage of single administration of high doses without serious adverse effects.
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Affiliation(s)
- Vineet Mishra
- Institute of Kidney Diseases and Research Centre, B. J. Medical College Campus, Asarwa, Ahmedabad - 380016. India
| | - Priyankar Roy
- Institute of Kidney Diseases and Research Centre, B. J. Medical College Campus, Asarwa, Ahmedabad - 380016. India
| | - Khushali Gandhi
- Institute of Kidney Diseases and Research Centre, B. J. Medical College Campus, Asarwa, Ahmedabad - 380016. India
| | - Sumesh Choudhary
- Institute of Kidney Diseases and Research Centre, B. J. Medical College Campus, Asarwa, Ahmedabad - 380016. India
| | - Rohina Aggarwal
- Institute of Kidney Diseases and Research Centre, B. J. Medical College Campus, Asarwa, Ahmedabad - 380016. India
| | - Shaheen Sokabaj
- Institute of Kidney Diseases and Research Centre, B. J. Medical College Campus, Asarwa, Ahmedabad - 380016. India
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161
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Chua S, Gupta S, Curnow J, Gidaszewski B, Khajehei M, Diplock H. Intravenous iron vs blood for acute post-partum anaemia (IIBAPPA): a prospective randomised trial. BMC Pregnancy Childbirth 2017; 17:424. [PMID: 29258541 PMCID: PMC5735511 DOI: 10.1186/s12884-017-1596-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 11/24/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Acute post-partum anaemia can be associated with significant morbidity including a predisposition for postnatal depression. Lack of clear practice guidelines means a number of women are treated with multiple blood transfusions. Intravenous iron has the potential to limit the need for multiple blood transfusions but its role in the post-partum setting is unclear. METHODS/DESIGN IIBAPPA is a multi-centre randomised non-inferiority trial. Women with a primary post-partum haemorrhage (PPH) >1000 mL and resultant haemoglobin (Hb) 5.5-8.0 g/dL after resuscitation with ongoing symptomatic anaemia who are otherwise stable (no active bleeding) are eligible to participate. Patients with sepsis or conditions necessitating rapid Hb restoration are excluded. Eligible participants are randomised to receive a blood transfusion or a single dose of intravenous iron polymaltose calculated using the Ganzoni formula. Primary outcome measures include Hb, Ferritin and C-Reactive Protein levels on Day 7. Secondary outcomes evaluate (i) Hb, Ferritin and CRP levels on Day 14, 28, (ii) anaemia symptoms on Day 0, 7, 14 and 28 using structured health related quality of life questionnaires, (iii) treatment safety by assessing adverse reactions and infection endpoints and (iv) the quantitative impact of anaemia on breast feeding quality using a hospital designed questionnaire. DISCUSSION If equivalence in Hb and ferritin levels, symptom scores and safety endpoints is demonstrated, intravenous iron may become the preferred treatment for women with acute post-partum anaemia to minimise transfusion reactions and costs. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12615001370594 on 16th December, 2015 (prospective approval).
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Affiliation(s)
- Seng Chua
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
- Department of Medicine and Public Health, University of Sydney, Camperdown, NSW 2050 Australia
| | - Sarika Gupta
- Department of Medicine and Public Health, University of Sydney, Camperdown, NSW 2050 Australia
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, NSW 2305 Australia
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Westmead, NSW 2145 Australia
| | - Beata Gidaszewski
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
| | - Marjan Khajehei
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
| | - Hayley Diplock
- Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, NSW 2145 Australia
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162
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Rohner E, Grabik M, Tonia T, Jüni P, Pétavy F, Pignatti F, Bohlius J. Does access to clinical study reports from the European Medicines Agency reduce reporting biases? A systematic review and meta-analysis of randomized controlled trials on the effect of erythropoiesis-stimulating agents in cancer patients. PLoS One 2017; 12:e0189309. [PMID: 29228059 PMCID: PMC5724886 DOI: 10.1371/journal.pone.0189309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/22/2017] [Indexed: 12/05/2022] Open
Abstract
Since 2010, the European Medicines Agency (EMA) has provided access to clinical study reports (CSRs). We requested CSRs for randomized controlled trials (RCTs) of erythropoiesis-stimulating agents (ESAs) in cancer patients from EMA and identified RCT publications with literature searches. We assessed CSR availability and completeness, the impact of unreported and unpublished data obtained from CSRs on the effects of ESAs on quality of life (QoL) of cancer patients, and discrepancies between data reported in the public domain and in CSRs. We used random-effects meta-analyses to evaluate the effect of ESAs on QoL measured with Functional Assessment of Cancer Therapy-Anemia (FACT-An), FACT-Fatigue (FACT-F) and FACT-Anemia Total (FACT-An Total) stratified by data source and the impact of discrepancies on QoL, mortality, adverse events, and clinical effectiveness outcomes. We identified 94 eligible RCTs; CSRs or other study documentation were available for 17 (18%) RCTs at EMA. Median report length was 1,825 pages (range 72-14,569). Of 180 outcomes of interest reported in the EMA documentation, 127 (71%) were publicly available. For 80 of those (63%) we noted discrepancies, but these had little impact on the pooled effect estimates. Of 27 QoL outcomes reported in the CSRs, 17 (63%) were unpublished. Including six unpublished comparisons (pooled mean difference [MD] 0.20; 95% confidence interval [CI] -1.93, 2.33) reduced the pooled effect of ESAs for FACT-An from MD 5.51 (95% CI 4.20, 6.82) in published data to MD 3.21 (95% CI 1.38, 5.03), which is below a clinically important difference (defined as MD ≥4). Effects were similar for FACT-F and FACT-An Total. Access to CSRs from EMA reduced reporting biases for QoL outcomes. However, EMA received documentation for a fraction of all RCTs on effects of ESAs in cancer patients. Additional efforts by other agencies and institutions are needed to make CSRs universally available for all RCTs.
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Affiliation(s)
- Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michael Grabik
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Peter Jüni
- University of Toronto, Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Frank Pétavy
- European Medicines Agency, London, United Kingdom
| | | | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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163
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Abstract
Lower risk myelodysplastic syndromes (MDS), defined as MDS with a Revised International Prognostic Scoring System score ≤3.5 points, will remain a challenging entity in 2018. Supportive care continues to be the linchpin of treatment, although the options to reduce transfusion needs are broadening. To achieve red blood cell transfusion independence in non-del(5q) patients, erythropoiesis-stimulating agents remain a mainstay of therapy as long as endogenous erythropoietin levels are <500 U/L (and preferably <200 U/L). Experimental strategies for patients ineligible for erythropoiesis-stimulating agents or relapsing after gaining transfusion independence include immunosuppressive agents, transforming growth factor β inhibitors, and lenalidomide. All these alternatives have shown reasonable response rates in selected patient populations with lower risk MDS. Patients with del(5q) disease can derive long-term benefit from lenalidomide, and some patients remain transfusion free for extended periods even after discontinuation of the drug. In rare cases in which thrombocytopenia is the main clinical problem leading to clinically significant bleeding events, thrombopoietin receptor analogues may alleviate bleeding, increase platelet counts, and rarely lead to trilineage responses. It seems prudent to use these drugs only in patients with confirmed bone marrow blast counts <5%. Allogeneic stem cell transplantation is reasonable for patients with high molecular risk of progression and those failing several lines of treatment with signs of progression toward higher-risk MDS.
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Affiliation(s)
- Aristoteles Giagounidis
- Department of Hematology, Oncology and Palliative Care, Marien Hospital Düsseldorf, Düsseldorf, Germany
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164
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Dellanna F, Goldsmith D, Krendyukov A, Seidl A, Höbel N, Combe C. HX575: established biosimilarity in the treatment of renal anemia and 10 years of clinical experience. Drug Des Devel Ther 2017; 12:9-14. [PMID: 29296077 PMCID: PMC5739117 DOI: 10.2147/dddt.s146147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Erythropoiesis-stimulating agents, such as recombinant human erythropoietin, are commonly used for the treatment of anemia in patients with chronic kidney disease (CKD). In 2007, HX575 (Binocrit®) became the first biosimilar epoetin alfa to be approved by the European Medicines Agency (EMA). The decision to approve a biosimilar is based on the totality of evidence obtained in a comprehensive comparability exercise that involves extensive analytical characterization, nonclinical studies and clinical studies. The development process for HX575 included extensive analytical characterization and comparison with the reference epoetin alfa. This was followed by a clinical development program, comprising Phase I pharmacokinetic/pharmacodynamic studies to show bioequivalence to the reference medicine and a confirmatory Phase III study to demonstrate therapeutic effectiveness in anemia related to CKD. In addition to the comparability exercises, extensive clinical experience over the last decade also confirms that HX575 provides an effective treatment for CKD-related anemia, with a favorable safety profile. Growing clinical experience with EMA-approved biosimilars, including HX575, should offer additional reassurance to health care professionals and patients that these agents are as effective and well tolerated as others in the therapeutic class.
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Affiliation(s)
| | - David Goldsmith
- Division of Nephrology, Guy’s and St Thomas’ Hospitals, London, UK
| | - Andriy Krendyukov
- Hematology/Nephrology, Hexal AG, Holzkirchen
- Correspondence: Andriy Krendyukov, Sandoz Biopharmaceuticals, Hexal AG, Industriestr. 25, D-83607 Holzkirchen, Germany, Tel +49 8024 476 4855, Fax +49 8024 476 2979, Email
| | - Andreas Seidl
- Technical Development Biosimilars, Hexal AG, Oberhaching
| | - Nadja Höbel
- Biostatistics Medical Affairs/Late Phase, Hexal AG, Holzkirchen, Germany
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux
- Université Bordeaux, INSERM 1026, Bordeaux, France
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165
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Lapina E, Batiushin M, Terentiev V, Gasanov M, Gasanova A. CLINICAL FEATURES OF THERAPY OF ANEMIA AND THE SIGNIFICANCE OF ITS FLUCTUATION IN THE DEVELOPMENT OF ANEMIA IN DIALYSIS PATIENTS. Georgian Med News 2017:64-69. [PMID: 29227261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of our study was to examine the features of therapy of anemia, and the influence of fluctuation in dose of antianemic drugs on hemoglobin levels in dialysis patients. The study included 100 patients with chronic kidney disease stage 5D receiving hemodialysis, mean age was 53,4±15,8 years. The clinical and anamnestic data were studied and laboratory tests were performed in all patients. The correlation between hemoglobin level and fluctuations in dose of antianemic drugs for 12 months: erythropoietin (R= -0,51, p=0,004) and iron (R= -0,46, p=0,01) was determined. The higher doses of erythropoietin and their fluctuation and the fluctuation in dose of iron drugs were observed in the group of patients with middle degree anemia. The least fluctuation of erythropoietin and iron drugs was detected among patients with normal hemoglobin level. There were the correlation between the dose of erythropoietin used in the last month with transferrin (R=-0,25, p=0.011) and ferritin (R=0,22, p=0.028)and the relationship of fluctuations in dose of antianemic drugs and parameters of ferrokinetic, in particular, between the fluctuation in dose of iron drugs for 6 months and ferritin index (R=0,38, p=0.008), and soluble transferrin receptors (R=-0,37, p=0.01). Thus, high variability of doses of antianemic drugs determines less successful erythron's response to the treatment in dialysis patients, which indicates the need of monitoring the fluctuation of drug's doses.
