Nephrol Dial Transplant (2004) 19: 288-293
© ERA–EDTA 2004; all rights reserved
Editorial Comments
Erythropoiesis-stimulating agents and antibody-mediated pure red-cell aplasia: here are we now and where do we go from here?
1Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy, 2Hospital Universitario Reina Sofia, Servicio de Nefrologia, Cordoba, Spain, 3Division of Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden, 4Department of Nephrology, Lapeyronie University Hospital, Montpellier, France, 5Department of Nephrology and Dialysis, Hospital SAMS, Lisbon, Portugal, 6Department of Nephrology and Medical Intensive Care, Charite, Humboldt University, Berlin, Germany, 7Department of Renal Medicine, King's College Hospital, London, UK, 8Department of Medicine and Therapeutics, University of Aberdeen Medical School, Aberdeen, UK, 9Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, Austria, 10Department of Nephrology, Endocrinology and Metabolic Diseases, Silesian University Medical School, Katowice, Poland and 11Department of Nephrology and Transplantation, Guy's Campus, Guy's, St Thomas’ and King's Medical School, London, UK
Correspondence and offprint requests to: Professor Francesco Locatelli, Divisione di Nefrologia e Dialisi, Ospedale ‘Alessandro Manzoni’, I-23900 Lecco, Italy. Email: nefrologia@ospedale.lecco.it
Keywords: anaemia; antibodies; guidelines; pure red-cell aplasia; rHuEpo
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Introduction
Erythropoietin molecules produced by means of gene technology (erythropoiesis-stimulating agents, ESA) have been the agents of choice to correct the anaemia of chronic kidney disease (CKD) since the first of these drugs was licensed in the late 1980s. The side effects seen in the early days may have been due to a too-rapid rise in haemoglobin concentration, along with possible direct effects on non-haematopoietic tissues, including the vascular endothelium. Recently, antibody-mediated pure red-cell aplasia (PRCA) associated with the administration of ESAs has been identified as a serious problem. The number of cases reported has risen from four in the period from 1988, when human recombinant erythropoietin was first introduced to the market, through 1997, to over 100 cases in the last 3 years.
To date, cases of PRCA have been predominantly, though not exclusively, associated with a single brand of ESA, Eprex®. Currently, PRCA is a rare but serious
PRCA
PRCA and erythropoietic proteins
Current situation
Possible mechanism of immunogenicity
Testing for antibody-mediated PRCA
Actions so far
Recommendations
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