Effect of switching from darbepoetin alfa to methoxy polyethylene glycol-epoetin beta in chronic kidney disease

A recent study suggests the effect of switching from erythropoiesis-stimulating agent (ESA) treatment from darbepoetin alfa (DA) to methoxy polyethylene glycol-epoetin beta (PEG-Epo) in treating anemia associated with chronic kidney disease (CKD). This study was published in the journal, Advances in Therapy.

The AFFIRM study was a retrospective, multi-site, observational study that included 206 patients who had received hemodialysis for ≥ 12 months and DA for ≥ 7 months. The dose conversion ratio (DCR) was calculated for patients with hemoglobin level (Hb) and ESA data for the pre-switch evaluation period (months 1 and 2) and post-switch EP (months 6 and 7). Red blood cell transfusions during both evaluation periods were noted.

The results showed a geometric mean DCR of 1.17. DCR showed a decrease with increasing pre-switch DA dose. The geometric mean weekly ESA doses in the pre-switch and post-switch EP were 24.1 μg DA and 28.6 μg PEG-Epo, respectively. Mean Hb in the pre-switch EP and post-switch EP were found to be 11.5 g/dL and 11.4 g/dL, respectively. Overall, 16 transfusions and 34 units were transfused in the pre-switch EP whereas 48 transfusions and 95 units were transfused in the post-switch EP.

It may be concluded that in hemodialysis patients switched from DA to PEG-Epo, the DCR was 1.17 and 1.21. Thus, the number of transfusions and units transfused increased three-fold times from the pre to post-switch period.