From the Guidelines
No, you should not use Mircera (methoxy polyethylene glycol-epoetin beta) and Procrit (epoetin alfa) together. These medications are both erythropoiesis-stimulating agents (ESAs) that work by stimulating your bone marrow to produce more red blood cells. Using them simultaneously would be redundant and potentially dangerous, as it could significantly increase your risk of serious cardiovascular events including heart attack, stroke, blood clots, and death, as suggested by the guidelines for the management of anemia in patients with cancer 1. Taking both medications could also lead to excessive red blood cell production (polycythemia), causing your blood to become too thick and further increasing cardiovascular risks.
Key Considerations
- The primary cause of anemia in patients with chronic kidney disease is insufficient production of erythropoietin (EPO) by the diseased kidneys 1.
- Iron supplementation is usually essential to assure an adequate response to Epoetin in patients with chronic kidney disease because the demands for iron by the erythroid marrow frequently exceed the amount of iron that is immediately available for erythropoiesis 1.
- The management of anemia and iron deficiency in patients with cancer should follow the ESMO clinical practice guidelines, which recommend ESA treatment in patients with symptomatic anemia who receive chemotherapy and present with an Hb level < 10 g/dL, as well as patients with asymptomatic anemia who receive chemotherapy and present with an Hb level < 8 g/dL 1.
Recommendations
- If you're currently prescribed one of these medications for anemia related to chronic kidney disease, cancer treatment, or other conditions, you should only take the specific ESA prescribed by your healthcare provider at the exact dosage recommended.
- If you're considering changing medications or have concerns about your current treatment's effectiveness, consult with your healthcare provider before making any changes to your medication regimen.
- The dosing of ESAs should follow the approved labels of the individual products, and the Hb target range for treatment with an ESA is a stable level of 12 g/dL without RBC transfusions 1.
From the Research
Erythropoiesis-Stimulating Agents (ESAs) for Anemia in Chronic Kidney Disease (CKD)
- Mircera (methoxy polyethylene glycol-epoetin beta) and Procrit (epoetin alfa) are both ESAs used to treat anemia in patients with CKD.
- Studies have shown that Mircera is effective in correcting and maintaining hemoglobin levels in patients with CKD, with a high response rate and stable hemoglobin levels when administered once every 2 weeks or monthly 2, 3.
- Procrit, on the other hand, is a shorter-acting ESA that requires more frequent administration.
Combination Therapy with Mircera and Procrit
- There is no direct evidence to suggest that Mircera and Procrit can be used together safely and effectively.
- However, studies have compared Mircera with other ESAs, such as epoetin alfa/beta and darbepoetin alfa, and found that Mircera is noninferior in terms of cardiovascular outcomes and all-cause mortality 4.
- It is possible that using Mircera and Procrit together could increase the risk of adverse events, such as hypertension, nasopharyngitis, and diarrhea, which are commonly reported with ESA use 2, 3.
Safety and Efficacy of Mircera
- Mircera has been shown to be generally well tolerated, with most adverse events being of mild to moderate severity 2, 3.
- The safety record of Mircera is considered to be similar to that of other ESAs, with a potential for nephroprotective and cardiovascular protective effects in non-dialysis CKD patients 5.
- The administration requirements of Mircera, which can be given once every 2 weeks or monthly, may make it a more convenient option for patients with CKD 6.