Switch From Epoetin Beta to Darbepoetin Alfa Treatment of Anemia in Taiwanese Hemodialysis Patients: Dose Equivalence by Hemoglobin Stratification
Shang-Chih Liao
Division of Nephrology, Kaohsiung Municipal Feng-Shan Hospital, Taiwan
Search for more papers by this authorCheng-Chieh Hung
Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChien-Te Lee
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChih-Hsiung Lee
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChin-Chan Lee
Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChun-Liang Lin
Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChiao-Yin Sun
Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorBen-Chung Cheng
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChih-Chao Yang
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChien-Hsing Wu
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorCorresponding Author
Jin-Bor Chen
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Address correspondence and reprint requests to Dr Jin-Bor Chen, 123 Ta Pei Rd, Niao Song, District, Kaohsiung, Taiwan. Email: [email protected]Search for more papers by this authorShang-Chih Liao
Division of Nephrology, Kaohsiung Municipal Feng-Shan Hospital, Taiwan
Search for more papers by this authorCheng-Chieh Hung
Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChien-Te Lee
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChih-Hsiung Lee
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChin-Chan Lee
Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChun-Liang Lin
Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChiao-Yin Sun
Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorBen-Chung Cheng
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChih-Chao Yang
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorChien-Hsing Wu
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Search for more papers by this authorCorresponding Author
Jin-Bor Chen
Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
Address correspondence and reprint requests to Dr Jin-Bor Chen, 123 Ta Pei Rd, Niao Song, District, Kaohsiung, Taiwan. Email: [email protected]Search for more papers by this authorAbstract
This multicenter study was designed to assess the hemoglobin (Hb) stability and conversion ratio of the switch from epoetin beta to darbepoetin alfa in Taiwanese hemodialysis (HD) patients. A total of 135 HD patients were enrolled and randomized with intravenous darbepoetin alfa or epoetin beta. The study duration was 24 weeks. Equivalent doses and conversion ratios were assessed with respect to Hb stratification: low Hb (≥8.0 g/dL to ≤10.0 g/dL) and high Hb (>10.0 g/dL to ≤11.0 g/dL). The results showed stable Hb levels in the study period. At week 24, the conversion ratio was higher for high Hb than low Hb (296.4 IU/dose epoetin beta: 1 µg/dose darbepoetin alfa. vs. 277.2 IU/dose epoetin beta: 1 µg/dose darbepoetin alfa). In conclusion, the conversion ratio in the present study was higher than 1 µg: 200 IU for darbepoetin alfa: epoetin for treating anemia in Taiwanese HD patients.
References
- 1Gilbertson DT, Ebben JP, Foley RN, Weinhandl ED, Bradbury BD, Collins AJ. Hemoglobin level variability: associations with mortality. Clin J Am Soc Nephrol 2008; 3: 133–8.
- 2Eckardt KU, Kim J, Kronenberg F et al. Hemoglobin variability does not predict mortality in European hemodialysis patients. J Am Soc Nephrol 2010; 21: 1765–75.
- 3Horl WH. Anaemia management and mortality risk in chronic kidney disease. Nat Rev Nephrol 2013; 9: 291–301.
- 4Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial. New Engl J Med 1987; 316: 73–8.
- 5Hung SC, Lin YP, Tarng DC. Erythropoiesis-stimulating agents in chronic kidney disease: what have we learned in 25 years? J Formos Med Assoc 2014; 113: 3–10.
- 6Besarab A, Bolton WK, Browne JK et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. New Engl J Med 1998; 339: 584–90.
- 7Bohlius J, Schmidlin K, Brillant C et al. Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials. Lancet 2009; 373: 1532–42.
- 8Macdougall IC. Novel erythropoiesis-stimulating agents: a new era in anemia management. Clin J Am Soc Nephrol 2008; 3: 200–7.
- 9Macdougall IC. Optimizing the use of erythropoietic agents– pharmacokinetic and pharmacodynamic considerations. Nephrol Dial Transpl 2002; 17(Suppl 5): 66–70.
- 10Aljama P, Bommer J, Canaud B et al. Practical guidelines for the use of NESP in treating renal anaemia. Nephrol Dial Transpl 2001; 16(Suppl 3): 22–8.
- 11Nissenson AR, Swan SK, Lindberg JS et al. Randomized, controlled trial of darbepoetin alfa for the treatment of anemia in hemodialysis patients. Am J Kidney Dis 2002; 40: 110–8.
- 12Barnett AL, Cremieux PY. Dose conversion from epoetin alfa to darbepoetin alfa for patients with chronic kidney disease receiving hemodialysis. Pharmacotherapy 2003; 23: 690–3.
- 13Locatelli F, Canaud B, Giacardy F, Martin-Malo A, Baker N, Wilson J. Treatment of anaemia in dialysis patients with unit dosing of darbepoetin alfa at a reduced dose frequency relative to recombinant human erythropoietin (rHuEpo). Nephrol Dial Transpl 2003; 18: 362–9.
- 14Bock HA, Hirt-Minkowski P, Brunisholz M, Keusch G, Rey S, von Albertini B. Darbepoetin alpha in lower-than-equimolar doses maintains haemoglobin levels in stable haemodialysis patients converting from epoetin alpha/beta. Nephrol Dial Transpl 2008; 23: 301–8.
- 15Arrieta J, Moina I, Molina J et al. Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability. Int J Nephrol Renovasc Dis 2014; 7: 353–9.
- 16Hirai T, Sugiya N, Nakashima A, Takasugi N, Yorioka N. Switching from epoetin alpha to darbepoetin alpha in Japanese hemodialysis patients: dose conversion ratio. Nephron Clin Pract 2009; 111: c81–6.
- 17Icardi A, Sacco P, Salvatore F, Romano U. Long-term intravenous epoetin-alpha / darbepoetin-alpha ratio in iron-replete hemodialysis patients. J Nephrol 2007; 20: 73–9.
- 18Nissenson AR. Dosing darbepoetin alfa. Am J Kidney Dis 2002; 40: 872.
- 19Locatelli F, Nissenson AR, Barrett BJ et al. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2008; 74: 1237–40.
- 20Locatelli F, Barany P, Covic A et al. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrol Dial Transpl 2013; 28: 1346–59.
- 21Hung SC, Kuo KL, Tarng DC, Hsu CC, Wu MS, Huang TP. Anaemia management in patients with chronic kidney disease: Taiwan practice guidelines. Nephrology 2014; 19: 735–9.
