title: Peginesatide for the treatment of anemia due to chronic kidney disease - an unfulfilled promise.
abstract: BACKGROUND
  The introduction of recombinant human erythropoietin revolutionized the management of anemia in patients with chronic kidney disease (CKD). In order to circumvent costly recombinant DNA technology, synthetic chemistry techniques were used to manufacture peginesatide, a synthetic peptide that bore no resemblance to previous erythropoiesis-stimulating agents (ESAs), and yet was capable of stimulating erythropoiesis. Compared with other ESAs, peginesatide was deemed to have advantages related to immunogenicity, administration schedule, and cost. Marketing approval was restricted to CKD patients on dialysis because cardiovascular events were more common with peginesatide than with darbepoetin in non-dialysis CKD patients. Unfortunately, unexplained serious adverse drug reactions (sADR) led to quick withdrawal of peginesatide from the market.
  
  
  METHODS
  This review describes the efficacy and safety of peginesatide in pre-approval clinical trials, sADRs after marketing approval, and lessons learned during its short life-span.
  
  
  CONCLUSIONS
  The case of peginesatide illustrates the difficulties in detecting rare sADRs in trials with limited patient populations and the need for improved pharmacovigilance after marketing approval. However, the need for simpler drug production methods as a result of non-dependence on recombinant DNA techniques and mammalian cell lines remains. Lessons learned during the scientific development of peginesatide can be used in developing other drugs.
authors.affiliation: a Comprehensive Cancer Center , Helsinki University Central Hospital , Helsinki , Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Hermanson
authors.affiliation: a Comprehensive Cancer Center , Helsinki University Central Hospital , Helsinki , Finland.|b SmartState Center for Medication Safety and Efficacy, South Carolina College of Pharmacy , University of South Carolina , Columbia , SC , United States.|c Medical University of South Carolina , Hollings Cancer Center , Charleston , SC , United States.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.affiliation: d Department of Renal Medicine , King's College Hospital , London , UK.
authors.forename: Iain C
authors.initials: IC
authors.lastname: Macdougall
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D017277:Drug Approval; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy
chemical_list: D006397:Hematinics; D010455:Peptides; D011994:Recombinant Proteins; C556270:peginesatide
keywords: Adverse drug reactions; anaphylactic; anemia; chronic kidney disease; darbepoetin; epoetin; erythropoiesis-stimulating agent; hemodialysis; hemoglobin; peginesatide; pharmacovigilance