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Affiliation(s)
- E Lapina
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - M Batiushin
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - V Terentiev
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - M Gasanov
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - A Gasanova
- Rostov State Medical University, Rostov-on-Don, Russian Federation
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166
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Pakkyara A, Jha A, Al Salmi I, Siddiqi WA, Al Rahbi N, Kurkulasurya AP, Mohsin J. Persistent anemia in a kidney transplant recipient with parvovirus B19 infection. Saudi J Kidney Dis Transpl 2017; 28:1447-1450. [PMID: 29265066 DOI: 10.4103/1319-2442.220846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Anemia after kidney transplant is not uncommon. This paper reports a case of unexplained anemia in a kidney transplant recipient that persisted for more than two months, and that did not respond to recombinant human erythropoietin treatment but was successfully treated after diagnosing Parvovirus B19 (ParvoV B19) infection. A middle-aged male underwent living-unrelated kidney transplantation from Pakistan in April 2015. He was on triple immuno-suppression therapy consisting of prednisolone, tacrolimus, and mycophenolate mofetil. He presented with anemia which persisted for more than two months that did not improve with Darbepoetin alpha and required blood transfusions. A bone marrow biopsy demonstrated pure erythroid hypoplasia and occasional giant pronormoblasts characteristic of a ParvoV B19 infection. The serum was highly positive for ParvoV B19 DNA polymerase chain reaction. The anemia resolved completely three weeks after the administration of intravenous immunoglobulin. ParvoV B19 infection should be considered in the differential diagnosis of kidney transplant recipients who present with anemia associated with a low reticulocyte count.
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Affiliation(s)
| | - Amitabh Jha
- Department of Nephrology, Royal Hospital, Muscat, Oman
| | - Issa Al Salmi
- Department of Nephrology, Royal Hospital, Muscat, Oman
| | | | | | | | - Jalila Mohsin
- Department of Microbiology, Royal Hospital, Muscat, Oman
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167
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Weir MR, Pergola PE, Agarwal R, Fink JC, Kopyt NP, Singh AK, Kumar J, Schmitt S, Schaffar G, Rudy A, McKay JP, Kanceva R. A Comparison of the Safety and Efficacy of HX575 (Epoetin Alfa Proposed Biosimilar) with Epoetin Alfa in Patients with End-Stage Renal Disease. Am J Nephrol 2017; 46:364-370. [PMID: 29084409 DOI: 10.1159/000481736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND HX575 (biosimilar epoetin alfa) was approved in Europe in 2007 for the treatment of chronic kidney disease (CKD)-related anemia. This study assessed the clinical equivalence of HX575 with the US-licensed reference epoetin alfa (Epogen®/Procrit®, Amgen/Janssen) following subcutaneous (SC) administration in dialysis patients with CKD-related anemia. METHODS This randomized, double-blind, parallel-group, multicenter study (NCT01693029) was conducted at 49 US clinical sites. Eligible patients were aged ≥18 years, had end-stage renal disease, were on hemodialysis or peritoneal dialysis for ≥6 months (or ≥12 months in the case of a failed kidney transplant), and were receiving treatment with stable SC doses of epoetin alfa. Eligible patients also had mean hemoglobin (Hb) concentration between 9.0 and 11.5 g/dL during the screening period. The primary endpoint was the mean absolute change in Hb concentration between the screening/baseline period (week-4 to week-1) and the evaluation period (weeks 21 to 28). RESULTS Hb values at the end of the evaluation period and the Hb change from baseline to evaluation period were similar between treatment groups. The estimated difference between groups in mean absolute change in Hb concentration was -0.093 g/dL, with 90% CI (-0.23 to 0.04) entirely within the pre-specified equivalence limits (-0.5 to 0.5 g/dL). The safety profile of each medicine was similar and as expected in dialysis patients, and neither method of treatment led to the development of neutralizing, clinically relevant antibodies. CONCLUSIONS SC HX575 in dialysis patients with renal anemia was therapeutically equivalent to the reference medicine in terms of maintaining stable Hb levels and safety.
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Affiliation(s)
- Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Rajiv Agarwal
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey C Fink
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Ajay K Singh
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jayant Kumar
- Renal Medicine Associates, Albuquerque, New Mexico, USA
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168
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Casadevall N, Dobronravov V, Eckardt KU, Ertürk S, Martynyuk L, Schmitt S, Schaffar G, Rudy A, Krendyukov A, Ode M. Evaluation of the safety and immunogenicity of subcutaneous HX575 epoetin alfa in the treatment of anemia associated with chronic kidney disease in predialysis and dialysis patients
. Clin Nephrol 2017; 88:190-197. [PMID: 28766493 PMCID: PMC5607454 DOI: 10.5414/cn109159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/07/2017] [Indexed: 01/22/2023] Open
Abstract
AIM To assess the safety and immunogenicity of subcutaneous (SC) HX575 (epoetin-α) in dialysis- and nondialysis-dependent adult patients with chronic kidney disease (CKD). METHODS Open-label, single-arm, multicenter study in patients (n = 416) from Germany, Italy, Poland, Romania, Russia, Turkey, and Ukraine. RESULTS Mean (standard deviation (SD)) age was 52.3 (15.8) years, all patients were Caucasian, and similar proportions were male/female. 250 patients (60.1%) were erythropoiesis-stimulating agent (ESA)-naïve, and 166 (39.9%) were receiving ESA maintenance therapy at study start; mean (SD) on-study treatment duration with HX575 was 43.4 (15.8) weeks and 45.3 (13.7) weeks, respectively. Binding antierythropoietin (EPO) antibodies were detected by radioimmunoprecipitation (RIP) assay in 7 patients (1.7%; incidence 0.019); 5 of these were ESA-naïve at study entry. No patient developed neutralizing antibodies as determined in a cell-based epoetin neutralizing assay. Of the 7 patients with a positive binding anti-EPO RIP assay, 4 tested negative at later time points while continuing HX575 treatment. Three patients had low titers of anti-EPO antibodies at the last study assessment. There were no clinical signs of immunogenicity or hypersensitivity. CONCLUSIONS SC HX575 was effective for correcting and maintaining correction of anemia, and the mean weekly dose remained stable over time.
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Affiliation(s)
- Nicole Casadevall
- Service d’Immunologie et Hématologie Biologiques, Hopital Saint Antoine, Paris, France
| | - Vladimir Dobronravov
- Research Institute of Nephrology, 1st St Petersburg Pavlov State Medical University, St. Petersburg, Russia
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Germany
| | - Sehsuvar Ertürk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Liliya Martynyuk
- Subdepartment of Internal Medicine, Higher Educational Institution, I. Ya. Horbachevsky Ternopil State Medical University, Ternopil, Ukraine, and
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169
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Liberti ME, Garofalo C, Sagliocca A, Borrelli S, Conte G, De Nicola L, Minutolo R. [Iron deficiency in ND-CKD: from diagnosis to treatment]. G Ital Nefrol 2017; 34:50-61. [PMID: 28963827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In non-dialysis-chronic kidney disease (CKD), iron deficiency is a frequent nutritional disorder due to either the greater tendency to occult gastrointestinal bleeding or to the chronic inflammatory state resulting in a reduced intestinal iron reabsorption through an increased synthesis of hepcidin. These phenomenon are responsible for a negative iron balance that compromises erythropoiesis and contributes to the pathogenesis of anemia in CKD. Several laboratory tests are now available to allow an adequate diagnosis of iron deficiency. Among the new parameters, the percentage of hypochromic red cells (% HYPO) and the reticulocyte hemoglobin content (CHr) are now considered as the most specific markers for diagnosing iron-deficiency erythropoiesis. Unfortunately, their implementation in clinical practice is limited by the scarce availability. In non-dialyzed CKD , subjects intolerant or non-responsive to oral iron therapy, can be effectively treated with novel intravenous iron preparations, such as iron carboxymaltose, that allow a complete and rapid correction of iron deficient anemia. Furthermore, this iron compound is associated with lower rate of adverse effects since the carbohydrate shell (carboxymaltose) is more stable than gluconate and saccarate thus reducing the release of free iron in the bloodstream. Of note, the possibility of administering this drug at high doses and reduced frequency decreases the risk of infusion reactions. Finally, a substantial economic saving mainly dependent on a reduction in indirect costs represents a further advantage in the use of iron carboxymaltose in this population.
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Affiliation(s)
- Maria Elena Liberti
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
| | - Carlo Garofalo
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
| | - Adelia Sagliocca
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
| | - Silvio Borrelli
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
| | - Giuseppe Conte
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
| | - Luca De Nicola
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
| | - Roberto Minutolo
- Cattedra di Nefrologia, Università della Campania Luigi Vanvitelli, Napoli, Italia
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170
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Mishra V, Gandhi K, Roy P, Hokabaj S, Shah KN. Role of Intravenous Ferric Carboxy-maltose in Pregnant Women with Iron Deficiency Anaemia. J Nepal Health Res Counc 2017; 15:96-99. [PMID: 29016575 DOI: 10.3126/jnhrc.v15i2.18158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia is associated with significant maternal, foetal and infant morbidity. Current options for treatment include oral iron, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a modern treatment option. The study was designed to assess the safety and efficacy of intravenous ferric carboxymaltose for correction of iron deficiency anaemia in pregnant women. METHODS A prospective study was conducted at Institute of Kidney Disease and Research Centre, Ahmedabad from January 2014 to December 2016. Antenatal women (108) with iron deficiency anaemia were the study subjects. Socio-demographic profile was recorded and anaemia was assessed based on recent haemoglobin reports. Iron deficiency was diagnosed on basis of serum ferritin value. Intravenous ferric carboxymaltose as per total correction dose (maximum 1500mg) was administered to all women; the improvement in haemoglobin levels were assessed after 3 weeks of total dose infusion. RESULTS Most of the women(n= 45, 41.7%), were in the age group of 27-30 years. Most of the women (n = 64, 59.3%) had moderate anaemia as per WHO guidelines. Mean haemoglobin levels significantly increased over a period of 3 weeks after Ferric carboxymaltose administrationand no serious life threatening adverse events were observed. CONCLUSIONS Intravenous ferric carboxymaltose was safe and effective in pregnent women with iron deficiency anaemia.
