Extended administration of erythropoiesis-stimulating agents for optimising the management of renal anaemia: what is the evidence?
BACKGROUND
Erythropoiesis-stimulating agents (ESAs) have transformed the management of anaemia in patients with chronic kidney disease (CKD), reducing transfusion requirements and leading to improved quality of life. However, effective anaemia management with current ESAs is labour-intensive and time-consuming. Approaches are required to simplify anaemia management and reduce the burden on healthcare systems. There is increasing interest in extending the administration interval of ESAs. This would result in considerable time-savings, reducing the workload of healthcare providers and potentially reducing healthcare system costs. Time saved could be utilised in improving other aspects of patient care, such as implementation of guidelines, or treating more patients. Potential benefits of extended administration intervals for patients include a less demanding regimen and fewer injections, which could lead to improved adherence to treatment.


OBJECTIVE
This article reviews studies of the efficacy of current ESAs in maintaining stable haemoglobin (Hb) levels when used at extended administration intervals of up to once monthly.


RESULTS
Patients who are already stable on more frequent ESA therapy and who respond well to treatment may be able to maintain stable Hb with extended dosing regimens with established ESAs. However, few patients with CKD currently receive ESAs once-monthly in clinical practice. New agents with long half-lives offer the potential for extended dosing regimens in all patients with CKD.
Roger
S D
SD
Department of Renal Medicine, Gosford Hospital, Gosford, NSW, Australia. sroger@nsccahs.health.nsw.gov.au
D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications*
D006397:Hematinics; D006454:Hemoglobins