From the Guidelines
Erythropoiesis-stimulating agents (ESAs) should be used to treat anemia in patients with chemotherapy-induced anemia, with a target hemoglobin level of 10-12 g/dL, as this has been shown to reduce the need for red blood cell transfusions and improve health-related quality of life 1. The use of ESAs in patients with cancer has been extensively studied, and the evidence suggests that they can be effective in reducing the need for transfusions and improving quality of life.
- The European Medicines Agency (EMEA) recommends the use of ESAs in patients with chemotherapy-induced anemia, with a target hemoglobin level of less than 12 g/dL 1.
- A study published in the Journal of the National Comprehensive Cancer Network found that ESAs reduced the need for transfusions and improved quality of life in patients with cancer 1.
- The dosing regimen for ESAs varies depending on the specific condition being treated and patient response, but typical initial dosing for epoetin alfa is 50-100 units/kg three times weekly, while darbepoetin alfa is typically started at 0.45 mcg/kg once weekly.
- Patients should have their hemoglobin levels monitored regularly, and the dose of ESA should be adjusted as needed to maintain a target hemoglobin level of 10-12 g/dL.
- Side effects of ESAs may include hypertension, headache, and rarely, serious cardiovascular events or pure red cell aplasia, and proper injection technique, including site rotation and sterile procedures, is essential for effectiveness and to minimize complications 1.
From the FDA Drug Label
INDICATIONS AND USAGE 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 (1.1). The effects of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy (1. 2).
The ESA injection is indicated for the treatment of anemia due to:
- Chronic Kidney Disease (CKD) in patients on dialysis and patients not on dialysis
- The effects of concomitant myelosuppressive chemotherapy, with a minimum of two additional months of planned chemotherapy 2
From the Research
ESA Injection Overview
- ESA (Erythropoiesis-Stimulating Agent) injections are used to treat anemia in patients with chronic kidney disease or cancer chemotherapy-induced anemia.
- Darbepoetin alfa is a novel erythropoiesis-stimulating protein with a three-fold longer terminal half-life than recombinant human erythropoietin (r-HuEPO) 3, 4.
Administration and Dosage
- The recommended starting dose for darbepoetin alfa in chronic renal failure patients is 0.45 microg/kg once weekly for both intravenous and subcutaneous administration, with subsequent titration based on the hemoglobin concentration 3.
- In cancer patients, the recommended starting dose is 2.25 microg/kg once weekly by subcutaneous injection and subsequent titration 3.
- Extended-interval ESA dosing (administration less than once weekly) is common with darbepoetin alfa, and clinical studies have shown that it is safe and effective in alleviating anemia at dose intervals of once every 1,2, or 3 weeks 5, 6.
Efficacy and Safety
- Clinical studies have shown that darbepoetin alfa is equivalent to r-HuEPO in terms of increases in hemoglobin concentration, percentage of patients achieving target hemoglobin concentration, and average time to reach target hemoglobin concentration 3, 4.
- The adverse event profile of darbepoetin alfa is similar to that of r-HuEPO, with no reports of antibody formation associated with darbepoetin alfa in chronic renal failure patients, and three cases of antibody formation, with neutralizing activity in one of the cases, reported in cancer patients 3.
- A systematic review of ESA studies found that darbepoetin alfa appeared to have a dose efficiency advantage compared to short-acting ESAs, with lower mean weekly doses and fewer dose increases required 7.