ERYTHROPOIETIC GROWTH FACTORS


  1. Erythropoietin
    1. Epoetin alfa (Epogen), Procrit)
    2. Darbepoetin alfa (Aranesp)
  2. In a study in 1,432 pts with GFR 15-50 ml/min/1.73m2 and Hb < 11 g/dL but not on dialysis randomized to Hb treatment target of 11.3 g/dL vs. 13.5 g/dL (all treated with epoetin alfa), after 16mos, the lower-target group had sig. lower incidence of (death, MI, hospitalization for heart failure, or CVA) (13.5% vs. 17.5%); no sig. diff. in quality of life scores (NEJM 355:2085, 2006--JW)
  3. In a study in 603 pts with GFR 15-35 mL/min/1.73m2 and Hb 11-12.5g/dL randomized to epoetin beta treatment target of 13-15g/dL vs. > 10.5 g/dL; over mean 3y f/u, no sig. diff in incidence of first cardiovascular event; high-Hb target pts were sig. more likely to initiate dialysis during the study (NEJM 355:2071, 2006--JW)
  4. In a meta-analysis of 9 randomized trials comparing low (< 12 g/dL) vs. high (>12 g/dL) Hb targets for erythropoietin tx in pts with anemia caused by chronic renal disease (tx x 12wks), after 12-48mo f/u, high-target pts had sig. high all-cause mortality (RR 1.17) (Lancet 369:381, 2007--JW)
  5. In a meta-analysis of 52 studies involving > 12,000 pts with cancer-related anemia randomized to erythropoetin or darbepoetin vs. no treatment, over median 1y f/u, active-treatment groups had sig.  higher all-cause mortality (RR 1.15; similar for both agents); no diff. noted based on type of Ca or target Hb level. (CMAJ 180:E62, 2009-JW)