1887
Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Chronic kidney disease (CKD) often results in renal anemia, impacting the well-being of patients and causing various negative consequences. Erythropoiesis-stimulating agents (ESAs) offer promising solutions for managing anemia in CKD. This study aimed to evaluate and compare the effectiveness, safety profile, and cost-effectiveness of short-acting (Eprex®) and long-acting (Aranesp®) ESAs.

Method: This comparative prospective cohort cost-effectiveness study was carried out over 6 months among adult Egyptian hemodialysis patients of either gender. Participants were categorized into two groups based on the type of ESA administered: the Eprex group, receiving epoetin alfa, and the Aranesp group, receiving darbepoetin alfa. These two treatment groups’ efficacy, safety, and cost were analyzed and compared.

Results: Of 127 hemodialysis patients, 60 (47.2%) received Eprex, while 67 (52.8%) were treated with Aranesp. Target hemoglobin (Hb) was achieved by 50.6% of patients in the Eprex group versus 63.4% in the Aranesp group, with a significant difference ( < 0.001). Both treatment groups exhibited a similar safety profile, while Aranesp® was considered the cost-saving protocol.

Conclusion: In hemodialysis Egyptian patients, Aranesp with extended dosing intervals proved to be more effective in achieving target Hb with comparable adverse effect profiles, a substantial cost-saving strategy, and offered time-saving advantages for medical staff workload compared to Eprex.

Trial registration: The Clinicaltrial.gov registration ID is NCT05699109 (26/01/2023).

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2024.16
2024-03-11
2024-07-21
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2024/1/qmj.2024.16.html?itemId=/content/journals/10.5339/qmj.2024.16&mimeType=html&fmt=ahah

