Switch of ESA therapy from darbepoetin-alpha to epoetin-beta in hemodialysis patients: a single-center experience.
OBJECTIVE
No study has previously investigated a switch from darbepoetin-alpha to epoetin-beta in unselected dialysis patients. Our study determined the intravenous epoetin-beta dose necessary to maintain or to achieve hemoglobin targets after switching from darbepoetin-alpha.


METHODS
In our dialysis center, all eligible dialysis patients (n = 90) were switched from darbepoetin-alpha i.v. to epoetin-beta i.v. in 2005. The epoetin-beta dose was calculated according to the recommended European equimolar conversion factor (1 : 200 microg darbepoetin-alpha corresponds to 200 IU epoetin-beta. The intraindividual evaluation compared 12 weeks before with 16 weeks after the switch. The dose of the erythropoiesis-stimulating agents (ESA) and the hemoglobin levels were analyzed for the whole period and for the last 4 weeks of both treatment periods.


RESULTS
During treatment with darbepoetin-alpha, 71% of a total of 90 patients achieved a hemoglobin level > or = 11.0 g/dl. After switching to epoetin-beta, the mean hemoglobin level decreased significantly from 11.4 A+/- 1.0 g/dl to 11.1 A+/- 0.9 g/dl (p = 0.0016) and the percentage of patients with hemoglobin levels > or = 11.0 g/dl fell to 50% (p = 0.00138). Furthermore, the mean required ESA dose increased by 13% from 4,335 A+/- 3,217 IU/week darbepoetin-alpha to 4,885 A+/- 3,077 IU/week epoetin-beta (p = 0.0001). Comparing the last 4 weeks, the ESA dose increased by 17% from 4,583 A+/- 3,391 IU/week darbepoetin-alpha to 5,372 A+/- 3,672 IU/week epoetin-beta (p = 0.0003).


CONCLUSIONS
After switching from darbepoetin-alpha i.v. to epoetin-beta i.v., the equimolar epoetin-beta dose was not sufficient to maintain hemoglobin levels with the same efficacy above 11.0 g/dl. Significantly less patients achieved hemoglobin target values as suggested by the EBPG guidelines.
Biggar
P
P
Klinikum Coburg, Coburg, Germany. patrick.biggar@kfh-dialysis.de
Ketteler
M
M
Hennemann
H
H
Dömling
R
R
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D000068256:Darbepoetin alfa; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa