What alternative treatments should be considered for anemia of chronic disease when treating the underlying condition is not successful or possible?

From the Guidelines

When treating the primary illness in patients with anemia of chronic disease is not successful or possible, erythropoietic therapy should be considered, particularly when combined with intravenous iron supplementation. This approach is supported by a study published in the Journal of Crohn's and Colitis in 2013 1, which suggests that erythropoiesis-stimulating agents (ESA) can be a valid option for treating anemia in patients with inflammatory bowel disease (IBD) when iron, folic acid, and vitamin B12 supplementation is insufficient.

Key Considerations

• Erythropoietic therapy, such as erythropoietin, can be effective in correcting anemia in patients with IBD when combined with intravenous iron supplementation 1.
• The therapeutic goal with ESA should be a hemoglobin level of 11-13 g/dL, although it is unclear if this goal can be applied to treatment of anemia in patients with IBD 1.
• Iron supply is critical for the success of ESA therapy, and functional iron deficiency can be expected, making intravenous iron administration necessary 1.
• The use of ESA is a risk factor for thrombosis, a common complication in IBD, and should be considered when making treatment decisions 1.

Treatment Options

• Erythropoiesis-stimulating agents (ESA) such as erythropoietin can be used to stimulate erythropoiesis and improve anemia.
• Intravenous iron supplementation is necessary to optimize the effect of ESA therapy and prevent functional iron deficiency.
• Red blood cell transfusions may be reserved for severe anemia or symptomatic patients requiring immediate intervention.

From the FDA Drug Label

In patients with cancer receiving myelosuppressive chemotherapy when the anticipated outcome is cure In patients with cancer receiving myelosuppressive chemotherapy in whom the anemia can be managed by transfusion.

When treating the primary illness in patients with anemia of chronic disease is not successful or possible, consider the following for treatment:

• Red blood cell (RBC) transfusions may be an option for patients who require immediate correction of anemia.
• Alternative treatments for the underlying disease or condition may be necessary to manage anemia. It is essential to note that ESAs (erythropoiesis-stimulating agents), such as darbepoetin alfa and epoetin alfa, are not indicated for patients receiving myelosuppressive chemotherapy when the anticipated outcome is cure, or in patients with cancer receiving myelosuppressive chemotherapy in whom the anemia can be managed by transfusion 2 3.

From the Research

Treatment Options for Anemia of Chronic Disease

When treating the primary illness in patients with anemia of chronic disease is not successful or possible, other treatment options should be considered.

• Erythropoiesis-stimulating agents (ESAs) can be used to stimulate the production of red blood cells in the bone marrow 4, 5, 6, 7, 8.
• The choice of ESA should take into account their pharmacokinetics and pharmacodynamics, administration route, and economic issues 5.
• The treatment goal should be to achieve a hemoglobin level of 11-12 g/dL, while avoiding high ESA doses and disproportionately high dosages to achieve recommended hemoglobin targets 5, 6, 7.
• The potential benefits of reducing blood transfusions and anemia-related symptoms should be weighed against the risks of harm, particularly in patients with significant cardiovascular morbidity or ESA resistance 6, 7, 8.
• Regular monitoring of patients during and after therapy with ESAs is necessary to minimize the risks and maximize the benefits of treatment 4, 5, 6, 7, 8.

Erythropoiesis-Stimulating Agents

Different types of ESAs are available, including:

• Epoetin alfa
• Epoetin beta
• Darbepoetin alfa
• Methoxy polyethylene glycol-epoetin beta
• Biosimilar ESAs 4, 5, 6, 7, 8.
• Each ESA has its own clinical characteristics, stabilities, and potential risks and benefits 4, 5, 6, 7, 8.

Patient-Specific Factors

The effectiveness of ESAs can vary depending on individual patient characteristics and etiologies of anemia 4, 5, 6, 7, 8.

• Patient-specific factors, such as age, comorbidities, and kidney function, should be taken into account when selecting an ESA and determining the treatment goal 5, 6, 7, 8.