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Affiliation(s)
- Vineet Mishra
- Department of Obstetrics and Gynecology, Institute for Kidney Disease and Research Centre, BJ Medical College, Asarwa, Ahemdabad, India
| | - Khusaili Gandhi
- Department of Obstetrics and Gynecology, Institute for Kidney Disease and Research Centre, BJ Medical College, Asarwa, Ahemdabad, India
| | - Priyankur Roy
- Department of Obstetrics and Gynecology, Institute for Kidney Disease and Research Centre, BJ Medical College, Asarwa, Ahemdabad, India
| | - Shaheen Hokabaj
- Department of Obstetrics and Gynecology, Institute for Kidney Disease and Research Centre, BJ Medical College, Asarwa, Ahemdabad, India
| | - Kunur N Shah
- Department of Obstetrics and Gynecology, Institute for Kidney Disease and Research Centre, BJ Medical College, Asarwa, Ahemdabad, India
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171
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Burman D. Sleep Disorders: Restless Legs Syndrome. FP Essent 2017; 460:29-32. [PMID: 28845959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Restless legs syndrome (RLS) is a common disorder that often is underdiagnosed and undertreated. Patients with RLS describe an urge to move their legs, especially in the evenings and during periods of inactivity. The prevalence of clinically significant RLS is approximately 2% to 3% in adults in Europe and North America. RLS can be an independent disorder or may occur in conjunction with other conditions (eg, iron deficiency, pregnancy, chronic renal failure). Diagnosis is based on clinical history. Routine polysomnography typically is not recommended unless there is suspicion of other sleep disorders (eg, obstructive sleep apnea). Management includes a combination of supportive measures, dopaminergic drugs, gabapentinoids, opioids, or benzodiazepines. Good sleep hygiene can help prevent development of insomnia related to RLS. Avoiding alcohol and reducing caffeine intake is recommended. If iron stores are low, iron supplementation may improve symptoms. The main pharmacologic options for RLS management are dopaminergic agonists (eg, pramipexole and ropinirole); gabapentinoids also are good options. Patients may experience augmentation, an increase in RLS symptom severity with increasing drug dosage, which is the main complication of dopaminergic drugs. There is no evidence to support use of vibratory devices that provide stimulation to the lower extremities.
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Affiliation(s)
- Deepa Burman
- Latterman Family Health Center, 2347 Fifth Ave, McKeesport, PA 15132
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172
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Sparks JA, Barbhaiya M, Karlson EW, Ritter SY, Raychaudhuri S, Corrigan CC, Lu F, Selhub J, Chasman DI, Paynter NP, Ridker PM, Solomon DH. Investigating methotrexate toxicity within a randomized double-blinded, placebo-controlled trial: Rationale and design of the Cardiovascular Inflammation Reduction Trial-Adverse Events (CIRT-AE) Study. Semin Arthritis Rheum 2017; 47:133-142. [PMID: 28284844 PMCID: PMC5765986 DOI: 10.1016/j.semarthrit.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/04/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND The role of low dose methotrexate (LDM) in potential serious toxicities remains unclear despite its common use. Prior observational studies investigating LDM toxicity compared LDM to other active drugs. Prior placebo-controlled clinical trials of LDM in inflammatory conditions were not large enough to investigate toxicity. The Cardiovascular Inflammation Reduction Trial (CIRT) is an ongoing NIH-funded, randomized, double-blind, placebo-controlled trial of LDM in the secondary prevention of cardiovascular disease. We describe here the rationale and design of the CIRT-Adverse Events (CIRT-AE) ancillary study which aims to investigate adverse events within CIRT. DESIGN CIRT will randomize up to 7000 participants with cardiovascular disease and no systemic rheumatic disease to either LDM (target dose: 15-20mg/week) or placebo for an average follow-up period of 3-5 years; subjects in both treatment arms receive folic acid 1mg daily for 6 days each week. The primary endpoints of CIRT include recurrent cardio vascular events, incident diabetes, and all-cause mortality, and the ancillary CIRT-AE study has been designed to adjudicate other clinically important adverse events including hepatic, gastrointestinal, respiratory, hematologic, infectious, mucocutaneous, oncologic, renal, neurologic, and musculoskeletal outcomes. Methotrexate polyglutamate levels and genome-wide single nucleotide polymorphisms will be examined for association with adverse events. SUMMARY CIRT-AE will comprehensively evaluate potential LDM toxicities among subjects with cardiovascular disease within the context of a large, ongoing, double-blind, placebo-controlled trial. This information may lead to a personalized approach to monitoring LDM in clinical practice.
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Affiliation(s)
- Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Medha Barbhaiya
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Elizabeth W Karlson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Susan Y Ritter
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Soumya Raychaudhuri
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA; Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA
| | - Cassandra C Corrigan
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA
| | - Fengxin Lu
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA
| | - Jacob Selhub
- Jean Mayer USDA, Human Nutrition Center on Aging, Tufts University, Boston, MA
| | - Daniel I Chasman
- Harvard Medical School, Boston, MA; Department of Medicine, Center for Cardiovascular Disease Prevention, Brigham and Women׳s Hospital, Boston, MA
| | - Nina P Paynter
- Harvard Medical School, Boston, MA; Department of Medicine, Center for Cardiovascular Disease Prevention, Brigham and Women׳s Hospital, Boston, MA
| | - Paul M Ridker
- Harvard Medical School, Boston, MA; Department of Medicine, Center for Cardiovascular Disease Prevention, Brigham and Women׳s Hospital, Boston, MA
| | - Daniel H Solomon
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Harvard Medical School, Boston, MA
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173
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Abstract
Nephrotic syndrome is one of the most common glomerular diseases that affect in children. Complications may occur in nephrotic syndrome as a result of the disease itself as well as its treatment. Most of these complications result from excessive urinary protein losses, and control of proteinuria is the most effective treatment strategy. Anemia is one of the many complications seen in patients with persistent nephrotic syndrome and may occur as a result of excessive urinary losses of iron, transferrin, erythropoietin, transcobalamin and/or metals. This leads to a deficiency of substrates necessary for effective erythropoiesis, requiring supplementation in order to correct the anemia. Supplementation of iron and erythropoietin alone often does not lead to correction of the anemia, suggesting other possible mechanisms which need further investigation. A clear understanding of the pathophysiologic mechanisms of anemia in nephrotic syndrome is necessary to guide appropriate therapy, but only limited evidence is currently available on the precise etiologic mechanisms of anemia in nephrotic syndrome. In this review we focus on the current state of knowledge on the pathogenesis of anemia in nephrotic syndrome.
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Affiliation(s)
- Franca Iorember
- Division of Pediatric Nephrology, Department of Pediatrics, Louisiana State University Health Sciences Center, 200 Henry Clay Avenue, Rm 4241, Now Orleans, LA, 70118, USA
| | - Diego Aviles
- Division of Pediatric Nephrology, Department of Pediatrics, Louisiana State University Health Sciences Center, 200 Henry Clay Avenue, Rm 4241, Now Orleans, LA, 70118, USA.
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174
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Cybulska P, Goss C, Tew WP, Parameswaran R, Sonoda Y. Indications for and complications of transfusion and the management of gynecologic malignancies. Gynecol Oncol 2017; 146:416-426. [PMID: 28528916 PMCID: PMC5527999 DOI: 10.1016/j.ygyno.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023]
Abstract
Anemia, which is highly prevalent in oncology patients, is one of the most established negative prognostic factors for several gynecologic malignancies. Multiple factors can cause or contribute to the development of anemia in patients with gynecologic cancers; these factors include blood loss (during surgery or directly from the tumor), renal impairment (caused by platinum-based chemotherapy), and marrow dysfunction (from metastases, chemotherapy, and/or radiation therapy). Several peri- and intra-operative strategies can be used to optimize patient management and minimize blood loss related to surgery. Blood transfusions are routinely employed as corrective measures against anemia; however, blood transfusions are one of the most overused healthcare interventions. There are safe and effective evidence-based blood transfusion strategies used in other patient populations that warrant further investigation in the surgical oncology setting. Blood is a valuable healthcare resource, and clinicians can learn to use it more judiciously through knowledge of the potential risks and complications of blood interventions, as well as the ability to properly identify the patients most likely to benefit from such interventions.
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Affiliation(s)
- Paulina Cybulska
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cheryl Goss
- Hematology and Coagulation Laboratory Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rekha Parameswaran
- Transfusion Medicine Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Hematology Service, Department of Medicine, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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175
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Hasegawa T, Zhao J, Fuller DS, Bieber B, Zee J, Morgenstern H, Hanafusa N, Nangaku M. Erythropoietin Hyporesponsiveness in Dialysis Patients: Possible Role of Statins. Am J Nephrol 2017; 46:11-17. [PMID: 28564644 PMCID: PMC5841138 DOI: 10.1159/000477217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypothesizing that statins may be useful as adjuvant treatment for renal anemia, we examined the association between statin prescription (Rx) and erythropoiesis-stimulating agent (ESA) hyporesponsiveness in Japanese hemodialysis (HD) patients prescribed ESAs. METHODS We examined 3,602 patients in 60 HD facilities dialyzed 3 times/week for ≥4 months from the Japan Dialysis Outcomes and Practice Patterns Study phases 3-5 (2005-2015). Statin Rx was reported at the end of a 4-month interval (baseline) for each patient. ESA hyporesponsiveness in the subsequent 4 months was then defined as a binary indicator (mean hemoglobin [Hgb] level <10 g/dL and mean ESA dose >6,000 units/week) and separately as the ESA resistance index (ERI; mean ESA dose/[dry weight × mean Hgb]). We used adjusted logistic and linear regressions to evaluate the associations between statin Rx and ESA hyporesponsiveness. RESULTS At baseline, 16.2% of patients reported statin Rx; 12.8% were classified as having ESA hyporesponsiveness during 4 months of follow-up. Compared to patients without statin Rx, patients with statin Rx had lower odds of ESA hyporesponsiveness (OR 0.87; 95% CI 0.66-1.15). Similarly, the ERI was lower for those with statin Rx than without (ratio of means, 0.94; 95% CI 0.89-0.99) after adjustment for possible confounders. CONCLUSIONS Our results suggest that statins may slightly reduce ESA hyporesponsiveness in HD patients. However, any causal inference is limited by the observational study design and unmeasured compliance with statin Rx.
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Affiliation(s)
- Takeshi Hasegawa
- Office for Promoting Medical Research, Showa University, Tokyo, Japan
- Anemia Working Group of the Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS), Tokyo, Japan
- Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Hal Morgenstern
- Department of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Norio Hanafusa
- Anemia Working Group of the Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS), Tokyo, Japan
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Anemia Working Group of the Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS), Tokyo, Japan
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176
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Oka S, Obata Y, Torigoe K, Torigoe M, Abe S, Muta K, Ota Y, Kitamura M, Kawasaki S, Hirose M, Uramatsu T, Yamashita H, Arai H, Mukae H, Nishino T. A Comparative Study of the Hemoglobin-Maintaining Effects Between Epoetin-β Pegol and Darbepoetin-α in Patients with Chronic Kidney Disease During 3 Months Before Dialysis Initiation. Drugs R D 2017; 17:389-396. [PMID: 28547536 PMCID: PMC5629129 DOI: 10.1007/s40268-017-0188-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objective We compared the hemoglobin-maintaining effects between continuous erythropoietin receptor activator (CERA) and darbepoetin-α (DA) in patients with chronic kidney disease (CKD) during the 3 months before dialysis initiation. Methods This study was conducted with 37 CERA-administered patients and 26 DA-administered patients who had initiated dialysis at a participating facility between January 2012 and December 2014. We investigated clinical laboratory data 3 months before and at dialysis initiation, and compared these data between the CERA and DA groups. Results No significant differences in hemoglobin level or reticulocyte count were found between the two groups 3 months before dialysis initiation. However, at dialysis initiation, the hemoglobin level (CERA 9.82 ± 1.52 vs. DA 8.79 ± 1.07 g/dL; P = 0.003) and the reticulocyte count (CERA 5.21 ± 2.95 vs. DA 3.15 ± 1.62 × 104/μL; P = 0.004) were significantly higher in the CERA group than in the DA group. Moreover, the extent of changes in the erythropoietin resistance index during the 3 months before dialysis initiation was significantly increased in the DA group compared with the CERA group. Conclusions Our results suggest that CERA may be more effective than DA in maintaining hemoglobin levels in patients with CKD during 3 months before dialysis initiation.
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Affiliation(s)
- Satoru Oka
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yoko Obata
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
- Medical Educational Development Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Kenta Torigoe
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Miki Torigoe
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Shinichi Abe
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Blood Purification, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Satoko Kawasaki
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Misaki Hirose
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Tadashi Uramatsu
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Hiroshi Yamashita
- Department of Nephrology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Hideyuki Arai
- Department of Nephrology, Japan Community Health Care Organization Isahaya General Hospital, 24-1 Eishouhigashi-machi, Isahaya, Nagasaki, 854-8501, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
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177
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Kim YW, Bae JM, Park YK, Yang HK, Yu W, Yook JH, Noh SH, Han M, Ryu KW, Sohn TS, Lee HJ, Kwon OK, Ryu SY, Lee JH, Kim S, Yoon HM, Eom BW, Choi MG, Kim BS, Jeong O, Suh YS, Yoo MW, Lee IS, Jung MR, An JY, Kim HI, Kim Y, Yang H, Nam BH. Effect of Intravenous Ferric Carboxymaltose on Hemoglobin Response Among Patients With Acute Isovolemic Anemia Following Gastrectomy: The FAIRY Randomized Clinical Trial. JAMA 2017; 317:2097-2104. [PMID: 28535237 PMCID: PMC5815040 DOI: 10.1001/jama.2017.5703] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Acute isovolemic anemia occurs when blood loss is replaced with fluid. It is often observed after surgery and negatively influences short-term and long-term outcomes. OBJECTIVE To evaluate the efficacy and safety of ferric carboxymaltose to treat acute isovolemic anemia following gastrectomy. DESIGN, SETTING, AND PARTICIPANTS The FAIRY trial was a patient-blinded, randomized, phase 3, placebo-controlled, 12-week study conducted between February 4, 2013, and December 15, 2015, in 7 centers across the Republic of Korea. Patients with a serum hemoglobin level of 7 g/dL to less than 10 g/dL at 5 to 7 days following radical gastrectomy were included. INTERVENTIONS Patients were randomized to receive a 1-time or 2-time injection of 500 mg or 1000 mg of ferric carboxymaltose according to body weight (ferric carboxymaltose group, 228 patients) or normal saline (placebo group, 226 patients). MAIN OUTCOMES AND MEASURES The primary end point was the number of hemoglobin responders, defined as a hemoglobin increase of 2 g/dL or more from baseline, a hemoglobin level of 11 g/dL or more, or both at week 12. Secondary end points included changes in hemoglobin, ferritin, and transferrin saturation levels over time, percentage of patients requiring alternative anemia management (oral iron, transfusion, or both), and quality of life at weeks 3 and 12. RESULTS Among 454 patients who were randomized (mean age, 61.1 years; women, 54.8%; mean baseline hemoglobin level, 9.1 g/dL), 96.3% completed the trial. At week 12, the number of hemoglobin responders was significantly greater for ferric carboxymaltose vs placebo (92.2% [200 patients] for the ferric carboxymaltose group vs 54.0% [115 patients] for the placebo group; absolute difference, 38.2% [95% CI, 33.6%-42.8%]; P = .001). Compared with the placebo group, patients in the ferric carboxymaltose group experienced significantly greater improvements in serum ferritin level (week 12: 233.3 ng/mL for the ferric carboxymaltose group vs 53.4 ng/mL for the placebo group; absolute difference, 179.9 ng/mL [95% CI, 150.2-209.5]; P = .001) and transferrin saturation level (week 12: 35.0% for the ferric carboxymaltose group vs 19.3% for the placebo group; absolute difference, 15.7% [95% CI, 13.1%-18.3%]; P = .001); but there were no significant differences in quality of life. Patients in the ferric carboxymaltose group required less alternative anemia management than patients in the placebo group (1.4% for the ferric carboxymaltose group vs 6.9% for the placebo group; absolute difference, 5.5% [95% CI, 3.3%-7.6%]; P = .006). The total rate of adverse events was higher in the ferric carboxymaltose group (15 patients [6.8%], including injection site reactions [5 patients] and urticaria [5 patients]) than the placebo group (1 patient [0.4%]), but no severe adverse events were reported in either group. CONCLUSION AND RELEVANCE Among adults with isovolemic anemia following radical gastrectomy, the use of ferric carboxymaltose compared with placebo was more likely to result in improved hemoglobin response at 12 weeks. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01725789.
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Affiliation(s)
- Young-Woo Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jae-Moon Bae
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Kyu Park
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wansik Yu
- Center for Gastric Cancer, Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Jeong Hwan Yook
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Gastrointestinal Surgery, Yonsei University Health System, Seoul, Republic of Korea
| | - Mira Han
- Cancer Registration and Biostatistics Branch, Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Tae Sung Sohn
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Oh Kyoung Kwon
- Center for Gastric Cancer, Gastric Cancer Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Seung Yeob Ryu
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Jun-Ho Lee
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Min-Gew Choi
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Beom Su Kim
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Oh Jeong
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon-Won Yoo
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In Seob Lee
- Center for Gastric Cancer, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Ran Jung
- Department of Gastroenterologic Surgery, Chonnam National University Hwasun Hospital, Hwasun County, Republic of Korea
| | - Ji Yeong An
- Center for Gastric Cancer, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Gastrointestinal Surgery, Yonsei University Health System, Seoul, Republic of Korea
| | - Youngsook Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hannah Yang
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Byung-Ho Nam
- Cancer Registration and Biostatistics Branch, Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea
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Limbkar K, Dhenge A, Jadhav DD, Thulasiram HV, Kale V, Limaye L. Oral feeding with polyunsaturated fatty acids fosters hematopoiesis and thrombopoiesis in healthy and bone marrow-transplanted mice. J Nutr Biochem 2017; 47:94-105. [PMID: 28570944 DOI: 10.1016/j.jnutbio.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 12/13/2022]
Abstract
Hematopoietic stem cells play the vital role of maintaining appropriate levels of cells in blood. Therefore, regulation of their fate is essential for their effective therapeutic use. Here we report the role of polyunsaturated fatty acids (PUFAs) in regulating hematopoiesis which has not been explored well so far. Mice were fed daily for 10 days with n-6/n-3 PUFAs, viz. linoleic acid (LA), arachidonic acid (AA), alpha-linolenic acid and docosahexanoic acid (DHA) in four separate test groups with phosphate-buffered saline fed mice as control set. The bone marrow cells of PUFA-fed mice showed a significantly higher hematopoiesis as assessed using side population, Lin-Sca-1+ckit+, colony-forming unit (CFU), long-term culture, CFU-spleen assay and engraftment potential as compared to the control set. Thrombopoiesis was also stimulated in PUFA-fed mice. A combination of DHA and AA was found to be more effective than when either was fed individually. Higher incorporation of PUFAs as well as products of their metabolism was observed in the bone marrow cells of PUFA-fed mice. A stimulation of the Wnt, CXCR4 and Notch1 pathways was observed in PUFA-fed mice. The clinical relevance of this study was evident when bone marrow-transplanted recipient mice, which were fed with PUFAs, showed higher engraftment of donor cells, suggesting that the bone marrow microenvironment may also be stimulated by feeding with PUFAs. These data indicate that oral administration of PUFAs in mice stimulates hematopoiesis and thrombopoiesis and could serve as a valuable supplemental therapy in situations of hematopoietic failure.
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MESH Headings
- Animals
- Bone Marrow Cells/cytology
- Bone Marrow Cells/metabolism
- Bone Marrow Transplantation/adverse effects
- Cells, Cultured
- Dietary Supplements/adverse effects
- Fatty Acids, Omega-3/adverse effects
- Fatty Acids, Omega-3/therapeutic use
- Fatty Acids, Omega-6/adverse effects
- Fatty Acids, Omega-6/therapeutic use
- Female
- Gene Expression Regulation
- Graft Survival
- Hematinics/therapeutic use
- Hematopoiesis
- Mice, Congenic
- Mice, Inbred C57BL
- Receptor, Notch1/agonists
- Receptor, Notch1/genetics
- Receptor, Notch1/metabolism
- Receptors, CXCR4/agonists
- Receptors, CXCR4/genetics
- Receptors, CXCR4/metabolism
- Thrombopoiesis
- Transplantation Conditioning/adverse effects
- Up-Regulation
- Wnt Proteins/agonists
- Wnt Proteins/genetics
- Wnt Proteins/metabolism
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Affiliation(s)
- Kedar Limbkar
- National Centre for Cell Science, NCCS Complex, Savitribai Phule Pune University Campus, Pune 411007, India
| | - Ankita Dhenge
- National Centre for Cell Science, NCCS Complex, Savitribai Phule Pune University Campus, Pune 411007, India
| | - Dipesh D Jadhav
- Chemical Biology Unit, Division of Organic Chemistry, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411008, India
| | - Hirekodathakallu V Thulasiram
- Chemical Biology Unit, Division of Organic Chemistry, CSIR-National Chemical Laboratory, Dr. Homi Bhabha Road, Pune 411008, India; CSIR-Institute of Genomics and Integrative Biology, Mall Road, New Delhi 110007, India
| | - Vaijayanti Kale
- National Centre for Cell Science, NCCS Complex, Savitribai Phule Pune University Campus, Pune 411007, India
| | - Lalita Limaye
- National Centre for Cell Science, NCCS Complex, Savitribai Phule Pune University Campus, Pune 411007, India.
