Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Wu, Rui; Peng, Yaxin

doi:10.1111/sdi.12991

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…In addition, roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that simulates intracellular hypoxia to promote the production of endogenous EPO. Successful treatment with roxadustat in anti-EPO antibody-mediated PRCA has been noted in some case reports (23)(24)(25). However, it was reported that anti-EPO antibodies were found in patients who had never received rHuEPO (26), indicating that endogenous EPO may also induce the development of autoantibodies.…”

Section: Discussionmentioning

confidence: 99%

Case report: Dynamic antibody monitoring in a case of anti-recombinant human erythropoietin-mediated pure red cell aplasia with prolonged course after kidney transplantation

Chen

et al. 2022

Front. Immunol.

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Anti-erythropoietin (anti-EPO) antibody-mediated pure red cell aplasia (PRCA) is a rarely seen disease. Anti-EPO antibodies were mostly found in patients with chronic kidney disease who received recombinant human erythropoietin (rHuEPO) injections subcutaneously. The treatment against anti-EPO antibody-mediated PRCA included discontinuation of rHuEPO, immunosuppressive agents, intravenous immunoglobulin, plasmapheresis, or kidney transplantation. We reported a case of kidney transplant recipient with anti-EPO antibody-mediated PRCA, who had no trend of recovery after stopping rHuEPO, receiving regular induction and maintenance immunosuppressive regimens. He was further given 6 consecutive plasmapheresis sessions, cyclophosphamide, and adjusted maintenance immunosuppressive regimen into cyclosporine, sirolimus and prednisone. We monitored his anti-EPO antibody levels with a self-created simple mixing test. At 10 months post kidney transplant, his anti-EPO antibody finally turned negative, and his reticulocyte count dramatically increased. Cyclosporine, sirolimus and prednisone combined with roxadustat eventually alleviated the patient’s anti-EPO antibody-mediated PRCA. Our self-created simple mixing test for anti-EPO antibody titer was very helpful in disease monitoring and therapeutic guidance.

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Section: Discussionmentioning

confidence: 99%

Case report: Dynamic antibody monitoring in a case of anti-recombinant human erythropoietin-mediated pure red cell aplasia with prolonged course after kidney transplantation

Chen

et al. 2022

Front. Immunol.

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“…Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are a novel class of oral drugs that stimulate the production of endogenous EPO. These drugs can be helpful for the management of anemia in patients with EPO-associate PRCA [32] [33] [34] [35].…”

Section: Most Cases Of Nonmentioning

confidence: 99%

Anemia in ESKD Patient (End-Stage Kidney Disease): The Rare Cause Is in the Forefront

Magbri¹,

El-Magbri²,

Hernandez³

2022

OJNeph

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We reported a case of severe anemia in a patient with end-stage kidney disease (ESKD) on dialysis. The anemia developed when the patient is switched from hemodialysis (HD) to peritoneal dialysis (PD) when the intra-venous erythropoietin stimulating agent (ESA, Epogen) was changed into subcutaneous injection of darbepoetin. The patient's hemoglobin dropped 2 grams in about two months during this period. Extensive work-up including, bleeding disorders, hemolysis, iron deficiency, infections including CMV, Epstein-Bar virus, parvo-19 virus infection were unrevealing The anti-Epogen neutralizing antibodies were not measured due to unavailability. Bone marrow biopsy and aspirate were negative for infiltrations or myelodysplastic syndrome (MDS). The leukocyte and platelet counts were normal. Even though anti-ESA antibodies were not measured in this case, all tentative causes of his anemia were excluded by laboratory investigations. The patient's anemia was treated symptomatically with blood transfusion and discontinuation of the ESA treatment. He made a remarkable recovery.

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“…Roxadustat is a hypoxia-inducible factor prolyl hydroxylase inhibitor that regulates the expression of EPO and hepcidin as well as others, thus promoting erythropoiesis at multiple levels (6,7). Multiple reports have implicated that roxadustat could effectively treat EPO-induced PRCA after an immunosuppressive treatment (8)(9)(10)(11). It has been even suggested that roxadustat still shows good efficacy without immunosuppressive therapy (12).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Roxadustat in Combination With Rituximab Was Used to Treat EPO-Induced Pure Red Cell Aplasia

You¹,

Guo²,

Wang³

et al. 2022

Front. Nephrol.

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Recombinant human erythropoietin (rHuEPO) is a drug given to patients who have low hemoglobin related to chronic kidney disease or other anemia-related diseases. Some patients who receive rHuEPO repeatedly develop anti-rHuEPO-neutralizing antibodies, leading to the occurrence of pure red cell aplasia (PRCA). PRCA associated with rHuEPO includes severe rHuEPO resistance, blood transfusion dependence, high serum ferritin, severe reticulocytopenia, and presence of anti-rHuEPO antibody. However, the optimal treatment of erythropoietin (EPO)-induced PRCA is unclear. Therapeutic options against it remain a major clinical challenge. Herein we report on 2 male patients with PRCA during rHuEPO treatment, who received a combination therapy of roxadustat plus rituximab but had completely different clinical outcomes. The results obtained in this study show that roxadustat in combination with rituximab could be one of the treatment options for EPO-induced PRCA, but the treatment efficacy can vary from one individual to another. Additionally, we recommend starting reticulocyte monitoring and immunosuppressive agent therapy as early as possible to shorten the course of the disease and improve the outcomes of the patients.

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Roxadustat on anti‐erythropoietin antibody‐related pure red cell aplasia in the patient with end‐stage renal disease

Cited by 4 publications

References 10 publications

Case report: Dynamic antibody monitoring in a case of anti-recombinant human erythropoietin-mediated pure red cell aplasia with prolonged course after kidney transplantation

Case report: Dynamic antibody monitoring in a case of anti-recombinant human erythropoietin-mediated pure red cell aplasia with prolonged course after kidney transplantation

Anemia in ESKD Patient (End-Stage Kidney Disease): The Rare Cause Is in the Forefront

Case Report: Roxadustat in Combination With Rituximab Was Used to Treat EPO-Induced Pure Red Cell Aplasia

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