P93
EXTENDED DOSING OF SHORT ACTING ESA’S – ARE WE MISSING THE
POINT?
Wilson, P, Wood, C, Jones, C
King’s College Hospital NHS Foundation Trust, London
BACKGROUND:
ESA therapy has been successfully used to treat the anaemia of chronic kidney disease (CKD)
for over 20 years, with initially ‘short acting’ preparations having a licence for thrice weekly
administration. Subsequent developments have seen the arrival of longer acting ESAs which
have the potential benefit of less frequent injections in the non-dialysis population, though
their cost is typically higher. With recent guidelines recommending lower target haemoglobin
levels and treatment costs more of a priority, we assessed the effectiveness of a short acting
ESA in a longer acting role, now that SmPC licensing has changed to include extended dosing
intervals.
AIM:
To describe the haemoglobin levels and ESA dose and frequency in a group of non-dialysis
patients from one large renal centre who were prescribe a ‘short acting’ ESA.
METHOD:
We reviewed the paper and electronic medical records of all CKD patients (i.e. not on dialysis
or had received renal transplant) who were prescribed EPREX® during 2012. Patients were
excluded if their ESA was not prescribed by the renal department, or if they were prescribed
other ESAs. Anaemia treatment and monitoring was carried out as per NICE guidelines 2011.
Patient haemoglobin levels, ESA dose and frequency and haematinics were collected for
analysis.
RESULTS:
224 patients not on renal replacement therapy were prescribed EPREX®, and of these 193
patients were being treated at a less frequent dosing regime than was previously
recommended in the SmPC. Of these 193 patients 44 patients were receiving EPREX® once
every 2 weeks, 91 patients receiving once a week, and 58 patients receiving EPREX® twice a
week. The majority of haemoglobins were maintained within the aspirational range of 10.0 –
12.0g/dL with the average haemoglobin being 10.3g/dL (range: 4.3 – 13.2g/dL). Serum
ferritin levels were maintained as per the recommendations in the NICE guidelines 2011 and
we aimed to keep the serum ferritin above 200mcg/L.
CONCLUSION:
This audit demonstrates that EPREX® can be safety and effectively used once weekly, once
every two weeks and in some cases once a month. It has allowed the patients to have less
frequent injections and maintain stable haemoglobin without having to move to a potentially
more expensive longer acting ESA. The licence has now changed for the maintenance phase
to include the options for the injections to be administered either once weekly or once every
two weeks.