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Mafodda A, Giuffrida D, Prestifilippo A, Azzarello D, Giannicola R, Mare M, Maisano R. Oral sucrosomial iron versus intravenous iron in anemic cancer patients without iron deficiency receiving darbepoetin alfa: a pilot study. Support Care Cancer 2017; 25:2779-2786. [PMID: 28391437 PMCID: PMC5527057 DOI: 10.1007/s00520-017-3690-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/31/2017] [Indexed: 12/16/2022]
Abstract
Purpose Erythropoiesis-stimulating agents (ESAs) are often used in treatment of patients with chemotherapy-induced anemia. Many studies have demonstrated an improved hemoglobin (Hb) response when ESA is combined with intravenous iron supplementation and a higher effectiveness of intravenous iron over traditional oral iron formulations. A new formulation of oral sucrosomial iron featuring an increased bioavailability compared to traditional oral formulations has recently become available and could provide a valid alternative to those by intravenous (IV) route. Our study evaluated the performance of sucrosomial iron versus intravenous iron in increasing hemoglobin in anemic cancer patients receiving chemotherapy and darbepoetin alfa, as well as safety, need of transfusion, and quality of life (QoL). Materials and methods The present study considered a cohort of 64 patients with chemotherapy-related anemia (Hb >8 g/dL <10 g/dL) and no absolute or functional iron deficiency, scheduled to receive chemotherapy and darbepoetin. All patients received darbepoetin alfa 500 mcg once every 3 weeks and were randomly assigned to receive 8 weeks of IV ferric gluconate 125 mg weekly or oral sucrosomial iron 30 mg daily. The primary endpoint was to demonstrate the performance of oral sucrosomial iron in improving Hb response, compared to intravenous iron. The Hb response was defined as the Hb increase ≥2 g/dL from baseline or the attainment Hb ≥ 12 g/dL. Results There was no difference in the Hb response rate between the two treatment arms. Seventy one percent of patients treated with IV iron achieved an erythropoietic response, compared to 70% of patients treated with oral iron. By conventional criteria, this difference is considered to be not statistically significant. There were also no differences in the proportion of patients requiring red blood cell transfusions and changes in QoL. Sucrosomial oral iron was better tolerated. Conclusion In cancer patients with chemotherapy-related anemia receiving darbepoetin alfa, sucrosomial oral iron provides similar increase in Hb levels and Hb response, with higher tolerability without the risks or side effects of IV iron. Electronic supplementary material The online version of this article (doi:10.1007/s00520-017-3690-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antonino Mafodda
- Department of Oncology, A.O. Bianchi-Melacrino-Morelli, Via Melacrino Giuseppe, 21, 89124 Reggio Calabria, (RC) Italy
| | - D. Giuffrida
- Istituto Oncologico del Mediterraneo, Via Penninazzo, 7 - 95029, Viagrande, (Catania) Italy
| | - A. Prestifilippo
- Istituto Oncologico del Mediterraneo, Via Penninazzo, 7 - 95029, Viagrande, (Catania) Italy
| | - D. Azzarello
- Department of Oncology, A.O. Bianchi-Melacrino-Morelli, Via Melacrino Giuseppe, 21, 89124 Reggio Calabria, (RC) Italy
| | - R. Giannicola
- Department of Oncology, A.O. Bianchi-Melacrino-Morelli, Via Melacrino Giuseppe, 21, 89124 Reggio Calabria, (RC) Italy
| | - M. Mare
- Istituto Oncologico del Mediterraneo, Via Penninazzo, 7 - 95029, Viagrande, (Catania) Italy
| | - R. Maisano
- Department of Oncology, A.O. Bianchi-Melacrino-Morelli, Via Melacrino Giuseppe, 21, 89124 Reggio Calabria, (RC) Italy
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Hsiao KC, Huang JY, Lee CT, Hung TW, Liaw YP, Chang HR. Different impact of aspirin on renal progression in patients with predialysis advanced chronic kidney disease with or without previous stroke. Eur J Intern Med 2017; 39:63-68. [PMID: 27884500 DOI: 10.1016/j.ejim.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/12/2016] [Accepted: 11/13/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefit of reducing the risk of stroke against increasing the risk of renal progression associated with antiplatelet therapy in patients with advanced chronic kidney disease (CKD) is controversial. METHODS We enrolled 1301 adult patients with advanced CKD treated with erythropoiesis stimulating agents from January 1, 2002 to June 30, 2009 from the 2005 Longitudinal Health Insurance Database in Taiwan. All of the patients were followed until the development of the primary or secondary endpoints, or the end of the study (December 31, 2011). The primary endpoint was the development of ischemic stroke, and the secondary endpoints included hospitalization for bleeding events, cardiovascular mortality, all-cause mortality, and renal failure. The adjusted cumulative probability of events was calculated using multivariate Cox proportional regression analysis. RESULTS Adjusted survival curves showed that the usage of aspirin was not associated with ischemic stroke, hospitalization for bleeding events, cardiovascular mortality or all-cause mortality, however, it was significantly associated with renal failure. In subgroup analysis, aspirin use was associated with renal failure in the patients with no history of stroke (HR, 1.41; 95% CI, 1.14-1.73), and there was a borderline interaction between previous stroke and the use of aspirin on renal failure (interaction p=0.0565). CONCLUSIONS There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke.
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Affiliation(s)
- Kuang-Chih Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Chun-Te Lee
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Tung-Wei Hung
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan.
| | - Horng-Rong Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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181
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Triferic for iron replacement. Med Lett Drugs Ther 2017; 59:55-6. [PMID: 28323812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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182
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Trotta F, Belleudi V, Fusco D, Amato L, Mecozzi A, Mayer F, Sansone M, Davoli M, Addis A. Comparative effectiveness and safety of erythropoiesis-stimulating agents (biosimilars vs originators) in clinical practice: a population-based cohort study in Italy. BMJ Open 2017; 7:e011637. [PMID: 28283484 PMCID: PMC5353346 DOI: 10.1136/bmjopen-2016-011637] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 12/23/2016] [Accepted: 01/23/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To evaluate the benefit/risk profile of epoetin α biosimilar with the erythropoiesis-stimulating agents (ESAs) originators when administered to naïve patients from clinical practice. DESIGN Population-based observational cohort study. SETTING All residents in the Lazio Region, Italy, with chronic kidney disease (CKD) or cancer retrieved from the Electronic Therapeutic Plan (ETP) Register for ESA between 2012 and 2014. PARTICIPANTS Overall, 13 470 incident ESA users were available for the analysis, 8161 in the CKD and 5309 in the oncology setting, respectively. INTERVENTIONS ESAs identified through the ATC B03XA were divided into 3 groups: (1) biosimilars; (2) epoetin α originator and (3) other originators. Patients were exposed to ESAs from the date of activation of the ETP, until the end of a 6-month follow-up period. OUTCOME MEASURES Effectiveness (all-cause mortality and blood transfusion) and safety (major cardiovascular events, blood dyscrasia). A composite outcome including all-cause mortality, blood transfusion and major cardiovascular events was predefined. HRs of any outcome were estimated through Cox regression. RESULTS We found no differences between patients on biosimilars or all originators with regard to the risk estimates of all-cause mortality, blood transfusion, major cardiovascular events and blood dyscrasia in the CKD setting. The composite outcome confirmed these results (biosimilars vs epoetin α originators: adjusted HR=1.02, 95% CI 0.78 to 1.33; biosimilars vs other originators: adjusted HR=1.09, 95% CI 0.85 to 1.41). Comparable risk estimates were observed between biosimilars and all originators in the oncology setting. CONCLUSIONS In both settings, our findings are suggestive of no difference between biosimilars and originators on relevant effectiveness and safety outcomes. This study may contribute to settling future drug policy for the health services and provides reassurance on the approval pathway for biosimilars. The oncology setting merits further research, taking into account tumour types, tumour stage and anticancer chemotherapy administered.
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Affiliation(s)
- Francesco Trotta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alessandra Mecozzi
- Drug Policy Area, General Directorate for Health, The Lazio Region, Rome, Italy
| | - Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Massimo Sansone
- Drug Policy Area, General Directorate for Health, The Lazio Region, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Promod PJ, Deshpande R, Mohanty NK, Kulkarni S, Shah HA, Ganju A, Kukreja A, Joshi S. Efficacy of C.E.R.A. in Routine Clinical Practice for Correction of Anaemia and Maintenance of the Haemoglobin Levels in CKD Patients not on Dialysis. J Assoc Physicians India 2017; 65:52-57. [PMID: 28462544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION C.E.R.A. reported effective correction of anaemia and was well tolerated in International studies on CKD patients not on dialysis. OBJECTIVE The study aimed to describe the management of renal anaemia in CKD patients not on dialysis with C.E.R.A. in routine clinical practice in India. METHODS This was a prospective, single-arm, open-label, multi-centre, non-interventional, Phase IV study which followed 108 CKD Stage III-IV patients, not on dialysis with Hb < 10 g/dL for correction of anaemia with C.E.R.A. RESULTS Of the 108 patients with Hb < 10 g/dL at baseline, 83 (90.2%) patients achieved target Hb of 10-12 g/dL and the time taken to achieve correction of anaemia was 9.6 weeks ± 6.13 weeks in the Intent-to-treat population. Haemoglobin concentration increased from 8.59 ± 0.808 g/dL pre-therapy to 10.91 ± 0.634 g/dL post-therapy. The change in mean ± SD Hb value was 2.32 ± 0.174 g/dL. Maintenance of Hb levels within the target range of Hb 10 - 12 g/dL was observed in 78.2% of ITT and 80.8% of the PP population for mean duration of 16.69 weeks. Four patients (3.7%) experienced 5 AEs and 2 patients (1.9%) experienced 3 SAEs in the safety population. As per the treating physician none of the AEs or SAEs was considered related to study drug. There were no deaths reported. CONCLUSIONS This study demonstrated successful correction of anaemia in Indian patients with C.E.R.A. treatment as well as maintenance of Hb levels within the target range. C.E.R.A. was well tolerated with no new safety concerns specific to the Indian population. The less frequent up to monthly dosing schedule of C.E.R.A. may offer clinicians and patients a simplified regimen of anaemia management as compared to traditional frequently administered (thrice weekly to once weekly) ESAs.
