Subcutaneous (SC) versus intravenous (IV) administration of recombinant human erythropoietin (rHuEPO) in hemodialysis (HD) patients (pts).
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Oct) 8:196A 1997
Administration of EPO by the SC route has been demonstrated by most studies to lead to greater drug efficacy, leading to a need for a lower dose of EPO. When EPO is administered IV, receptor sites become fully saturated, and much of the drug is therefore excluded from receptor binding (and therefore cannot lead to a positive effect on RBC production). When the drug is given SC, the release of drug into the circulation is slower, receptors are not saturated, and more of the drug has the opportunity to bind to receptors. The recent NKF-DOQI guidelines stated that SC dosing of EPO was preferred for hemodialysis patients based on the published literature on this subject.
This was a prospective randomized trial conducted at 24 VA medical centers. It involved a 26 week follow-up period of patients randomized to receive EPO either SC or IV. The primary result was a 32% reduction in the overall need for EPO when the drug was administered SC instead of IV. 86% of patients said the pain of SC injection was mild to none.
Comment: This was a very well performed study which adds to the growing body of evidence that SC dosing of EPO is more effective than IV. To date the proportion of hemodialysis patients treated with SC has been relatively small in the US. There are two major reasons for this: 1) Concerns regarding pain of injections for the patient, 2) The higher the dose of EPO given, the greater the profitability to the dialysis unit. It is likely that as dialysis care moves to capitation that SC EPO dosing will quickly become the standard of care. (Stephen Fishbane, M.D., Winthrop University Hospital, Mineola, NY)
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ASN 30th Annual Meeting, San Antonio
CRF by problem area : Anemia/Erythropoietin/Iron