References

  1. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. (2011). 2022; 12:(1):7–11. doi: 10.1016/j.kisu.2021.11.003
    [Google Scholar]
  2. Hassaballa M, El-Wakil H, Elsharkawy M, Khamis S, El Tantawy T, Wahby W, et al.. Egyptian renal data system (ERDS) 2020: an annual report of end-stage kidney disease patients on regular hemodialysis. J Egypt Soc Nephrol Transplant. 2022; 22:(1):1–28. doi: 10.4103/jesnt.jesnt_37_21
    [Google Scholar]
  3. Eschbach JW. The anemia of chronic renal failure: pathophysiology and the effects of recombinant erythropoietin. Kidney Int. 1989; 35:(1):134–48. doi: 10.1038/ki.1989.18
    [Google Scholar]
  4. Regidor DL, Kopple JD, Kovesdy CP, Kilpatrick RD, McAllister CJ, Aronovitz J, et al.. Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients. J Am Soc Nephrol. 2006; 17:(4):1181–91. doi: 10.1681/ASN.2005090997
    [Google Scholar]
  5. Efstratiadis G, Konstantinou D, Chytas I, Vergoulas G. Cardio-renal anemia syndrome. Hippokratia. 2008; 12:(1):11–6.
    [Google Scholar]
  6. Rao M, Pereira BJ. Optimal anemia management reduces cardiovascular morbidity, mortality, and costs in chronic kidney disease. Kidney Int. 2005; 68:(4):1432–8. doi: 10.1111/j.1523-1755.2005.00554.x
    [Google Scholar]
  7. Moreno F, Gomez JL, Sanz-Guajardo D, Jofre R, Valderrabano F. Quality of life in dialysis patients. A Spanish multicentre study. Spanish cooperative renal patients Quality of Life Study Group. Nephrol Dial Transplant. 1996; 11:(Suppl. 2):125–9. doi: 10.1093/ndt/11.supp2.125
    [Google Scholar]
  8. Palmer SC, Saglimbene V, Mavridis D, Salanti G, Craig JC, Tonelli M, et al.. Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis. Cochrane Database Syst Rev. 2014; 2014:(12):Cd010590. doi: 10.1002/14651858.CD010590.pub3
    [Google Scholar]
  9. Portolés J, Krisper P, Choukroun G, de Francisco AL. Exploring dosing frequency and administration routes in the treatment of anaemia in CKD patients. Nephrol Dial Transpl. 2005; 20: (Suppl. 8):viii13–7. doi: 10.1093/ndt/gfh1111
    [Google Scholar]
  10. Egyptian Essential Drug List 2018-2019. 2019[cited 2022 30/7/2022]; [Available from: https://dokumen.tips/download/link/egyptian-essential-drug-list-2018-egyptian-essential-drug-list-2018-2019-capsule].
  11. Farag YM, El-Sayed EJK. Global dialysis perspectives: Egypt. Kidney360. 2022; 3:(7):1263–8. doi: 10.34067/KID.0007482021
    [Google Scholar]
  12. Sinha SD, Bandi VK, Bheemareddy BR, Thakur P, Chary S, Mehta K, et al.. Efficacy, tolerability and safety of darbepoetin alfa injection for the treatment of anemia associated with chronic kidney disease (CKD) undergoing dialysis: a randomized, phase-III trial. BMC Nephrol. 2019; 20:(1):90. doi: 10.1186/s12882-019-1209-1
    [Google Scholar]
  13. Di Iorio BR, Di Micco L, Russo L, Nardone L, De Simone E, Sirico ML, et al.. A strategy to reduce inflammation and anemia treatment’s related costs in dialysis patients. G Ital Nefrol. 2018; 35:(1):2018-vol1. PMID: 29390245
    [Google Scholar]
  14. Stephens JM, Emerson LC, Spry LA, Caloyeras JP, Anderson ER, Reitan JF, et al.. Time savings of weekly versus three-times-per-week administration of erythropoiesis stimulating agents in United States dialysis patients. Curr Med Res Opin. 2016; 32:(2):313–20. doi: 10.1185/03007995.2015.1123144
    [Google Scholar]
  15. Kourlaba G, Boletis I, Goumenos D, Iatrou C, Papagiannopoulou V, Tritaki G, et al.. Cost consequence analysis of darbepoetin alfa for the treatment of anemia due to chronic kidney disease (CKD) in Greece. Value Health. 2014; 17:(7):A468–9. doi: 10.1016/j.jval.2014.08.1323
    [Google Scholar]
  16. Bernieh B, Abouchacra S, Boobes Y, Al Hakim MR, Nagelkerke N, Chaaban A, et al.. Comparison between short- and long-acting erythropoiesis-stimulating agents in hemodialysis patients: target hemoglobin, variability, and outcome. Int Urol Nephrol. 2014; 46:(2):453–9. doi: 10.1007/s11255-013-0640-7
    [Google Scholar]
  17. Biggar P, Ketteler M, Hennemann H, Dömling R. Switch of ESA therapy from darbepoetin-alpha to epoetin-beta in hemodialysis patients: a single-center experience. Clin Nephrol. 2008; 69:(3):185–92. doi: 10.5414/cnp69185
    [Google Scholar]
  18. George M, Joseph L, Jose CK, PournamiA SJ. Comparison of erythropoietin and darbepoetin in chronic kidney disease patients in a tertiary care hospital. Journal of drug discovery and therapeutics. 2017; 5:192-205.
