Comparing ESAs for Anemia in CKD
the MPR take:
Is one erythropoiesis-stimulating agent (ESA) superior to others for treating anemia in patients with chronic kidney disease (CKD)? A Cochrane Library review of 56 randomized controlled studies on 15,596 adults with CKD assessed the comparative effects of ESAs (epoetin alfa, epoetin beta, darbepoetin alfa, and methoxy polyethylene glycol-epoetin beta) on preventing blood transfusions and all-cause mortality. All proprietary ESAs increased the odds of hypertension vs. placebo epoetin alfa OR 2.31, 95% CI 1.27– 4.23; epoetin beta OR 2.57, 95% CI 1.23–5.39; darbepoetin alfa OR 1.83, 95% CI 1.05– 3.21; methoxy polyethylene glycol-epoetin beta OR 1.96, 95% CI 0.98– 3.92) but the effect of biosimilar ESAs on developing hypertension was less certain (OR 1.18, 95% CI 0.47–2.99). Due to the lack of quality evidence, all ESAs were found to be superior to placebo for preventing blood transfusions; there was insufficient high quality data on differences in mortality and cardiovascular outcomes between the ESA formulations. Because of the lack of current data, clinicians should consider individual patient factors and preferences when determining a treatment plan for anemia with CKD.
Several erythropoiesis-stimulating agents (ESAs) are available for treating anaemia in people with chronic kidney disease (CKD). Their relative efficacy (preventing blood transfusions and reducing fatigue and breathlessness) and safety (mortality and cardiovascular events) are unclear due to the limited power of head-to-head studies.