What is the dosing for Epoetin alfa (Epogen)?

From the Guidelines

Retacrit dosing should be initiated at 150 U/kg subcutaneously three times weekly or 40,000 U subcutaneously weekly for chemotherapy-induced anemia, with adjustments made to maintain hemoglobin between 10-11 g/dL, as recommended by the most recent guidelines 1. The dosing of Retacrit, also known as epoetin alfa-epbx, is crucial for managing anemia in various conditions, including chemotherapy-induced anemia.

Key Considerations

• The initial dose for chemotherapy-induced anemia is 150 U/kg subcutaneously three times weekly or 40,000 U subcutaneously weekly, as per the updated guidelines from 2019 1.
• Dose adjustments should be made to maintain hemoglobin levels between 10-11 g/dL, with increases or decreases in dose based on hemoglobin response, as outlined in the guidelines 1.
• It is essential to monitor hemoglobin levels regularly and adjust the dose accordingly to avoid excessive increases in hemoglobin, which can lead to adverse effects.
• The subcutaneous route is preferred for administration, especially in patients not on dialysis.

Dosing Adjustments

• If hemoglobin increases by less than 1 g/dL and remains below 10 g/dL after 4 weeks of therapy, the dose can be increased to 300 U/kg subcutaneously three times weekly 1.
• Conversely, if hemoglobin reaches a level needed to avoid transfusion or increases by more than 1 g/dL in 2 weeks, the dose should be decreased by 25% 1.
• Dose withholding and reinitiation at a lower dose may be necessary if hemoglobin exceeds target levels, as guided by the most recent clinical practice guidelines 1.

Patient Monitoring and Education

• Regular monitoring of hemoglobin levels, blood pressure, and iron status is vital during Retacrit treatment.
• Patients should be informed about potential side effects, including hypertension, thrombotic events, and the need for regular blood tests to monitor response to therapy.
• By following the recommended dosing guidelines and closely monitoring patients, healthcare providers can optimize the use of Retacrit to improve outcomes for patients with anemia due to chemotherapy or other conditions.

From the FDA Drug Label

In Studies C1 and C2, efficacy was demonstrated by a reduction in the proportion of patients who received an RBC transfusion, from week 5 through end of the study, with the last-known RBC transfusion status carried forward for patients who discontinued treatment Study C1 was conducted in patients with anemia (hemoglobin < 11.5 g/dL for males; < 10. 5 g/dL for females) with non-myeloid malignancies receiving myelosuppressive chemotherapy. Randomization was stratified by type of malignancy (lung vs. breast vs. other), concurrent radiation therapy planned (yes or no), and baseline hemoglobin (< 9 g/dL vs ≥ 9 g/dL); patients were randomized to epoetin alfa 40,000 Units (n=174) or placebo (n=170) as a weekly subcutaneous injection commencing on the first day of the chemotherapy cycle. Study C2 was conducted in 222 patients with anemia, ages 5 to 18, receiving chemotherapy for the treatment of various childhood malignancies Randomization was stratified by cancer type (solid tumors, Hodgkin's disease, acute lymphocytic leukemia, vs. non-Hodgkin's lymphoma); patients were randomized to receive epoetin alfa at 600 Units/kg maximum 40,000 Units (n=111) or placebo (n=111) as a weekly intravenous injection The results of 6 studies of similar design and that randomized 131 patients to epoetin alfa or placebo were pooled to assess the safety and effectiveness of epoetin alfa. Patients were randomized to receive epoetin alfa at 150 Units/kg (n=63) or placebo (n=68), subcutaneously three times per week for 12 weeks in each study The safety and efficacy of PROCRIT were evaluated in a placebo-controlled, double-blind study (S1) enrolling 316 patients scheduled for major, elective orthopedic hip or knee surgery who were expected to require ≥ 2 units of blood and who were not able or willing to participate in an autologous blood donation program Patients were stratified into 1 of 3 groups based on their pretreatment hemoglobin [≤ 10 g/dL (n=2), > 10 to ≤ 13 g/dL (n=96), and > 13 to ≤ 15 g/dL (n=218)] and then randomly assigned to receive 300 Units/kg PROCRIT, 100 Units/kg PROCRIT, or placebo by subcutaneous injection for 10 days before surgery, on the day of surgery, and for 4 days after surgery

The dosing for Retacrit (epoetin alfa) is as follows:

• For patients with anemia due to non-myeloid malignancies receiving myelosuppressive chemotherapy: 40,000 Units as a weekly subcutaneous injection commencing on the first day of the chemotherapy cycle 2
• For patients with anemia, ages 5 to 18, receiving chemotherapy for the treatment of various childhood malignancies: 600 Units/kg maximum 40,000 Units as a weekly intravenous injection 2
• For patients scheduled for major, elective orthopedic hip or knee surgery: 300 Units/kg or 100 Units/kg by subcutaneous injection for 10 days before surgery, on the day of surgery, and for 4 days after surgery 2
• For other patients: 150 Units/kg subcutaneously three times per week for 12 weeks in each study 2

From the Research

Retacrit Dosing

There is no direct information available on Retacrit dosing in the provided studies. However, the studies discuss the dosing of erythropoiesis-stimulating agents (ESAs) in general, which may be relevant to Retacrit dosing.

• The studies suggest that ESAs should be used at the lowest possible dose to achieve a target hemoglobin level of 10-11 g/dL 3, 4.
• The choice of ESA and dosing schedule should take into account the patient's individual needs and response to treatment 4, 5.
• The studies also discuss the importance of monitoring hemoglobin levels and adjusting ESA doses accordingly to minimize the risk of adverse events 5, 6.
• A network meta-analysis of ESAs found that the comparative effects of different ESAs on blood transfusions, death, and major cardiovascular events were uncertain 7.

Key Points

• ESAs should be used at the lowest possible dose to achieve a target hemoglobin level of 10-11 g/dL.
• The choice of ESA and dosing schedule should be individualized based on patient needs and response to treatment.
• Hemoglobin levels should be monitored regularly and ESA doses adjusted accordingly to minimize the risk of adverse events.
• The comparative effects of different ESAs on clinical outcomes are uncertain and require further study.