When should Recormon (epoetin‑beta) be discontinued in a patient being treated for anemia (e.g., chronic kidney disease or chemotherapy‑induced)?

When to Discontinue Recormon (Epoetin-Beta)

Recormon should be discontinued in three specific clinical scenarios: (1) after 6–8 weeks of therapy if hemoglobin has not increased by 1–2 g/dL despite appropriate dose escalation, (2) when chemotherapy concludes (typically within 4–6 weeks after the last cycle), or (3) when hemoglobin exceeds 12–13 g/dL. 1

Discontinuation for Non-Response

Stop Recormon after 6–8 weeks if there is inadequate response, defined as:

• Hemoglobin increase <1–2 g/dL from baseline 1
• No reduction in transfusion requirements 1
• This applies even after attempting FDA-approved dose escalation 1

Before discontinuing for non-response, you must investigate reversible causes 1:

• Iron deficiency (the most common culprit—check transferrin saturation and ferritin) 1
• Underlying tumor progression 1
• Occult blood loss 1
• Infection or inflammation 1

The 6–8 week timeframe is critical because continuing beyond this point without response provides no benefit and exposes patients to unnecessary thromboembolism risk 1.

Discontinuation After Chemotherapy Completion

Discontinue Recormon within 4–6 weeks after the final chemotherapy cycle, regardless of hemoglobin level 1. This recommendation is based on:

• Increased mortality risk when ESAs are used in patients not receiving concurrent chemotherapy 1
• The anemia indication disappears once myelosuppressive therapy ends 1

Critical pitfall: Do not continue Recormon in cancer survivors or patients between chemotherapy cycles—this significantly increases mortality risk 1, 2.

Discontinuation for Excessive Hemoglobin Response

Withhold Recormon immediately when hemoglobin exceeds 13 g/dL 1. Resume at 25% lower dose only after hemoglobin falls below 12 g/dL 1.

Reduce dose by 25–50% when 1:

• Hemoglobin exceeds 12 g/dL 1
• Hemoglobin rises >2 g/dL over 4 weeks 1
• Hemoglobin increase exceeds 1 g/dL in any 2-week period 1

The rationale is straightforward: hemoglobin targets above 12 g/dL are associated with increased thromboembolism (67% increased risk) and mortality 1, 2. The goal is the lowest hemoglobin concentration needed to avoid transfusions, not normalization 1.

Special Considerations for Chronic Kidney Disease

In CKD patients (non-oncology setting), discontinuation criteria differ slightly 1:

• Target hemoglobin is 11–12 g/dL 1
• Resistance is defined as requiring >30,000 IU/week to maintain target 1
• Before stopping, ensure transferrin saturation >20% and ferritin 100–500 mcg/L 1

Do not discontinue in CKD patients solely because they are not on dialysis—Recormon remains indicated for predialysis CKD anemia 3, 4.

Absolute Contraindications Requiring Immediate Discontinuation

Stop Recormon immediately if 1:

• Refractory hypertension or hypertensive encephalopathy develops 5
• Pure red cell aplasia (PRCA) from anti-erythropoietin antibodies is suspected (sudden loss of efficacy with severe reticulocytopenia) 5
• Thromboembolic event occurs (though evidence for causality is circumstantial, clinical judgment favors discontinuation) 1

Monitoring Schedule to Guide Discontinuation Decisions

• Weeks 1–8: Check hemoglobin weekly to assess response 1
• After week 8: If stable, check monthly 1
• At 6–8 weeks: Make the critical go/no-go decision on continuation 1

Common pitfall: Waiting beyond 8 weeks to discontinue in non-responders wastes resources and increases thrombotic risk without benefit 1.

Algorithm Summary

1. At 6–8 weeks: Has hemoglobin increased ≥1–2 g/dL?

   • No → Check iron studies, investigate causes, then discontinue 1
   • Yes → Continue with dose adjustments

2. When chemotherapy ends: Discontinue within 4–6 weeks 1

3. If hemoglobin >13 g/dL: Withhold immediately 1

4. If hemoglobin 12–13 g/dL: Reduce dose by 25–50% 1

5. If refractory hypertension or PRCA: Discontinue permanently 5