ESA use in CKD patients decreases due to managed care policies, reports says

EXTON, Pa.—Nephrologists report that their use of anemia drugs in chronic kidney disease patients has decreased significantly in one year, partly due to managed care policies, according to a recent report.

CKD stage 3 and 4 patients were treated with less erythropoiesis-stimulating agents between 2007 and 2008, according to the 182 nephrologists surveyed online through June by the research company BioTrends Research Group. In addition, approximately one-third of the surveyed nephrologists said the decrease in ESA use was specifically due to managed care policies. ESA use in dialysis patients remained consistent.

Amgen’s Epogen is still the ESA market leader in dialysis, and Ortho Biotech’s Procrit and Amgen’s Aranesp continue to battle to be the market leader in CKD, according to BioTrend’s 10th quarterly Nephrology TreatmentTrends publication.

However, the survey found indicators of brand switching, particularly related to office stocking and managed care reimbursement. Despite the decreased use of ESAs in CKD, nephrologists do not expect any significant change in treatment prevalence with ESAs in the next three months.

IV Iron Trends

Unlike the use of ESAs in CKD, the use of IV Iron has not changed significantly since last year, but treatment prevalence with IV iron in CKD remains much lower than treatment prevalence with ESAs, according to the BioTrends report.

The lower use of IV iron is related to the fact that very few nephrologists stock IV iron (36 percent compared to the 73 percent who stock ESAs), according to the report. Primary reasons for not stocking IV iron are "limited staffing resources" and "logistics of buying and billing."

The report found that American Regent's Venofer continues to hold its position as market leader in both dialysis and CKD, but the majority of surveyed nephrologists view Venofer and Watson's Ferrlecit as interchangeable. For those who do perceive the products to be differentiated, Venofer tends to have a perceived advantage on ease of administration in both dialysis and CKD, the report found.

AMAG Pharmaceutical's ferumoxytol could be commercially available by the end of the year. The report found that those with higher familiarity of the product feel it has a dosing and administration advantage.