    [Google Scholar]
  19. Chen N, Xing C, Niu J, Liu B, Fu J, Zhao J, et al.. Darbepoetin alfa injection versus epoetin alfa injection for treating anemia of Chinese hemodialysis patients with chronic kidney failure: a randomized, open-label, parallel-group, non-inferiority Phase III trail. Chronic Dis Transl Med. 2022; 8:(1):59–70. doi: 10.1002/cdt3.13
    [Google Scholar]
  20. Al-Ali FS, El-Sayed Abdelfattah M, Fawzy AA, Hamdy AF, Abdulla AE. Erythropoietin-stimulating agents in the management of anemia of end-stage renal disease patients on regular hemodialysis: a prospective randomized comparative study from Qatar. Hemodial Int. 2015; 19:(1):33–43. doi: 10.1111/hdi.12181
    [Google Scholar]
  21. Johnson & Johnson Innovative Medicine. Pharmaceutical Companies of Johnson & Johnson; 2022 [cited 2022 31-12-2022] [Available from: https://www.janssen.com/about].
    [Google Scholar]
  22. Amgen. Amgen Company: Amgen; 2022 [cited 2022 31-12-2022] [Available from: https://www.amgen.com].
  23. Egrie JC, Browne JK. Development and characterization of novel erythropoiesis stimulating protein (NESP). Br J Cancer. 2001; 84:Suppl 1(Suppl. 1):3–10. doi: 10.1054/bjoc.2001.1746
    [Google Scholar]
  24. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. 2012[cited 2022 30/7/2022] [Available from: https://kdigo.org/guidelines/anemia-in-ckd/].
  25. Gutiérrez OM. Treatment of iron deficiency anemia in CKD and end-stage kidney disease. Kidney Int Rep. 2021; 6:(9):2261–9. doi: 10.1016/j.ekir.2021.05.020
    [Google Scholar]
  26. Kim Y, Evangelista LS, Phillips LR, Pavlish C, Kopple JD. The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis. Nephrol Nurs J. 2010; 37:(4):377–93.
    [Google Scholar]
  27. Naalweh KS, Barakat MA, Sweileh MW, Al-Jabi SW, Sweileh WM, Zyoud SH. Treatment adherence and perception in patients on maintenance hemodialysis: a cross-sectional study from Palestine. BMC Nephrol. 2017; 18:(1):178. doi: 10.1186/s12882-017-0598-2
    [Google Scholar]
  28. Briggs A, Tambour M. The design and analysis of stochastic cost-effectiveness studies for the evaluation of health care interventions. Ther Innov Regul Sci. 1998; 35:1455–68. doi: 10.1177/009286150103500441
    [Google Scholar]
  29. Ashton D. Blood transfusion during hemodialysis: an evidence-based procedure. Nephrol Nurs J. 2014; 41:(4):424–8.
    [Google Scholar]
  30. Lawesson SS, Swahn E, Alfredsson J. Adherence to study drugs: a matter of sex? Circulation. 2021; 143:(7):696–8. doi: 10.1161/CIRCULATIONAHA.121.053493
    [Google Scholar]
  31. Singh AK. Resolved: targeting a higher hemoglobin is associated with greater risk in patients with CKD anemia: Pro. J Am Soc Nephrol. 2009; 20:(7):1436–43. doi: 10.1681/asn.2009040444
    [Google Scholar]
  32. Jordan J, Breckles J, Leung V, Hopkins M, Battistella M. Conversion from epoetin alfa to darbepoetin alfa: effects on patients’ hemoglobin and costs to canadian dialysis centres. Can J Hosp Pharm. 2012; 65:(6):443–9. doi: 10.4212/cjhp.v65i6.1192
    [Google Scholar]
  33. Stoppa G, D’Amore C, Conforti A, Traversa G, Venegoni M, Taglialatela M, et al.. Comparative safety of originator and biosimilar epoetin alfa drugs: an observational prospective multicenter study. BioDrugs. 2018; 32:(4):367–75. doi: 10.1007/s40259-018-0293-2
    [Google Scholar]
  34. Agarwal R. Mechanisms and mediators of hypertension induced by erythropoietin and related molecules. Nephrol Dial Transplant. 2018; 33:(10):1690–8. doi: 10.1093/ndt/gfx324
    [Google Scholar]
  35. Woodland AL, Murphy SW, Curtis BM, Barrett BJ. Costs associated with intravenous darbepoetin versus epoetin therapy in hemodialysis patients: a randomized controlled trial. Can J Kidney Health Dis. 2017; 4:2054358117716461. doi: 10.1177/2054358117716461
    [Google Scholar]
  36. Carrera F, Burnier M. Use of darbepoetin alfa in the treatment of anaemia of chronic kidney disease: clinical and pharmacoeconomic considerations. NDT Plus. 2009; 2:(Suppl_1):i9–17. doi: 10.1093/ndtplus/sfn175
    [Google Scholar]
/content/journals/10.5339/qmj.2024.16
Loading
/content/journals/10.5339/qmj.2024.16
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): anemiachronic renal failurehemodialysispharmacoeconomics and Short-/long-acting ESAs
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error