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Affiliation(s)
- P J Promod
- Endocare Clinic and Diagnostic Centre, Vellore, Tamil Nadu
| | | | | | | | | | - A Ganju
- Premier Kidney Hospital, Vadodara, Gujarat
| | - A Kukreja
- Roche Products (India) Pvt. Ltd., Mumbai, Maharashtra
| | - S Joshi
- Roche Products (India) Pvt. Ltd., Mumbai, Maharashtra
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184
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Rivera RF, Alibrandi MTS, Di Lullo L, Fioccari F. [Clinical management of anemia in patients with CKD]. G Ital Nefrol 2017; 34:20-35. [PMID: 28682026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Anemia is a frequent complication in chronic kidney disease (CKD), and it is often accompanied by various clinical symptoms. The primary cause of anemia in CKD patients is the reduction in the erythropoietin production, which results in a decrease of signaling molecule that stimulates red blood cell production. Other possible causes of anemia in CKD include iron deficiency, inflammation, and the accumulation of uremic toxin. This chapter focuses the discussion on the strategy of the management of anemia in patients with CKD. Erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. The introduction of ESAs into clinical practice was a success goal, mediating an increase in hemoglobin concentrations without the risk for recurrent blood transfusions and improving quality of life substantially.
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Affiliation(s)
| | | | - Luca Di Lullo
- U.O.C Nefrologia e Dialisi, Ospedale L. Parodi Delfino, Colleferro, Rome, Italy
| | - Fulvio Fioccari
- U.O.C. Nefrologia e Dialisi, Ospedale S. Paolo, Civitavecchia, Rome, Italy
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185
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Nand N, Deshmukh AR, Joshi S, Sachdeva MP. Role of ACE and IL-1β Gene Polymorphisms in Erythropoeitin Hyporesponsive Patients with Chronic Kidney Disease with Anemia. J Assoc Physicians India 2017; 65:32-36. [PMID: 28457029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Hyporesponse to erythropoietin is a common problem seen in around 5-10% of patients. Recently the focus from these remediable factors has been shifted to the non-modifiable innate factors i.e polymorphism of ACE and IL-1B gene and studies have shown that DD genotype and IL-1B CC genotype have lower erythropoietin requirement. The aim of our study was to evaluate the role of ACE and IL-1B gene polymorphisms in erythropoietin hyporesponse in CKD patients with anemia. METHODS A total of 50 patients were selected. After taking pre-informed written consent, they were segregated into two groups, group A and B with 25 patients in each group. Group A included CKD stage III-IV patients and Group B included CKD stage V patients who were on regular maintenance. All patients were given erythroepoietin and response was monitored using erythropoietin resistance index (ERI). Genotyping of ACE and IL-1B genes were done and serum levels of ACE and IL-1B were measured. Mean values of ERI were compared between different genotype subgroups and analysed using binary regression analysis. RESULTS The study group included 6 patients with diabetic nephropathy and out of these 4(66.6%) had DD genotype. On comparing the effect of ACE polymorphism on ERI levels it was seen that the mean ERI values in DD subgroup were significantly lower (16.97±5.35, 21.88±6.25, 22.69±8.35 at 1,3 and 5th month) as compared to ID (18.16±3.39, 24.17±3.66, 32.74±9.95 and II (20.73±5.17, 27.74±7.30, 41.08±13.83 U/Kg/g/dL). In the case of IL-1B the mean ERI values were lowest in the TT subgroup (16.46±4.45, 21.96±5.77,23.98±8.48) as compared to CC (19.49 ±5.62,25.46±7.07, 33.59±12.61) and CT (18.12±4.27,24.14±5.70, 31.89±13.83 U/Kg/g/dL). The mean serum values of ACE were in a decreasing trend i.e DD> ID> II (238.05 ± 52.46, 194.73±50.28 and 162.99±39.71 ng/ml, (p < 0.05). The mean serum values of IL1B in CC, CT and TT were 23.24±28.77, 18.32±16.25, 23.34±13.83 pg/ml (p>0.05). CONCLUSIONS D allele positively affected the serum ACE level but there was no association between IL-1B genotype and its levels. ACE gene polymorphism has an important role in determining the response to EPO and progression of CKD. Pre-treatment screening for genotype may help in predicting the patients at risk and poor responders.
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Affiliation(s)
- N Nand
- Senior Professor & Unit Head
| | - A R Deshmukh
- Resident, Pt. B.D. Sharma PGIMS, Rohtak, Haryana
| | - S Joshi
- Research Fellow, Department of Anthropology, University of Delhi, Delhi
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186
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Nand N, Mittal R. Evaluation of Effect of Vitamin D Deficiency on Anemia and Erythropoietin Hyporesponsiveness in Patients of Chronic Kidney Disease. J Assoc Physicians India 2017; 65:38-42. [PMID: 28457030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The role of vitamin D deficiency and inflammation levels in renal anemia has been documented. However, no study is available in India where the role of vitamin D supplementation in patients with hyporesponsiveness to increased doses of erythropoietin is available. Hence this study. MATERIAL AND METHODS This study was conducted on 50 adult patients of CKD, on regular, twice weekly hemodialysis. It included 38 cases in group A with deficient serum vitamin D levels (<30 ng/ml) and 12 cases in group B with sufficient vitamin D levels (>30 ng/ml). Both groups of cases were receiving erythropoietin in a dose of 4000 I.U. subcutaneously twice weekly following dialysis and had failed to show rise in hemoglobin (Hb) >1gm/dl after one month, hence erythropoietin was increased to 6000 I.U. Group A was given additional vitamin D in a dose of 60000 I.U. orally, once a week for next three months along with erythropoietin 6000 I.U. where as Group B served as control. Hematological and renal parameters, ESR, high sensitivity C reactive protein (HsCRP) and serum ferritin were estimated at baseline and then at one monthly intervals for next four months. Parathyroid hormone (iPTH), serum B12, folic acid and vitamin D (25OHD3) were measured at the start and end of the study only. Erythropoietin resistance index (ERI) was calculated to evaluate dose response. RESULTS Basal ERI, HsCRP and ESR and serum ferritin were raised in both the groups. At the end of four months, there was a significant increase in the Hb and hematocrit (Hct) (p<.001) and a significant fall in ERI, ESR, HsCRP, serum ferritin and iPTH (p<.001) in group A. Group B, also had a significant increase in the hemoglobin and hematocrit (p<.001) and decrease in ERI, ESR, HsCRP, serum ferritin and iPTH which was not significant. Basal vitamin D and ERI had a positive and insignificant correlation (r=0.05; p=0.756) in group A where as a negative and insignificant correlation was observed between them at the end of four months (r= -0.195; p >0.05). CONCLUSIONS vitamin D play an important role in reducing inflammation and thereby in the cure of anemia in EPO hyporesponsive CKD patients and needs to be supplemented, if deficiency is found.
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Affiliation(s)
- N Nand
- Senior Professor and Unit Head
| | - R Mittal
- Resident, Department of Medicine, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana
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Ryu SR, Park SK, Jung JY, Kim YH, Oh YK, Yoo TH, Sung S. The Prevalence and Management of Anemia in Chronic Kidney Disease Patients: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). J Korean Med Sci 2017; 32:249-256. [PMID: 28049235 PMCID: PMC5219990 DOI: 10.3346/jkms.2017.32.2.249] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022] Open
Abstract
Anemia is a common and significant complication of chronic kidney disease (CKD). However, its prevalence and current management status has not been studied thoroughly in Korea. We examined the prevalence of anemia, its association with clinical and laboratory factors, and utilization of iron agents and erythropoiesis stimulating agents using the baseline data from the large-scale CKD cohort in Korea. We defined anemia when hemoglobin level was lower than 13.0 g/dL in males and 12.0 g/dL in females, or received by erythropoiesis stimulating agents. Overall prevalence of anemia was 45.0% among 2,198 non-dialysis CKD patients from stage 1 to 5. Diabetic nephropathy (DN) as a cause, CKD stages, body mass index (BMI), smoking, leukocyte count, serum albumin, iron markers, calcium, and phosphorus concentration were identified as independent risk factors for anemia. Considering the current coverage of Korean National Health Insurance System, only 7.9% among applicable patients were managed by intravenous iron agents, and 42.7% were managed by erythropoiesis stimulating agents.
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Affiliation(s)
- Sang Ryol Ryu
- Department of Internal Medicine, Yeosu Chonnam Hospital, Yeosu, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Tae Hyun Yoo
- Department of Internal Medicine, Severance Hospital, Yonsei University, Seoul, Korea
| | - Suah Sung
- Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, Korea.
