Addition of roxadustat to erythropoiesis‐stimulating agent ( ESA ) effectively corrects ESA ‐hyporesponsive anaemia in patients on peritoneal dialysis

Abstract

What Is Known and Objective Erythropoiesis‐stimulating agent (ESA) hyporesponsiveness is an important cause for the undertreatment of anaemia. A decrease in haemoglobin (Hb) levels was observed during the initial stage of the conversion from ESA to roxadustat. The study aims to investigate the effectiveness and safety of adding roxadustat to an ESA for the treatment of ESA‐hyporesponsive anaemia in patients on peritoneal dialysis (PD). Methods Patients on PD with ESA‐hyporesponsive anaemia were enrolled from January 2020 to April 2020 with a 24‐week follow‐up period. Patients were treated with roxadustat at a starting dose of 50 or 100 mg thrice weekly without changing the ESA dose. Roxadustat and ESA dose adjustments were made as needed to maintain Hb levels within 11.0 to 13.0 g/dl. Efficacy outcomes and safety were assessed. Results and Discussion Nine patients were recruited in the study. Both the cumulative responsive rate and maintenance rate of Hb > 11 g/dl were 100%. Six patients required ESA dose reduction from ≥15,000 UI/week to ≤7000 IU/week at week 24. No drug‐related severe adverse events were observed in this study. What Is New and Conclusion The addition of roxadustat effectively and smoothly corrected anaemia in patients who were hyporesponsive to ESA, and permitted reduction of the ESA dose.

A retrospective study on the efficacy of Roxadustat in peritoneal dialysis patients with erythropoietin hyporesponsiveness

“…Renal anemia is a common complication of CKD, and traditional treatment options include ESAs and iron agents, but thorny problems such as erythropoietin hyporesponsiveness can also come with it. There were only a few previous conducted clinical studies on the efficacy of roxadustat in PD patients with erythropoietin hyporesponsiveness, but the sample size was small (the largest one included 55 patients) and the study content was relatively simple [ 14 , 15 ]. In the current study, we aimed to discuss this issue in depth.…”

What Is the Role of Daprodustat in Treatment of Anemia in People on Maintenance Dialysis?

“…8 In an open-label study of 26 hemodialysis and six peritoneal dialysis patients identified as having ESA hyporesponsiveness switched from EPO roxadustat, hemoglobin levels increased in all but two patients, although the target of 10-12 g/dl was reached in fewer than half. 9 Thus, it appears that daprodustat and other HIF-PHIs can increase hemoglobin concentrations in some ESAhyporesponsive maintenance dialysis patients, although not always to desired levels. The more important question, which is likely never going to be satisfactorily answered without large randomized clinical trials, is whether HIF-PHI treatment reduces mortality or meaningfully improves important clinical outcomes or QoL in such patients.…”

“…8 In an open-label study of 26 hemodialysis and six peritoneal dialysis patients identified as having ESA hyporesponsiveness switched from EPO to roxadustat, hemoglobin levels increased in all but two patients, although the target of 10–12 g/dl was reached in fewer than half. 9…”