[Treatment of anemia in chronic renal failure by a long-activing activator of erythropoiesis].
THE INTEREST AND LIMITS OF ERYTHROPOIETIN: Chronic renal failure (CRF) is often associated with anemia, mainly because of insufficient renal synthesis of erythropoietin (EPO). This observation led in the early 1980 to the cloning of the complementary DNA coding for the EPO molecule, the large-scale production of a recombinant human EPO (rHuEPO), and its large utilisation in clinical practice. More than a decade after this outstanding research progress, the use of rHuEPO has literally transformed the treatment of anemia of CRF. The efficacy of rHuEPO is dose-dependent and corrects the anemia in the majority of the patients. However, its relative short plasma half-live (4-8 hours) requires repeated injections of the drug, usually two to three times a week.
The novel erythropoiesis stimulating protein (NESP) is a hyperglycosylated analogue of rHuEPO capable of stimulating erythropoiesis by the same mechanisms as the natural EPO. NESP possesses five N-linked oligosaccharide chains and two times more sialic acid residues than rHuEPO. The addition of these extra-carbohydrate chains gives NESP greater metabolic stability and a half-life 3.6 times longer than rHuEPO.
Numerous studies have shown that NESP normalized and maintained stable the hemoglobin concentration when administered once a week and even at the frequency of one injection every other week. The optimal and maintenance dose is 0.45 microgram/kg/week, either intravenously or subcutaneously. Adverse events are similar to those seen with rHuEPO, and no antibodies against NESP have been detected in over 1,500 patients treated with NESP for more than 1 year.


CONCLUSIONS
This novel long acting activator of the erythropoiesis is efficient and safe for the treatment of anemia of IRC patients. Its prolonged half-life, the delay between injections, and the decrease in the frequency of dose changes might result in an advantage for the patients and the medical staff.
Ureña
Pablo
P
Service de Néphrologie-Dialyse, Clinique de l'Orangerie, 11, boulevard Anatole France, 93300 Aubervilliers, France. purenat@fr.inter.net
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000494:pharmacology*; D006207:Half-Life; D006397:Hematinics; D006801:Humans; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000150:complications*; D011994:Recombinant Proteins
D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin