Impact of erythropoiesis-stimulating agents on red blood cell transfusion in Korea.
BACKGROUND
Erythropoiesis-stimulating agents (ESAs) have been shown to reduce the need for red blood cell (RBC) transfusions and to improve quality of life for cancer patients with anaemia. However, increased risks of mortality and disease progression have been reported when using ESAs with excessive target haemoglobin levels. In 2007, the United States Food and Drug Administration and Korea Food and Drug Administration issued regulatory alerts for using ESAs in cancer patients.


OBJECTIVE
This retrospective study was performed to evaluate changes in ESA prescribing patterns between 2006 and 2010 and the impact on RBC transfusions in patients with solid tumours.


METHODS
The Seoul National University Hospital (SNUH) in Korea.


METHODS
This study includes adult patients with solid tumours who were diagnosed and treated in the SNUH from January 2006 to December 2010. The exclusion criterion was concomitant chronic renal failure. The patients' Hb levels and prescription data for ESAs and RBC transfusions were statistically analysed. The number of inpatient and outpatient solid-tumour patients was also analysed as a baseline. Main outcome measure Prescription data on ESAs and RBC transfusion.


RESULTS
After adjusting for the number of patient visits, the monthly mean ESA doses dispensed decreased by an average of 1,192 mcg per quarter over the last 5 years, and the number of RBC transfusions ordered increased by 3.77 instances per quarter. After correcting for the number of patients, the mean doses of ESA dispensed each month decreased by 3,190 mcg per quarter, and the number of RBC transfusions ordered increased by 9.51 instances per quarter.


CONCLUSIONS
During the last 5 years, the number of ESA doses dispensed at SNUH decreased and the number of RBC transfusions at SNUH increased, independent of the number of patients. The reduction in ESA use was thought to be due to the release of the safety alert letter in 2007. However, this study did not analyse other risk factors that may have influenced the number of RBC transfusions (e.g. metastatic cancer, comorbidities, surgery). Still, the results of this study suggest that the decreased ESA doses were relevant to the increased RBC transfusions.
Seoul National University Hospital, Seoul, Korea.
Rae Young
RY
Kang
Juyeun
J
Lee
Yong Hwa
YH
Lee
Hye Suk
HS
Lee
Ji Hoon
JH
Jeong
Yu Jeung
YJ
Lee
D000740:Anemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004909:Erythrocyte Indices / Q000187:drug effects; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000639:trends*; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D019983:Guideline Adherence / Q000639:trends; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D056910:Republic of Korea; D012189:Retrospective Studies; D014481:United States; D014486:United States Food and Drug Administration
D006397:Hematinics; D004921:Erythropoietin