What is an Erythropoiesis-Stimulating Agent (ESA) injection?

From the Guidelines

ESA injection refers to Erythropoiesis-Stimulating Agent injection, a medication used to treat anemia by stimulating red blood cell production, with dosing regimens varying based on the specific condition being treated, patient weight, and hemoglobin levels, as outlined in the 2010 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update 1.

Key Points

• Common ESAs include epoetin alfa (Epogen, Procrit), darbepoetin alfa (Aranesp), and methoxy polyethylene glycol-epoetin beta (Mircera) 1.
• These medications are typically administered via subcutaneous or intravenous injection, with initial doses for adult patients with cancer ranging from 150 U/kg SC TIW for epoetin alfa or 40,000 U SC weekly for darbepoetin alfa 1.
• ESAs work by mimicking the action of erythropoietin, a hormone naturally produced by the kidneys that signals the bone marrow to make red blood cells.
• The main benefit of ESA therapy is the avoidance of transfusion, as demonstrated in a randomized, placebo-controlled study by Littlewood et al., where epoetin alfa reduced transfusion requirements in patients with anemia receiving chemotherapy 1.
• Regular blood tests are necessary to monitor hemoglobin levels and adjust dosing appropriately, as excessive treatment can increase risks of cardiovascular events and thrombosis, particularly in patients with a high baseline risk of thromboembolic events 1.

Important Considerations

• Therapy should not be initiated at Hb levels < 10 g/dL, and dosing regimens should be adjusted based on patient response and hemoglobin levels 1.
• Patients with multiple myeloma who are being treated with thalidomide or lenalidomide and doxorubicin or corticosteroids are at particularly increased risk of thromboemboli, and the use of ESAs in these patients should be approached with caution 1.
• Adverse events that occur with increased frequency during ESA therapy include increased blood pressure, hemodialysis access thrombosis, and increased risk of death, stroke, and pure red cell aplasia (PRCA) 1.

From the FDA Drug Label

Aranesp is an erythropoiesis-stimulating agent (ESA) indicated for the treatment of anemia due to: Chronic Kidney Disease (CKD) in patients on dialysis and patients not on dialysis RETACRIT is an erythropoiesis-stimulating agent (ESA) indicated for: • Treatment of anemia due to o Chronic Kidney Disease (CKD) in patients on dialysis and not on dialysis ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in clinical studies of patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers

ESA injection is an erythropoiesis-stimulating agent used to treat anemia due to various conditions, including Chronic Kidney Disease (CKD) and the effects of myelosuppressive chemotherapy 2, 2, 3.

• Key uses:
  • Treatment of anemia in patients with CKD on dialysis and not on dialysis
  • Treatment of anemia due to myelosuppressive chemotherapy
• Important considerations:
  • Increased risk of mortality, myocardial infarction, stroke, and thromboembolism
  • Increased risk of tumor progression or recurrence in patients with cancer

From the Research

Definition of ESA Injection

• Erythropoiesis-stimulating agents (ESAs) are used to increase red blood cell production in patients with chemotherapy-induced anemia or chronic kidney disease-related anemia 4, 5, 6, 7, 8.
• ESAs, such as epoetin alfa, darbepoetin alfa, and peginesatide, work by stimulating the production of erythropoietin, a hormone that promotes the formation of red blood cells 4, 7.

Types of ESAs

• Short-acting ESAs, such as epoetin alfa and epoetin beta, have a shorter duration of action and require more frequent dosing 6.
• Long-acting ESAs, such as darbepoetin alfa, have a longer duration of action and can be administered less frequently 6, 8.

Administration and Dosage

• The dosing interval for ESAs varies depending on the specific agent and the patient's condition, with some ESAs administered weekly or every 2-4 weeks 5, 6.
• The dosage of ESAs is typically adjusted based on the patient's hemoglobin levels, with the goal of achieving a target hemoglobin level while minimizing the risk of adverse effects 4, 6.

Clinical Uses

• ESAs are used to treat anemia in patients with chronic kidney disease, chemotherapy-induced anemia, and other conditions characterized by inadequate red blood cell production 4, 7, 8.
• ESAs have been shown to reduce the need for blood transfusions and improve quality of life in patients with anemia, but may also increase the risk of certain adverse effects, such as hypertension and thromboembolism 4, 8.