The recent BioTrends survey in the quarterly report series—TreatmentTrends: US Nephrology—was fielded with approximately 200 nephrologists in early June.
Nephrologists also report significantly lower hemoglobin levels at ESA initiation and hold compared to last year, indicating more conservative use of ESAs, according to BioTrends. Moreover, 21 percent of nephrologists report seeing an increase in blood transfusions in dialysis patients in the past six months compared to 13 percent of nephrologists who reported this in the preceding quarter.
Although ESA use in chronic kidney disease non-dialysis (CKD-ND) has been stable, nephrologists reported that if they were not limited by cost, reimbursement or formularies, their use of Amgen's Aranesp would increase significantly at the expense of Centocor Ortho Biotech's Procrit, according to the survey results.
With more focus on iron as a potential strategy to lower overall ESA utilization, approximately one-third of nephrologists reported a change in their intravenous (IV) iron protocol in the dialysis setting in the past three months.
The most commonly reported protocol change is higher ferritin/transferrin saturation (TSAT) thresholds leading to more iron use, according to the report. Despite an increased focus on iron and a reported increase in use, there have been no significant changes in the percent of hemodialysis patients on IV iron compared to the prior year; however, the percent of peritoneal dialysis patients on IV iron has increased significantly.
Other significant events in the IV iron market include the recent availability Sanofi's Ferrlecit as a branded generic, Nulecit, marketed by Watson. Currently, use of Nulecit is very low, but there are differences based on primary chain affiliation, according to BioTrends. And regardless of affiliation, the vast majority of nephrologists report moderate or high comfort using Nulecit and feel the product is moderately to highly interchangeable with Ferrlecit. Interestingly, if they were not limited by cost, reimbursement or formularies, nephrologists report they would significantly increase their use of AMAG's Feraheme in both the dialysis and CKD-ND setting with market leader, Venofer, being the most negatively impacted.
