Comparison of the Therapeutic Efficacy of Epoetin Beta and Epoetin Alfa in Maintenance Phase Hemodialysis Patients

Abstract

In May 2009 for financial reasons, the epoetin product used for hemoglobin (Hb) maintenance in our renal dialysis unit was changed from epoetin beta to epoetin alfa. Although widely believed that the dosage requirements are the same, we undertook a retrospective analysis to investigate whether the dosage requirements in chronic renal failure patients were comparable for both preparations. We studied 128 stable end-stage renal failure patients on hemodialysis (three times per week) receiving erythropoietin therapy to maintain their Hb at 11-12.5 g/dL. Patients were excluded if within the study period they developed signs of infection, bleeding, required blood transfusion, were under-dialyzed, or required hospital admission. Regular monthly Hb concentrations and hematocrit (Hct) levels were measured for each patient. The weekly EPO index (defined as weekly epoetin dose/mean monthly Hct) was derived for each patient, before and after regime change. Of the 128 patients in end-stage renal failure, 79 were included in the study. There was no significant difference between the two preparations in terms of Hct level achieved (p = 0.15). However, the median weekly epoetin dose requirement increased from 6733 (range 750-30,000) IU/week to 9000 (250-30,667) IU/week (p < 0.001). EPO index similarly increased from 20,465 (2500-130,846) IU/week/% to 27,073 (729-98,937) IU/week/% (p < 0.001). Our study showed that a higher dose of epoetin alfa was needed to maintain target Hb concentration.

Therapeutic efficacy of erythropoietin alfa and erythropoietin beta in hemodialysis; a randomized controlled trial

“…However, doses of the agents administrated in the present study were different from above mentioned study. Additionally Loughnanm et al did not detect any statistically significant differences between erythropoietin Erythropoietin alfa versus erythropoietin beta alpha and beta in the case of increasing hemoglobin levels (11). However, in the case of needed dose they concluded that a lower dose of beta erythropoietin is needed to achieve the same hemoglobin level.…”

Comparing Therapeutic Efficacy and Safety of Epoetin Beta and Epoetin Alfa in the Treatment of Anemia in End-Stage Renal Disease Hemodialysis Patients

“…In another study, Loughnan et al [8] compared the efficacy and safety of epoetin beta and epoetin alfa in the maintenance phase of hemodialysis patients. Their results indicated that higher doses of epoetin alfa are required to maintain Hb in the target level.…”

“…Other studies have demonstrated that elimination half-life of epoetin beta is longer than epoetin alfa, which is probably due to different glycosylation. As a result, lower doses may be needed to maintain hemoglobin and hematocrit in the target level [7][8][9]. However, the Kidney Disease Improving Global Outcomes (KDIGO) guideline along with other evidence suggest that epoetin alfa and beta have the same efficacy and require the same dose to be administered to patients with CKD-induced anemia [10,11].…”

Сравнительный анализ влияния препаратов рекомбинантного эритропоэтина эпокрин и рекормон на эритропоэз <i>in vivo</i> и <i>in vitro</i>

“…Àâòîðû ïîêàçàëè, ÷òî ïðè âíóòðèâåííîé èíúåêöèè ó ýïîýòèíà-b íà 20 % áîëüøå, ÷åì ó ýïîýòèíà-a, ïåðèîä ïîëóâûâåäåíèÿ, ïðè ïîäêîaeíîì ââåäåíèè ýïîýòèí-b âñàñûâàåòñÿ ìåäëåííåå, ÷åì ýïîýòèí-a, è ðåòèêóëîöèòàðíûé îòâåò â ïåðèôåðè÷åñêîé êðîâè ÿð÷å âûðàaeåí ïðè èñïîëüçîâàíèè ýïîýòèíà-b [11]. Ïðè ïðèìåíåíèè ðÝÏÎ-a è ðÝÏÎ-b ó áîëüíûõ òåðìèíàëüíîé ñòàäèåé ïî÷å÷íîé íåäîñòàòî÷íîñòè, íàõîäÿùèõñÿ íà ãåìîäèàëèçå, èññëåäîâàòåëÿìè èç Áðóìôèëäñêîãî ãîñïèòàëÿ (×åëìñôîðä, Âåëèêîáðèòàíèÿ) áûëî ïîêàçàíî, ÷òî äëÿ ïîääåðaeàíèÿ êîëè÷åñòâà ãåìîãëîáèíà íà óðîâíå 110 -125 ã/ë íåîáõîäèìû áîëåå âûñîêèå äîçû ðÝÏÎ-a [12]. Îäíàêî â äðóãîì èññëåäîâàíèè, ïðîâåäåííîì â àíàëîãè÷íîé ãðóïïå ïàöèåíòîâ â Öåíòðå çäîðîâüÿ ã. Òóçëà (Áîñíèÿ è Ãåðöåãîâèíà), áûëè ïîëó÷åíû äàííûå î òîì, ÷òî íåò äîñòîâåðíûõ ðàçëè÷èé â êëèíè÷åñêîì ýôôåêòå ðÝÏÎ-a èëè ðÝÏÎ-b, è ïóòü ââåäåíèÿ ïðåïàðàòîâ (ïîäêîaeíûé èëè âíóòðèâåííûé) íå âëèÿåò íà ðåçóëüòàò [13].…”