Anemia Study Changed Way Docs Prescribe ESAs

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EXTON, Pa.—Recent clinical reports on erythropoietin-stimulating agents have changed the way nephrologists are prescribing anemia drugs, according to recent survey results from BioTrends Research.

Familiarity with Amgen’s clinical trial TREAT has increased, and approximately 90 percent of nephrologists are at least somewhat familiar with the study.  Close to two-thirds report the study had led to changes or expected changes in their use of erythropoietin-stimulating agents (ESAs) in chronic kidney disease non-dialysis (CKD-ND) patients; the study has also led to changes in anemia management in dialysis patients, albeit to a lesser extent, according to BioTrends. 

The study appears to have affected the ESA class as a whole, including both Amgen’s Aranesp/Epogen and Centocor Ortho Biotech’s Procrit, according to the BioTrends report.  In addition , there has been a significant decrease in reported use of ESAs in CKD-ND patients compared to last quarter. Also, nephrologists gave significantly lower safety ratings to ESA products compared to IV iron products. 

Furthermore, reported hemoglobin at initiation for both CKD-ND and dialysis patients has decreased significantly compared to the prior year and audited figures suggest that hemoglobin level at ESA initiation in dialysis patients is even lower than the reported figure, according to BioTrends.  Finally, nephrologists’ predicted a decreased use of ESAs in both the dialysis and CKD-ND setting in the next three months. 

The recent report is based on two surveys conducted by BioTrends. “ChartTrends: Renal Anemia” is an annual publication based on patient and laboratory data collected from over 1,000 dialysis patient charts.  The other, “TreatmentTrends: US Nephrology,” is a quarterly report series based on online survey results from over 100 nephrologists and captures physician attitudes, perceptions and self-reported behavior. 

Despite reports and indications of decreased use of ESAs, there have not been any significant changes compared to last year in the percent of patients treated with IV iron, according to the BioTrends survey.  However, the percent of nephrologists who report stocking IV iron in their offices is trending up and managed care seems to be having more of an impact on increased use of IV iron in CKD-ND patients.

American Regent’s Venofer and AMAG’s Feraheme are the most commonly stocked IV iron products and nephrologists have clear and distinct reasons for the choice of one over the other, according to BioTrends.  Feraheme has been making significant gains among IV iron treated hemodialysis, peritoneal dialysis and CKD-ND patients since its launch in July. 

While Feraheme has been used in all market segments, uptake has been greatest in CKD-ND patients and penetration in hemodialysis has varied depending on dialysis unit affiliation, BioTrends reported.  Fresenius’ Venofer continues to be the market share leader across all dialysis unit types with Sanofi-Aventis’ Ferrlecit (formerly marketed by Watson) in second position.  

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