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Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability

AIM: The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. METHODS: This was a multicenter, observational, retrospective study in...

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Autores principales: Arrieta, Javier, Moina, Iñigo, Molina, José, Gallardo, Isabel, Muñiz, María Luisa, Robledo, Carmen, García, Oscar, Vidaur, Fernando, Muñoz, Rosa Inés, Iribar, Izaskun, Aguirre, Román, Maza, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199978/
https://www.ncbi.nlm.nih.gov/pubmed/25336984
http://dx.doi.org/10.2147/IJNRD.S61895
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author Arrieta, Javier
Moina, Iñigo
Molina, José
Gallardo, Isabel
Muñiz, María Luisa
Robledo, Carmen
García, Oscar
Vidaur, Fernando
Muñoz, Rosa Inés
Iribar, Izaskun
Aguirre, Román
Maza, Antonio
author_facet Arrieta, Javier
Moina, Iñigo
Molina, José
Gallardo, Isabel
Muñiz, María Luisa
Robledo, Carmen
García, Oscar
Vidaur, Fernando
Muñoz, Rosa Inés
Iribar, Izaskun
Aguirre, Román
Maza, Antonio
author_sort Arrieta, Javier
collection PubMed
description AIM: The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. METHODS: This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. RESULTS: We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months −12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P<0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P<0.0001). The conversion rate was 354:1 in patients requiring high (>200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses. CONCLUSION: In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses.
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spelling pubmed-41999782014-10-21 Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability Arrieta, Javier Moina, Iñigo Molina, José Gallardo, Isabel Muñiz, María Luisa Robledo, Carmen García, Oscar Vidaur, Fernando Muñoz, Rosa Inés Iribar, Izaskun Aguirre, Román Maza, Antonio Int J Nephrol Renovasc Dis Original Research AIM: The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. METHODS: This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. RESULTS: We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months −12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P<0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P<0.0001). The conversion rate was 354:1 in patients requiring high (>200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses. CONCLUSION: In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses. Dove Medical Press 2014-10-09 /pmc/articles/PMC4199978/ /pubmed/25336984 http://dx.doi.org/10.2147/IJNRD.S61895 Text en © 2014 Arrieta et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Arrieta, Javier
Moina, Iñigo
Molina, José
Gallardo, Isabel
Muñiz, María Luisa
Robledo, Carmen
García, Oscar
Vidaur, Fernando
Muñoz, Rosa Inés
Iribar, Izaskun
Aguirre, Román
Maza, Antonio
Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
title Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
title_full Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
title_fullStr Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
title_full_unstemmed Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
title_short Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
title_sort switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199978/
https://www.ncbi.nlm.nih.gov/pubmed/25336984
http://dx.doi.org/10.2147/IJNRD.S61895
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