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Kalantar-Zadeh K. History of Erythropoiesis-Stimulating Agents, the Development of Biosimilars, and the Future of Anemia Treatment in Nephrology. Am J Nephrol 2017; 45:235-247. [PMID: 28142147 PMCID: PMC5405152 DOI: 10.1159/000455387] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Exogenous replacement of erythropoietin (EPO) by recombinant human EPO has been considered a standard of care for the treatment of anemia in patients with chronic kidney disease for more than 20 years. Genetically engineered biologic proteins derived from human, animal, or microorganism sources are a major area of growth in modern medical care, accounting for one-third of new drug approvals in the past decade. Despite benefit to patients, the use of biologics comes at a significant cost, representing one of the fastest growing segments of strained healthcare budgets around the world. SUMMARY Biosimilars, or biologic drugs that are designed to be highly similar to approved reference biologic drugs, have been available in Europe for more than 10 years with no unusual or unexpected effects compared to their reference biologics whose patents have expired. Given the success of the biosimilar approval pathway pioneered in Europe, it has served as a global reference for other regulatory authorities to establish and implement biosimilar licensure frameworks, including the United States (US), the largest pharmaceutical market in the world. Given 10 of the top 25 drugs sold in 2014 were biologics, and considering the rising costs of healthcare, biosimilars have the potential to become a significant part of the US market. Key Messages: For the nephrology community, the recent patent expiries for epoetin alfa (Epogen®, Amgen and Procrit®, Johnson & Johnson) have created the opportunity to develop biosimilar EPOs. And while no biosimilar in this therapeutic class is approved in the US, there are proposed biosimilars in development.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California-Irvine, School of Medicine, Orange, CA, USA
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Brar A, Markell M, Stefanov DG, Timpo E, Jindal RM, Nee R, Sumrani N, John D, Tedla F, Salifu MO. Mortality after Renal Allograft Failure and Return to Dialysis. Am J Nephrol 2017; 45:180-186. [PMID: 28110327 DOI: 10.1159/000455015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/05/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The outcomes of patients who fail their kidney transplant and return to dialysis (RTD) has not been investigated in a nationally representative sample. We hypothesized that variations in management of transplant chronic kidney disease stage 5 leading to kidney allograft failure (KAF) and RTD, such as access, nutrition, timing of dialysis, and anemia management predict long-term survival. METHODS We used an incident cohort of patients from the United States Renal Data System who initiated hemodialysis between January 1, 2003 and December 31, 2008, after KAF. We used Cox regression analysis for statistical associations, with mortality as the primary outcome. RESULTS We identified 5,077 RTD patients and followed them for a mean of 30.9 ± 22.6 months. Adjusting for all possible confounders at the time of RTD, the adjusted hazards ratio (AHR) for death was increased with lack of arteriovenous fistula at initiation of dialysis (AHR 1.22, 95% CI 1.02-1.46, p = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, p = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, p = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, p = 0.46), type of insurance, and zip code-based median household income were not associated with higher mortality. Glomerular filtration rate <10 mL/min/1.73 m2 at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, p = 0.001) was associated with reduction in mortality. CONCLUSIONS Excess mortality risk observed in patients starting dialysis after KAF is multifactorial, including nutritional issues and vascular access. Adequate preparation of patients with failing kidney transplants prior to resuming dialysis may improve outcomes.
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Affiliation(s)
- Amarpali Brar
- Department of Medicine, SUNY Downstate School of Medicine, Brooklyn, NY, USA
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Abstract
Chronic kidney disease leads to dysfunction of renal erythropoietin-producing cells, resulting in a decrease in erythrocyte production. A decrease in oxygen delivery to vital organs due to anemia results in worse quality of life and is associated with poor prognosis of the patients. Treatment with human recombinant erythropoietin or its improved version of erythropoiesis-stimulating agent (ESA) with a longer half-life is effective. However, some patients show hyporesponsiveness to ESA. Hyporesponsiveness to ESA, which can be induced by factors such as inflammation and uremic toxins, is associated with poor prognosis. Production of erythropoietin in the kidney is regulated by a transcription factor, hypoxia-inducible factor (HIF). PHD regulates HIF activity, and recently developed PHD inhibitors need to be clinically used as drugs to ameliorate anemia in CKD by activating HIF.
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Affiliation(s)
- Masaomi Nangaku
- The University of Tokyo Graduate School of Medicine, Division of Nephrology and Endocrinology
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191
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Nafar M, Samavat S, Khoshdel A, Alipour-Abedi B. Anemia Evaluation and Erythropoietin Dose Requirement Among Hemodialysis Patients: a Multicenter Study. Iran J Kidney Dis 2017; 11:56-65. [PMID: 28174354 DOI: pmid/28174354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/26/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Both anemia and high doses of erythropoietin have been associated with increased mortality among dialysis patients. This study was conducted to evaluate the effective dose of erythropoiesis-stimulating agents. MATERIALS AND METHODS This multicenter nationwide cross-sectional study assessed adult patients on hemodialysis for at least 3 months from 80 hemodialysis centers in Iran. Demographic data, erythropoietin dose, and laboratory data were collected. RESULTS A total of 7009 prevalent hemodialysis patients were enrolled. Fifty-five percent of the patients had their hemoglobin levels within the target values. In those with a hemoglobin level of 8 g/dL to 10 g/dL, an erythropoietin dose of 10000 IU/wk to 12000 IU/wk led to a significant increase in hemoglobin level. A mean erythropoietin dose of 7700 IU/wk was effective in maintaining the target hemoglobin of 10 g/dL to 12 g/dL during a 3-month follow-up period. Improvement in hemoglobin level was associated with male sex, diabetes mellitus, and hemodialysis adequacy, and its deterioration with lower parathyroid hormone, calcium-phosphorus product, and creatinine levels; malnutrition; transfusion; and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (R2 = 29.1%, P < .001). A dosage of 66.5 IU/kg/wk led to 1 g/dL increase in hemoglobin in anemic patients. CONCLUSIONS Data suggested that an estimated erythropoietin dose of 66.5 IU/kg/wk for each 1 g/dL hemoglobin level below the target could be used as a guide for prescription. A dosage of about 8000 IU/wk could help maintaining hemoglobin within the target. A longitudinal study is needed to estimate the required erythropoietin dose.
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Affiliation(s)
| | - Shiva Samavat
- Department of Nephrology, Shahid Labbafinejad Medical Center; Kidney Disease Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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192
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Nagata S, Ikegaya N, Ogino S, Uchida S, Itaya M, Momita A, Shinozaki S, Ohura M, Kuriki K, Kono S, Miyajima H, Hishida A. The Resection of Thyroid Cancer Was Associated with the Resolution of Hyporesponsiveness to an Erythropoiesis-stimulating Agent in a Hemodialysis Patient with Aceruloplasminemia. Intern Med 2017; 56:805-810. [PMID: 28381747 PMCID: PMC5457924 DOI: 10.2169/internalmedicine.56.7455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We herein report the case of a hemodialysis patient whose response to an erythropoiesis-stimulating agent (ESA) improved following the resection of thyroid cancer. Her hemoglobin level remained below 7 g/dL, despite the use of ESA. During the search for the causes of her hyporesponsiveness to ESA, papillary thyroid cancer and aceruloplasminemia were found. The existence of other potential causes, such as iron deficiency, infectious disease, severe hyperparathyroidism and malnutrition were ruled out. Following the resection of the thyroid cancer tumor, her hemoglobin level increased to 10.2 g/dL over a period of 4 months. This is the first report to demonstrate the resolution of hyporesponsiveness to ESA following the resection of a malignant tumor.
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193
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Dar Santos AE, Partovi N, Ford JAE, Yoshida EM. Use of Hematopoietic Growth Factors as Adjuvant Therapy for Anemia and Neutropenia in the Treatment of Hepatitis C. Ann Pharmacother 2016; 41:268-75. [PMID: 17299014 DOI: 10.1345/aph.1h169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: To review the hematologic adverse effects of hepatitis C virus (HCV) therapy and adjuvant treatment with epoetin alfa and granulocyte colony-stimulating factor (ie, filgrastim). Data Sources: Medical literature indexed in MEDLINE (1966–January 2007) and EMBASE (1980–January 2007) was searched, and published conference abstracts were reviewed. Study Selection and Data Extraction: Peer-reviewed articles and relevant conference abstracts regarding the use of epoetin alfa and granulocyte colony-stimulating factor were reviewed. Data Synthesis: Ribavirin induces a dose-dependent hemolytic anemia. Studies using epoetin alfa 40 000 units subcutaneously once weekly have demonstrated efficacy in maintaining hemoglobin, ribavirin dose, and quality of life scores, but clear benefit shown with sustained virologic response (SVR) is lacking. The hemoglobin threshold for initiation of epoetin alfa used in studies may not adequately reflect values used in clinical practice. Treatment-related neutropenia is caused primarily by interferon or peg interferon. Few studies have investigated the impact of granulocyte or granulocyte-macrophage colony-stimulating factor derivatives on neutropenia. Results of dose maintenance evaluation vary, and studies reporting data on SVR showed no effect from growth factor therapy. The frequency of bacterial infections was not reported. Conclusions: The role and benefit of hematopoietic growth factors in HCV therapy have not been conclusively determined to date. However, the possibility of a benefit to individual patients seen on an outpatient basis remains, and an individualized treatment approach is recommended.
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Affiliation(s)
- Anne E Dar Santos
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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194
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Abstract
Background: Inpatient costs associated with different erythropoietic-stimulating therapy regimens have not been compared in an oncology setting. Objective: To conduct a cost analysis of different regimens of epoetin alfa (EPO) and darbepoetin alfa (DARB) in an inpatient oncology setting. Methods: A retrospective evaluation of oncology diagnosis-related group discharges during 2003, in 30 community hospitals, identified EPO treatment patterns. Wholesale acquisition costs were determined for patients who received EPO 40 000 units or more once weekly. Potential differences in costs were calculated using conversion ratios for an equivalent EPO dose 3 times weekly or DARB dose once weekly (EPO:DARB ratio 260:1, approximating DARB 150 μg once weekly). A sensitivity analysis was performed using an EPO:DARB ratio of 400:1, approximating DARB 100 μg once weekly (1.5 μg/kg). Results: Among the 1410 EPO doses administered (n = 677 pts.), a dose of 40000 units or more was used 44% of the time (n = 311 pts.), with dosing initiated on average 5.6 days after admission. For these 311 evaluable patients, switching from EPO 40 000 units once weekly to EPO 10 000 units 3 times weekly reduced per-patient and total drug acquisition costs by approximately 50% ($704 vs $359 and $218 938 vs $111 615, respectively). Relative to EPO once weekly, switching patients to DARB resulted in increased drug acquisition costs at the 260:1 conversion and lower costs at the 400:1 conversion. However, EPO 3 times weekly remained the least costly option by 44–63%. The cost-savings realized with EPO 10000 units 3 times weekly increased with longer duration of hospitalization. Conclusions: In an inpatient setting, use of EPO 10000 units 3 times weekly may minimize expenditures associated with treatment of cancer-related anemia using erythropoietic-stimulating therapies.
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Affiliation(s)
- Aaron D Killian
- Cardinal Health Clinical Research Group, Dallas, TX 75204, USA.
