Optimizing anaemia management with subcutaneous administration of epoetin
Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
Correspondence and offprint requests to: Dr Anatole Besarab, Division of Nephrology and Hypertension, Henry Ford Hospital, CFP-511, 2799 West Grand Boulevard, Detroit, MI 48201, USA. Email: abesarab{at}ghsrenal.com
European and US guidelines for renal anaemia management recommend subcutaneous (s.c.) epoetin as the preferred route of administration in pre-dialysis, peritoneal dialysis and haemodialysis patients. However, the restriction of Eprex®/Erypro® to intravenous (i.v.) administration in Europe has increased the interest of health care professionals regarding the optimal route of administration for all epoetin formulations. There are five major considerations for the ‘optimal’ route of epoetin administration: efficacy; dosing frequency; convenience; safety and tolerability; and cost. Although epoetin bioavailability is lower after s.c. administration, its efficacy is higher, owing to its prolonged elimination half-life compared with i.v. epoetin. Several studies and clinical surveys comparing s.c. and i.v. administration have demonstrated that equivalent target haemoglobin levels can be maintained at much lower doses of epoetin when administered s.c. Furthermore, s.c. epoetin dosing frequency can be reduced in some patients to once every 2 weeks, without compromising efficacy. Devices such as the Reco-Pen® have been specifically designed to facilitate self-administration of s.c. epoetin-ß. An upsurge in the incidence of pure red cell aplasia (PRCA) was linked to the epoetin-
product Eprex/Erypo in Europe, and an increase in PRCA cases of the same magnitude was not seen in patients taking other epoetin products s.c. Therefore, PRCA should not be used as an argument against s.c. administration. The reduced dose with s.c. administration of epoetin-ß provides significant cost benefits, without compromising either safety or efficacy, and may also increase patient satisfaction and compliance with treatment.
Keywords: anaemia management; cost-effectiveness; dose; epoetin, safety and tolerability; subcutaneous administration
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Bacchus, N. O'Mara, H. Manley, and S. Fishbane Meeting New Challenges in the Management of Anemia of Chronic Kidney Disease Through Collaborative Care with Pharmacists Ann. Pharmacother., November 1, 2009; 43(11): 1857 - 1866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. C. Dowling Prevalence, etiology, and consequences of anemia and clinical and economic benefits of anemia correction in patients with chronic kidney disease: An overview Am. J. Health Syst. Pharm., July 1, 2007; 64(13_Supplement_8): S3 - S7. [Abstract] [Full Text] [PDF]
|
|