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/