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195
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Abstract
The majority of myelodysplastic syndrome (MDS) patients belong to the International Prognostic Scoring System (IPSS) and IPSS-revised (IPSS-R) lower-risk categories. Their precise diagnostics and prognostic stratification is often a challenge, but may ensure the optimization of therapy. The availability of diverse treatment options has significantly improved the quality of life and survival of this group of patients. Anemia is the most relevant cytopenia in terms of frequency and symptoms in lower-risk MDS, and may be treated successfully with erythropoietic stimulating agents, provided a careful selection is performed on the basis of IPSS-R, endogenous erythropoietin levels, and transfusion independence. Doses and duration of therapy of erythropoietic-stimulating agents (ESAs) are critical to determine efficacy. In case a patient fails ESA treatment, the available options may include lenalidomide (approved for del5q positive cases), hypomethylating agents, and a rather large number of experimental agents, whose clinical trials should be offered to a larger number of MDS patients. The choice for second-line treatment must take into account biologic, cytogenetic, and molecular-identified characteristics of individual patients, as well as frailty and comorbidities. Other cytopenias are less frequently presenting as isolated. Specific therapy for thrombocytopenia has been proposed in experimental clinical trials with thrombomimetic agents that have shown good efficacy, but raised some safety concern. Although neutropenia is targeted symptomatically with growth factor supportive care, the immunosuppressive treatments are indicated mainly for pancytopenic, hypoplastic lower-risk MDS; they are not widely used because of their toxicity, despite the fact that they may induce responses. Finally, hematopoietic stem cell transplant is the curative option also for lower-risk MDS and timing should be carefully evaluated, balancing toxicity and the possibility of survival advantage. Finally, even when considered suitable for lower-risk MDS, transplant application is limited to the rarer fit and younger MDS patient.
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Affiliation(s)
- Valeria Santini
- SODc Hematology, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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196
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Bukmir L, Fišić M, Diminić-Lisica I, Ljubotina A. [ANEMIA IN CHRONIC KIDNEY DISEASE]. Acta Med Croatica 2016; 70:217-224. [PMID: 29087100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Renal anemia develops secondary to chronic kidney disease (CKD) and its incidence increases with the progression of CKD. The aim is to inform family physicians about the latest developments and ways of approaching the issue, in accordance with national guidelines. The PubMed and Cochrane systematic reviews databases were searched for the 1996-2015 period using the following key words: anemia, chronic renal failure, erythropoietin, and primary health care. In addition, all relevant articles and textbooks available were manually searched to suggest the following conclusions. The use of erythropoiesis-stimulating agents (ESA) slows down the progression of CKD, reduces the need for blood transfusions and improves the patient quality of life. Target hemoglobin (Hb) concentration to be permanently maintained is 110-120 g/L. Higher Hb levels are associated with higher mortality and major cardiovascular events in dialysis patients. Target hemoglobin level should be strictly individualized depending on CKD stage (both non-dialyzed and dialyzed population), age, other risks, initial and maintenance treatment. Early recognition and appropriate correction of anemia using ESA is of utmost importance in CKD patients. Systematic primary and secondary prevention measures along with education and professional implementation of national guidelines in daily work of family practitioners can improve medical care of patients with CKD.
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197
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Deak AT, Troppan K, Rosenkranz AR. Anemia management in cancer patients with chronic kidney disease. Eur J Intern Med 2016; 36:13-19. [PMID: 27640913 DOI: 10.1016/j.ejim.2016.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/06/2016] [Accepted: 08/19/2016] [Indexed: 12/27/2022]
Abstract
Anemia is a common complication of cancer and chronic kidney disease (CKD) associated with decreased physical performance as well as poor prognosis for life expectancy. Renal and cancer-induced anemia share common features regarding pathogenesis and therapeutic strategies. It is typically treated with iron substitution, erythropoiesis-stimulating agents (ESA) and in refractory cases with red blood cell transfusions. However, studies of the past few years unveiled numerous setbacks in the use of ESAs. These included a higher risk of cerebrovascular events and increased mortality without the improvement of cardiovascular outcomes in patients with CKD. Moreover, particularly negative results were observed in patients with previous cancer history under ESA therapy. These unfavorable findings have forced the clinicians to reevaluate the management of renal anemia. This led to decrease of ESA usage, while iron substitution and alternative therapeutic options gained more significance. Iron supplementation is also accompanied with certain risks ranging from gastrointestinal complications to severe allergic reactions and increased rate of infections. Furthermore, the evaluation of the long-term safety of excessive iron therapy is still lacking, especially in CKD patients with cancer. In the absence of these clinical studies, this review aims to summarize the currently available therapeutic strategies in anemia management of CKD patients with concomitant cancer.
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Affiliation(s)
- Andras T Deak
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 27, 8036 Graz, Austria
| | - Katharina Troppan
- Clinical Division of Haematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 27, 8036 Graz, Austria.
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198
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Hempel JC, Poppelaars F, Gaya da Costa M, Franssen CFM, de Vlaam TPG, Daha MR, Berger SP, Seelen MAJ, Gaillard CAJM. Distinct in vitro Complement Activation by Various Intravenous Iron Preparations. Am J Nephrol 2016; 45:49-59. [PMID: 27889746 DOI: 10.1159/000451060] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/17/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intravenous (IV) iron preparations are widely used in the treatment of anemia in patients undergoing hemodialysis (HD). All IV iron preparations carry a risk of causing hypersensitivity reactions. However, the pathophysiological mechanism is poorly understood. We hypothesize that a relevant number of these reactions are mediated by complement activation, resulting in a pseudo-anaphylactic clinical picture known as complement activation-related pseudo allergy (CARPA). METHODS First, the in-vitro complement-activating capacity was determined for 5 commonly used IV iron preparations using functional complement assays for the 3 pathways. Additionally, the preparations were tested in an ex-vivo model using the whole blood of healthy volunteers and HD patients. Lastly, in-vivo complement activation was tested for one preparation in HD patients. RESULTS In the in-vitro assays, iron dextran, and ferric carboxymaltose caused complement activation, which was only possible under alternative pathway conditions. Iron sucrose may interact with complement proteins, but did not activate complement in-vitro. In the ex-vivo assay, iron dextran significantly induced complement activation in the blood of healthy volunteers and HD patients. Furthermore, in the ex-vivo assay, ferric carboxymaltose and iron sucrose only caused significant complement activation in the blood of HD patients. No in-vitro or ex-vivo complement activation was found for ferumoxytol and iron isomaltoside. IV iron therapy with ferric carboxymaltose in HD patients did not lead to significant in-vivo complement activation. CONCLUSION This study provides evidence that iron dextran and ferric carboxymaltose have complement-activating capacities in-vitro, and hypersensitivity reactions to these drugs could be CARPA-mediated.
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Affiliation(s)
- Julia Cordelia Hempel
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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199
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Djuric PS, Jankovic A, Popovic J, Tosic Dragovic J, Bulatovic A, Djuric Z, Mitrovic M, Dimkovic N. Survival Benefit of Hemodiafiltration Compared With Prolonged High-flux Hemodialysis. Iran J Kidney Dis 2016; 10:388-395. [PMID: 27903998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/23/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Patients on dialysis have a high rate of death, mainly of cardiovascular cause. Nephrologists are actively looking for ways to improve patients' outcomes, and alternative dialysis strategies, such as long conventional hemodialysis and hemodiafiltration, are currently being investigated. The aim of this study was to compare anemia, nutrition, inflammation, mineral metabolism, and 3-year survival rates between patients treated with hemodiafiltration and prolonged high-flux hemodialysis (HFH). MATERIALS AND METHODS A total of 58 dialysis patients were divided into 2 groups to undergo hemodiafiltration 3 times weekly, 12 hours in total per week, or prolonged duration of HFH (≥ 15 h/w). One-year biochemical parameters were collected retrospectively, together with 36 months patients' survival (prospectively). RESULTS Patients in the HFH group had longer dialysis vintage; significantly higher levels of hemoglobin (despite less frequent use of erythropoietin-stimulating agents), serum albumin, serum calcium, and serum bicarbonate; and a lower in-tact parathyroid hormone level. Survival rates were comparable between the two groups. The Cox proportional hazard model showed that patients treated with longer HFH had a 32% relative risk reduction of mortality compared to patients treated with hemodiafiltration, but without statistical significance (hazard ratio, 0.68; 95% confidence interval, 0.21 to 2.20; adjusted for diabetes mellitus). CONCLUSIONS Longer duration of hemodialysis with high-flux membranes had beneficial effects on anemia indexes, mineral metabolism, nutrition parameters, and acidosis in comparison with hemodiafiltration. However, hemodiafiltration did not offer a 36-months survival benefit over prolonged HFH.
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Affiliation(s)
- Petar S Djuric
- Clinical Department for Renal Diseases, Zvezdara University Medical Center, Belgrade, Serbia.
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200
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Chen L, Jiang H, Gao W, Tu Y, Zhou Y, Li X, Zhu Z, Jiang Q, Zhan H, Yu J, Fu C, Gao Y. Combination with intravenous iron supplementation or doubling erythropoietin dose for patients with chemotherapy-induced anaemia inadequately responsive to initial erythropoietin treatment alone: study protocol for a randomised controlled trial. BMJ Open 2016; 6:e012231. [PMID: 27855097 PMCID: PMC5073518 DOI: 10.1136/bmjopen-2016-012231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Erythropoietin (EPO) is a commonly used option in the treatment of chemotherapy-induced anaemia (CIA). However, ∼30-50% of patients fail to achieve an adequate response after initial treatment. Prior studies have demonstrated that intravenous iron might synergistically improve therapeutic response to EPO treatment in this patient population. METHODS AND ANALYSIS We will perform this multicentre, randomised, open-label, parallel-group, active controlled non-inferiority study to compare the two combination therapies of EPO plus intravenous iron regimen versus doubling the dose of EPO in patients with CIA who have an inadequate response to initial EPO treatment at a routine dose. A total of 603 patients with an increase in haemoglobin (Hb) <1 g/dL will be enrolled and randomised to one of the three study treatment groups at a 1:1:1 ratio Group 1: EPO treatment at the original dose plus intravenous iron dextran 200 mg every 3 weeks (Q3W) for 15 weeks; Group 2: EPO treatment at the original dose plus intravenous iron dextran 100 mg, twice a week for 5 weeks; Group 3: the control group, doubling the EPO dose without preplanned iron supplementation. The primary outcome measure to compare is the Hb response rate at week 15 and the secondary end points involve therapeutic blood transfusions. Time-to-progression, adverse events and quality of life will also be evaluated. ETHICS AND DISSEMINATION All participants will provide informed consent; the study protocol has been approved by the independent ethics committee of Shanghai East Hospital. This study would clearly demonstrate the potential benefit of combining epoetin treatment with intravenous iron supplementation. Findings will be shared with participating hospitals, policymakers and the academic community to promote the clinical management of CIA in China. TRIAL REGISTRATION NUMBER NCT02731378.
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Affiliation(s)
- Lin Chen
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Gao
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ye Tu
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi Li
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhe Zhu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qixin Jiang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Zhan
- Department of Gynecology, Jing'an District Centre Hospital of Shanghai (Huashan Hospital Fudan University Jing'an Branch), Shanghai, China
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital, Shanghai, China
| | - Chuangang Fu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong Gao
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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