Erythropoetin Stimulating Agent : Side Effects

• EPO is indicated for the treatment of anemia associated with chronic kidney disease (CKD) including patients in dialysis and patients not on dialysis.
• It works by stimulates erythropoiesis by interaction with eryhthropoetin receptor on progenitor cells in the bone marrow.
• Some serious side effects that might happen is cardiovascular events such as thrombosis,  stroke and myocardial infarction. EPO is believed to have pro-thrombotic or platelet-activating effects which can increase the risk of cardiovascular events.
• Besides that, there is one review on November 2006 in "Critical Reviews in Oncology Hematology" notes a possible link between EPO and increased cancer growth. Lung, breast and ovarian cancer were all found to have receptor sites for EPO on tumor cells, meaning that EPO could stimulate tumor growth.
• Besides, EPO also can increases blood pressure (BP) directly and notably independently of its erythropoietic effect and its effect on blood rheology.
• The common side effects that patient might have after taking EPO are
• Dizziness 
• Fever 
• Swelling 
• Nausea 
• Pain at the site of injection 

• Adverse drug reactions attributed to the treatment with MIRCERA (available in HKGU) in controlled clinical trials in CKD patients are :

Symptom organ class	Frequency	Adverse reaction
Vascular disorders	Common	hypertension
Injury, poisoning and procedural complications	Uncommon	Vascular access thrombosis
Nervous system disorders	Uncommon	Headache
Immune system disorders	Rare	Hypersensitivity
Nervous system disorders	Rare	Hypertensive encephalopathy
Skin and subcutaneous tissue disorders	Rare	Rash (macula-papular, serious)

Reference

1. http://cjasn.asnjournals.org/content/4/2/470.full
2. Product’s Leaflet Mircera (Methoxy polyethylene glycol-epoetin beta)
3. http://cardiovascres.oxfordjournals.org/content/59/3/538
4. http://www.livestrong.com/article/206029-side-effects-of-procrit-shots/
5. http://my.clevelandclinic.org/health/diseases_conditions/hic_Anemia/hic_erythropoietin-stimulating_agents