title: Switching from subcutaneous to intravenous erythropoietin alpha in haemodialysis patients requires a major dose increase.
abstract: BACKGROUND
  A change in the licensing arrangements for the use of erythropoietin alpha in haemodialysis patients has required a switch in the route of administration from subcutaneous (SC) to intravenous (IV). Previous work suggested that the IV route was less efficacious but studies since the enforced switch have not confirmed this.
  
  
  METHODS
  We studied haemoglobin levels and the mean weekly dose of erythropoietin alpha in 86 haemodialysis patients at monthly intervals over the 6 month period before and after a change in the route of administration of erythropoietin alpha from SC to IV. Changes in other parameters known to be associated with erythropoietin response were also monitored.
  
  
  RESULTS
  Mean haemoglobin level fell following the switch from 11.9 g/dl+/-1.4 at baseline to 11.3 g/dl+/-1.4 at 1 month (P = 0.001) and to a trough of 11.0 g/dl+/-1.3 at 2 months (P<0.001) before partial recovery to 11.4 g/dl+/-1.2 (P = 0.007) at 6 months. Mean weekly dose of erythropoietin after 2 months was significantly higher than baseline (8791 IU+/-5314 vs 8035 IU+/-4893). The dose continued to increase and by 6 months was 10605 IU (P<0.001), 32% higher than baseline. There was a small reduction in residual renal function, which was an independent predictor of change in dose requirement. There was a small increase in parathyroid hormone levels, but no change in serum ferritin, dosing frequency, total Kt/V, serum albumin, normalised protein catabolic rate, C-reactive protein, hospitalization rate and dialyser reuse rate.
  
  
  CONCLUSIONS
  Switching from SC to IV erythropoietin alpha caused a significant fall in haemoglobin levels in the first 2 months. This was partially reversed by 6 months at the expense of a 32% dose increase in the dose of erythropoietin alpha by 6 months. The economic impact may be considerable.
authors.affiliation: Renal Unit, Lister Hospital, Corey's Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Galliford
authors.forename: Rao
authors.initials: R
authors.lastname: Malasana
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007677:Kidney Function Tests; D010281:Parathyroid Hormone / Q000097:blood; D011994:Recombinant Proteins; D006435:Renal Dialysis
chemical_list: D006454:Hemoglobins; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins