Parker KP, LaCoursiere T, Macon EJ, Stivelman JC, Bailey JL,
Mitch WE, Sands JM
Can the erythropoietin dose be lowered safely? A case-control
study of subcutaneous administration
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:880 1995
Erythropoietin (epo) is extremely expensive, and accounts for about 25% of
the
budget for hemodialysis therapy. Thus, any method for reducing the cost of
this therapy
would be appreciated. This group previously showed that administration of
epo
subcutaneously once a week, using 1/3 of the weekly iv dose, could maintain a
stable
hematocrit in 4 dialysis patients for 6 months. They have extended their
initial report by
preforming a cross-over trial of subcutaneous vs intravenous epo. Patients
were initially
stabilized on iv epo for 6 months, crossed over to sc epo for 10 months, then
returned to iv
epo for 5 months. Again, the patients were given a sc dose equal to 1/3 of
the weekly iv
dose. The amount of iron given did not differ between the two groups. Both
treatments
were able to maintain stable hemoatocrits, reticulocyte counts, iron
saturation, and ferritin.
In addition, there was no change in dialysis indices (Kt/V, PCR, albumin, and
PTH). The
only side-effect was stinging at the injection site, which required
discontinuation of sc epo in
about 20% of patients. The group is working do develop a more appropriate
diluent to
minimize this side effect. Thus, weekly subcutaneous epo is safe, effective,
and allows for a
substantial reduction in the dose and cost of epo therapy.
Additional comments by Steven Fishbane: Several studies have
documented an improved erythropoietic response when
erythropoietin is administered sub-q vs. iv. Sub-q dosing has not, however,
become routinely used in clinical practice, probably because the modest
reduction in EPO doses is at the expense of subjecting the patient to
frequent injections. In this study, HD patients treated with iv EPO were
converted to once weekly sub-q EPO at 1/3rd the original weekly dose. 27
patients completed 10 months of follow-up and were compared to 27
retrospectively matched controls. The main result was that hematocrits were
maintained as well in the sub-q as in the iv group, but at 1/3 the weekly
EPO dose.
Comment: Despite the nonrandomized design, and a difficulty in iron
management during the study period, this is probably the most important
anemia study reported at the ASN. Given the high cost of EPO therapy, a 2/3
reduction in dosing would be very significant, and I think that most
patients
would find once weekly injections to be acceptable.
(Star)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Am Soc Nephrol
CRF by problem area :
Anemia/Erythropoietin/Iron