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Monday, February 15, 2016

Erythropoietin Stimulating Agent (ESA) Selection

Availability:
  • Epoetin Alfa 2000iu/0.5ml (Eprex)
  • Methoxy-ethylene glycol-epoietin beta 50mcg/0.3ml (Mircera®)


Advantages of Mircera
  • is the first of a new class of longer-acting ESAs designed to correct and maintain Hb levels in CKD patients.
  • Unlike shorter-acting ESAs, CERA’s lower affinity for erythropoietic receptors prompts repeated binding, further stimulating red blood cell production by bone marrow.
  • CERA’s long half-life allows for administration once every two weeks to correct anemia and once-monthly to maintain target Hb levels
  • Epoetin- alfa requires dosing once to three times per week
Advantages of Eprex
  • Financial cost saving
  • established safety and efficacy profile
Comparison


Conversion from Mircera to Eprex
  • Conversion from Mircera to Eprex in a cohort of patients receiving haemodialysis was not associated with a significant change in haemoglobin, achievement of haemoglobin targets, changes in intravenous iron use or indices of iron status.
  • Based on nationally published costs for Mircera, Eprex and nursing time, conversion from Mircera to Eprex led to a reduction in quarterly costs of approximately £165 per patient
Table 1: Definitions of low, medium and high dose ESA

Low dose
Medium dose
High dose
Eprex (per week)
<8,000iu
8,000 -<15,000iu
>15,000iu
Mircera  (per month)
<100mcg
100 - <200mcg
>200mcg
References:
  1. Anemia Drugs: Darbepoetin Alfa, Epoetin Alfa, and Methoxy Polyethylene Glycol-Epoetin Beta: Clinical Policy (Effective 02/01/2016)
  2. Continuous Erythropoietin Receptor Activator (Mircera®) for Renal Anemia
  3. Erythropoietin stimulating agent conversion from Mircera® to Eprex® at Ilkeston satellite dialysis unit: a retrospective service evaluation
  4. https://www.pharmac.govt.nz/medicines/my-medicine-has-changed/erythropoietin/

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