EXTON, Pa.— The use of erythropoietin-stimulating agents (ESAs) in patients with chronic kidney disease not on dialysis (CKD-ND) is showing signs of stabilization, according to the latest survey released by BioTrends Research.
Although use is still far lower than it was just a few years ago, for the first time in almost a year, the percent of Stage 4 CKD-ND patients on ESAs is trending up instead of down, according to the report, which got its information from online surveys with 200 nephrologists and 205 renal dietitians.
While not a statistically significant change, use of Centocor Ortho-Biotech's Procrit is lower than in prior quarters, and monthly contact rates for Procrit representatives are significantly lower than last year and than monthly contact rates for Amgen's Aranesp, according to BioTrends. Procrit also seems to be losing a competitive advantage on a number of attributes it once "owned," BioTrends wrote.
Despite prior projections of increased use of intravenous (IV) iron, use has remained steady as have the percent of nephrologists who report stocking and administering IV iron in their office, according to the survey results. Use of the newest IV iron agent, AMAG's Feraheme, is showing signs of a plateau; for the third quarter in a row, Feraheme share has remained relatively flat among IV iron treated CKD-ND patients. Moreover, the percent of nephrologists reporting use of Feraheme has not changed.
BioTrends wrote that there have been some major changes in the bone and mineral metabolism market, particularly as it relates to parathyroid hormone (PTH) modifiers. The majority of both nephrologists and renal dietitians are aware that DaVita, one of the largest dialysis providers, has changed from Abbott's Zemplar to Genzyme's Hectorol as its formulary product and that it has expanded its PTH target range. Despite potential preferences for one agent over another or opposition to the formulary change, very few nephrologists or renal dietitians expect to complete non-formulary requests for Zemplar.
The majority of renal dietitians expect their use of active vitamin D and Amgen's Sensipar will decrease due to the new PTH range, but alternatively, Sensipar may benefit from the upcoming dialysis bundled payment system, according to BioTrends. In fact, for the second quarter in a row, nephrologists report that Sensipar use in hemodialysis patients is at higher levels than it has been in recent quarters. In terms of phosphate binders, use in Stage 4 CKD-ND patients continues to be lower than it was last year, although brand dynamics have remained relatively unchanged.
