Erythropoiesis-stimulating agents in anemia: use and misuse.
Erythropoiesis-stimulating agents (ESAs) have been in use for 2 decades. After the initial introduction for their use in anemia of end-stage renal disease, indications for the use of ESAs have widened to anemia of predialysis chronic kidney disease, cancer chemotherapy, HIV disease and orthopedic surgery. Along with the considerable benefits associated with the use of ESAs, adverse events have become apparent, in large part from overcorrection of the anemia. Data from recent studies have prompted several FDA warnings imposing the health provider to follow stringent criteria for the use of ESAs; these include close follow-up of patients, along with use of specific laboratory tests and criteria for dosing. Although adverse effects may partly relate to misuse, when appropriately administered, ESAs are useful agents in the medication armamentarium in the treatment of certain forms of anemia, with potential to improve outcomes and quality of life in some anemic individuals.
Dharmarajan
T S
TS
New York Medical College, Valhalla, NY; Department of Medicine, Division of Geriatrics, and Geriatric Medicine Fellowship Program, Montefiore Medical Center (North Division), Bronx, NY, USA. dharmarajants@yahoo.com
Widjaja
David
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D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004920:Erythropoiesis / Q000187:drug effects / Q000502:physiology; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use; D006397:Hematinics / Q000009:adverse effects* / Q000627:therapeutic use*; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration
D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins