From the Guidelines
The primary treatment for anemia of chronic disease involves optimizing the underlying disease treatment, and if necessary, considering erythropoiesis-stimulating agents (ESAs) with a target hemoglobin level not above 12 g/dL. This approach is supported by the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases 1. The treatment should focus on addressing the underlying condition causing the inflammation, and when this is not possible or sufficient, specific interventions such as ESAs may be necessary.
Key considerations in the treatment of anemia of chronic disease include:
- Optimizing the treatment of the underlying disease, as indicated by the European consensus 1
- Considering ESAs for patients with an insufficient response to intravenous iron and optimized disease treatment, with a target hemoglobin level not above 12 g/dL 1
- Using intravenous iron formulations, which are preferred over oral supplements due to reduced oral iron absorption caused by inflammation
- Reserving blood transfusions for severe anemia or symptomatic patients
The pathophysiology of anemia of chronic disease involves inflammatory cytokines increasing hepcidin production, which blocks iron release from storage sites and reduces iron absorption, while also suppressing erythropoietin production and shortening red blood cell survival. Regular monitoring of hemoglobin levels, iron studies, and inflammatory markers is essential to assess treatment response and adjust therapy accordingly.
From the FDA Drug Label
1.1 Anemia Due to Chronic Kidney Disease PROCRIT is indicated for the treatment of anemia due to chronic kidney disease (CKD), including patients on dialysis and not on dialysis to decrease the need for red blood cell (RBC) transfusion.
1 INDICATIONS AND USAGE 1.1 Anemia Due to Chronic Kidney Disease Aranesp is indicated for the treatment of anemia due to chronic kidney disease (CKD), including patients on dialysis and patients not on dialysis.
The treatment for anemia of chronic disease is not explicitly stated in the provided drug labels. However, the labels do indicate that epoetin alfa (IV) 2 and darbepoetin alfa (IV) 3 are used to treat anemia due to chronic kidney disease (CKD).
- Epoetin alfa (IV) and darbepoetin alfa (IV) are erythropoiesis-stimulating agents (ESAs) that can be used to decrease the need for red blood cell (RBC) transfusions in patients with CKD.
- The labels do not provide information on the treatment of anemia of chronic disease in general, but rather specifically for anemia due to CKD.
From the Research
Treatment Options for Anemia of Chronic Disease
The treatment for anemia of chronic disease typically involves a combination of therapies, including:
- Supplementation with iron, folic acid, and vitamin B12 4, 5, 6
- A diet rich in hematopoietic factors, such as iron, folic acid, and vitamin B12 4
- Erythropoiesis-stimulating agents (ESAs) 5, 7, 8
- Novel methods of treating the underlying disease and anemia, including molecularly targeted drugs and administration of essential amino acids and vitamins involved in heme synthesis 4, 6
Administration Routes and Considerations
The route of administration for iron supplementation requires careful consideration of the benefits and possible side effects, and assessment of the patient's clinical status 4, 5. Options include:
- Oral iron supplementation 4, 5
- Intramuscular iron supplementation 5
- Intravenous iron supplementation 5, 7, 8
Emerging Therapies and Strategies
New methods of treating anemia of chronic disease are being developed, including:
- Biosimilar epoetins and follow-on biologics 7
- Synthetic peptide-based EPO receptor agonists, such as Hematide 7
- Orally active antianemic therapies 7
- Novel high-dose iron formulations, such as ferumoxytol and iron (III)-carboxymaltose 7, 8
- Prolyl hydroxylase inhibitors for stabilization of the hypoxia inducible factor 8