In a recent study, it was suggested that in patients undergoing hemodialysis, the conversion of epoetin alfa to darbepoetin alfa meant that achieving hemoglobin (Hb) stability was possible at a conversion ratio of 300:1 for patients receiving low doses of epoetin alfa and 350:1 for those receiving higher doses. This study was published in the International Journal of Nephrology and Renovascular Disease.

In this multicenter, observational, retrospective study, 125 patients above 18 years of age, who were switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa, were included. They were on hemodialysis from month 0 to at least 24 months. The dose conversion was adjusted to maintain Hb within 1.0 g/dL of baseline.

At the end of the study, it was observed that there were no significant changes in Hb levels. The erythropoiesis-stimulating agent (ESA) dose decreased significantly after conversion from epoetin to darbepoetin alfa. With epoetin, an annual mean of 174.7 international units (IU)/kg/week was achieved while it was 95.7 and 91.4 IU/kg/week during the first and second year, respectively for darbepoetin.

Based on the above results, it can be concluded that to maintain Hb stability, a conversion ratio of 300:1 may seem appropriate for patients who received low doses of epoetin while a ratio of 350:1 may seem better for those receiving higher doses.

A recent study found that hemoglobin concentrations were effectively maintained with darbepoetin alfa (DA) given once every two weeks (Q2W) in dialysis patients. This study was published in the journal, Clinical Nephrology.

The ALTERNATE was an observational study that included 6,104 adult dialysis patients initiating treatment with darbepoetin alfa administered Q2W. Data obtained was from 6 months prior and 12 months post Q2W initiation. The primary endpoint of the study was hemoglobin (Hb) concentration, one year after initiation.

It was found that before initiation, 77.3%, 8.8%, and 7.8% of patients were on DA, epoetin beta, and epoetin alpha, respectively. Mean Hb (g/dl) and geometric mean weekly ESA dose (µg/wk) 6 months before initiation, at initiation, and 12 months after initiation were 11.68, 12.00, and 11.62, respectively and 27.27, 23.69, and 26.80, respectively. A total of 77.3% of patients were found to be receiving DA Q2W at the end of the study (12 months).

From the above results, it can be concluded that Hb concentrations can be effectively maintained over 12 months in dialysis patients without the need for an increase in the Erythropoiesis-stimulating agents (ESAs) dose.

A recent study found that darbepoetin alfa dosed every-other-week (Q2W) is safe and efficacious in treating anemia in chronic kidney disease patients. This study was published in the journal, Current medical research and opinion.

This open-label, multicenter, single-arm study included 128 subjects with ESA-naïve chronic kidney disease (CKD), with baseline hemoglobin (Hb) < 11.0 g/dL. Darbepoetin alfa was dosed every-other-week at an initial dose of 0.75 microg/kg and titrated to achieve and maintain Hb levels at 11.0-13.0 g/dL. Treatment was given from week 1 to week 19. The primary endpoint of the study was the proportion of subjects who achieved Hb > or = 11 g/dL at any study visit, with the exception of week 1.

Out of 128 subjects, 118 received at least one dose of darbepoetin alfa and 112 of the subjects completed the study, achieved a Hb > or = 11 g/dL in a median time of 5 weeks. The median dose of darbepoetin alfa was 60 microg at week 1 and 80 microg at the time of Hb > or = 11 g/dL.

From the above results, it can be concluded that de novo Q2W darbepoetin alfa was well-tolerated and effective in correcting and maintaining Hb levels in ESA-naïve subjects with CKD who were not undergoing dialysis.

A recent study suggests that darbepoetin-α (DPO-α) is more advantageous than recombinant human erythropoietin (rHuEPO) in improving anemia in hemodialysis (HD) patients. This study was published in the European Journal of Haematology.

This study included a long-term crossover study for 3 years to compare the effects of the two erythropoiesis-stimulating agents (ESA) on serum iron, transferrin saturation (TSAT), and ferritin, as well as a short-term crossover study for 8 weeks to examine their effects on serum hepcidin-25 in HD patients.

From the long-term crossover study, it was demonstrated that the change of ESA from rHuEPO to DPO-α significantly decreased serum ferritin while serum iron and TSAT remained unchanged. On the other hand, DPO-α as well as rHuEPO maintained hemoglobin levels between 10.0 and 11.0 g/dL, which was the target range. In the short-term crossover study, area under the percent suppression of serum hepcidin-25 time curve for the first 7 days during the DPO-α treatment period was significantly greater than that during the rHuEPO period. Also, the greater suppression of hepcidin-25 by DPO-α may facilitate iron mobilization, resulting in a diminution of body iron stores without any significant effect on serum iron utilizable for erythropoiesis.

From the above results, it can be concluded that DPO-α has a greater advantage than rHuEPO in that it facilitates iron mobilization from body stores into the bone marrow to induce effective erythropoiesis.