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KMID : 0869620150320010033
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Journal of Korean Society of Hospital Pharmacists
2015 Volume.32 No. 1 p.33 ~ p.39
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Anemia Improvement in Chronic Kidney Disease Associated with Switch from Erythropoiesis-stimulating Agents to Methoxy Polyethylene Glycol Epoetin-beta
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Seo Ji-Yei
Han Hee-Sim
Shin Eun-Jeong
Lim Jung-Mi
Lee Yong-Hwa
Lee Hye-Sook
Han Hyun-Joo
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Abstract
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Background : Anemia is a common complication in patients with chronic kidney disease (CKD). Untreated anemia increases morbidity and mortality related to cardiovascular disease. Treatment of anemia commonly utilizes erythropoiesis-stimulating agents (ESAs). Conventional ESAs like epoetin have short half-lives, which necessitate frequent dosing (weekly or biweekly). Methoxy polyethylene glycol epoetin-beta (MPGEPO) is a recently developed ESA that can be administered monthly. This study evaluated the effect on anemia and potential side effects of anemia treatment involving a single agent switch to MPGEPO from conventional ESAs.
Methods : Study subjects were 41 patients who received MPGEPO at Seoul National University Hospital from September 2009 to September 2012. Patents were switched from epoetin-beta (n=24) or darbepopetin-alfa (n=17). To evaluate the efficacy and potential side effects, hemoglobin (Hb) levels were monitored 3 months before and after conversion. Efficacy was the percentage of patients whose one-month average Hb level increased more than 1 g/dl. Potential side effects, such as high blood pressure, were assessed by the percentage of patients whose Hb level was < 12 g/dl. Costs of treatment were calculated as one-month upper limit of insurance cost and ratio of patients who remained on the initial dose.
Results : Hb level improvement was evident in 5 of 24 (20.8%) patients treated with epoetin-beta, 10 of 24 (41.6%) patients after switching to MPGEPO, 7 of 17 (41.1%) patients treated with darbepoetinalfa, and 12 of 17 (70.6%) patients after switching to MPGEPO. Potential side effects in the same respective order of treatment were evident in 9 of 24 (38%), 7 of 24 (29%), 5 of 17 (29%), and 7 of 17 (41%) patients. One-month upper limit of insurance cost was increased 1.5- and 1.4- fold after switching to MPGEPO from epoetin-beta and darbepoetin-alfa, respectively, compared to before switch. The number of patients who remained on the initial dose was also increased after switching to MPGEPO.
Conclusions : Conversion from conventional ESAs to MPGEPO increased the Hb level and reduced dosing frequency. But drug switching did not reduce the frequency of potential side effects and increased drug costs. Drug selection must consider the state of patents, weighing the advantages and disadvantages of each drug.
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KEYWORD
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Methoxy Polyethylene Glycol Epoetin-beta, Epoetin-beta, Darbepetin-alfa, Anemia
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