The impact of C-reactive protein on the efficacy of roxadustat in managing anemia in chronic kidney disease

Chronic Kidney Disease

A recent study demonstrated that roxadustat displays similar efficacy across different blood C-reactive protein (CRP) levels. Additionally, in the CRP ≥ upper limit of normal (ULN) group, roxadustat can uphold efficacy comparable to erythropoiesis-stimulating agents (ESA) without the need for dose escalation. The study's results were recorded in the publication BMC Nephrology. 
A comprehensive search was conducted across electronic databases, including Web of Science, Pubmed, Embase, Cochrane Library, Wanfang, International Clinical Trials Registry Platform (ICTRP), and CNKI from their inception until 19thMay, 2022. A systematic review was performed on evidence from randomized controlled trials that used hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) for treating renal anemia. The meta-analysis findings were derived from the mean difference (MD) in changes in hemoglobin concentration (∆Hb) pre- and post-treatment, utilizing a random-effects model. Groups with CRP levels at or above the upper limit of normal (ULN) were compared with those below the ULN. Further analysis was conducted within the CRP ≥ ULN group, comparing erythropoiesis-stimulating agents (ESA) and HIF-PHIs.
This analysis included a total of seven studies from six publications. When comparing the CRP ≥ ULN group with the CRP < ULN group, 524 patients from four studies were analyzed. All patients were administered roxadustat as the primary intervention. The pooled results showed no significant difference in ΔHb between patients with CRP ≥ ULN and CRP < ULN at baseline (MD: 0.00, 95% CI: -0.32 to 0.33, P value= 0.99). The effectiveness of roxadustat and erythropoiesis-stimulating agents was compared in three studies involving 1399 patients within the CRP ≥ ULN group. The findings revealed no significant difference in ΔHb between patients treated with ESAs and HIF-PHIs (MD: 0.24, 95% CI: -0.08 to 0.56, P value = 0.14). Regarding medication dosage, an increase in ESA dose over time was observed in various studies, particularly noticeable in the CRP ≥ ULN group, while the roxadustat dose remained constant over time and was not affected by the baseline CRP levels.
Therefore, roxadustat exhibited similar efficacy regardless of the CRP levels. Additionally, in the CRP ≥ ULN group, roxadustat can sustain effectiveness comparable to erythropoiesis-stimulating agents without the necessity for dose escalation.
 

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