Research Reviews
NAAC Research Reviews contain summaries and commentaries of recently published clinical trials regarding prevalence, diagnosis, consequences and treatment of anemia. We provide a quick overview of the recently published article from a peer reviewed journal and also include an expert commentary written by our Council Members. The commentary discusses the study's results, authors’ conclusions and helps explain how this study or the questions raised may impact you, your practice or medical organization.
November 19, 2009
Although the benefit of erythropoiesis-stimulating agents (ESAs) has long been assumed, investigators do not know whether an increase of hemoglobin (Hb) levels through the use of ESAs will lower the risk for cardiovascular events and end-stage renal disease. The Trial to Reduce Cardiovascular Events with Aranesp therapy (TREAT) was designed to test this hypothesis in patients with type 2 diabetes, chronic kidney disease, and anemia who were not on dialysis. Unique in its comparison of an ESA to placebo, the results from the study by Pfeffer et al are likely to impact clinical practice to reduce risks associated with ESAs and maximize transfusion avoidance and quality of life benefits. [ full review ]
October 21, 2009
Pergola et al conducted a randomized, open label, multicenter study to test the hypothesis that extended dosing regimens of epoetin alfa would be as safe and effective as approved dosing regimens, concluding that extended dosing regimens were not inferior to the standard three times per week dosing regimen when used to treat anemia in subjects with stage 3-4 CKD. Unfortunately, the increased dose required for significant extension of the dosing interval would make this approach untenable in the anticipated environment of bundled payments for dialysis services. Until our understanding of the basic physiology improves, we will be continuing to use ESAs in a largely empirical fashion rather than based on the important and distinctive pharmacokinetics and pharmacodynamics of individual agents. [ full review ]
August 14, 2009
A recent study tested the hypothesis that normal Hb targets can reduce transfusion rates compared with conventional targets in 596 incident hemodialysis patients without symptomatic cardiac disease. This was a randomized, controlled trial comparing normal Hb targets to partial correction of anemia, when treating with epoetin alfa resulting in authors Foley et al concluding that based on the data, normal target Hb levels can lower blood transfusion requirements in incident hemodialysis patients without symptomatic cardiac disease, in which the mortality rates are low. [ full review ]
August 14, 2009
A retrospective analysis by Kulnigg et al evaluated the use of intravenous iron sucrose with and without ESAs to treat anemic patients with Crohn’s Disease and ulcerative colitis. Analysis notably indicated that achieving a post treatment ferritin level of 400 mcg/L resulted in the prevention of iron deficiency within 1-5 years of treatment. Close follow up of Hb and iron levels, as well as prompt treatment with iron with or without ESA therapy can help physicians provide a better quality of life for patients with inflammatory bowel disease. [ full review ]
July 15, 2009
To reevaluate the benefits and risks of ESAs in clinical settings, Ludwig et al conducted the first pooled analysis of all randomized, placebo-controlled trials that involved the ESA darbepoetin alfa. Analysis included six studies and 2,122 patients with CIA, with lung and hematologic cancers being the most frequent primary tumor type. The study's results reaffirm the value of ESAs in a clinical setting and suggest further reasons why other trials have shown contradictory results. [ full review ]
June 16, 2009
A study by Boudville et al examined the relationship of hemoglobin variability and mortality in nondialysis chronic kidney disease patients receiving erythropoiesis-stimulating agents to identify specific factors that are associated with hemoglobin variability. The results suggest an association between hemoglobin variability and adverse clinical outcomes, suggesting that future carefully designed controlled trials should search for better understanding of hemoglobin variability as a marker of illness and comorbidity. [ full review ]
June 16, 2009
In the study by Bohlius et al, patients receiving epoetin or darbepoetin plus red blood cell transfusion were compared to patients receiving only transfusion. Upon analysis, ESAs increased overall mortality by 17% in all patients compared to control groups, and by 10% in patients undergoing chemotherapy compared to control groups. Although methodologically more rigorous, including 13,933 patients from 53 trials, this trial shows similar results to other meta-analyses or reviews. To further elucidate the clinical benefits of the findings, specific patient sub-groups need to be investigated, and more uniform survival endpoints need to be defined to assess the long-term effects of ESA treatment. [ full review ]
May 16, 2009
The observational study by Rath et al, investigating the use of subcutaneous epoetin beta as an alternative to epoetin alfa for treatment of anemic patients on hemodialysis in Europe, provided further support for the use of epoetin beta in patients on hemodialysis and was well tolerated in CKD patients or patients on forms of renal replacement therapy. These findings suggest that switching to subcutaneous epoetin beta is a safe and effective treatment method, however, it is important to recognize the role concomitant iron therapy may have played in this study to contribute to the stability of target hemoglobin levels. [ full review ]
February 4, 2009
This review of literature by Minton et al is the first to assess the effects of common pharmacological treatments on cancer-related fatigue, most notably that of methylphenidate and hematopoietic treatments. In conclusion, it is encouraging to know from this study that the correction of anemia and the use of psychostimulants may improve fatigue, however studies are still needed to determine the mechanism of fatigue and the benefits of treating this symptom. [ full review ]
December 3, 2008
There has been much debate and discussion over the last two years about the quality of life (QOL) impact of ESA use in CKD patients. The results of this study by Finkelstein et al supports prior conclusions and clinical judgment that a hemoglobin level of 11-13 g/dL is associated with better QOL compared to lower Hb levels, and that even higher Hb levels are associated with continued, but perhaps, less improvement in QOL. Yet, readers of this study cannot conclude that raising Hb levels causes an increase in QOL, nor should they draw conclusions about any relationship between ESA use and QOL. [ full review ]
December 3, 2008
Without question, the greatest advance in the last decade of rheumatology therapeutics has been the introduction of TNFα blockade. The study by Doyle et al evaluated the effects of TNFα inhibition by analyzing three trials – ATTRACT, ASPIRE, and START – of RA patients with anemia who were randomly assigned to receive a combination of methotrexate therapy and infliximab or placebo. The results demonstrated that a therapy targeting a major proinflammatory cytokine produced improvement in anemia, but did so independently of a reduction in joint pain. [ full review ]
November 7, 2008
Using a multivariate analysis, Jädersten et al sought to confirm recent findings that suggest a positive impact of growth factors on survival in MDS without affecting the rate of progression to AML. Although this report offers some reassurance regarding the use of growth factors and cancer progression, definitive conclusions regarding survival are best drawn from randomized, prospective studies. [ full review ]
November 7, 2008
Although the recommended initiation dosage of epoetin alfa is within 50-100 IU/kg three-times-weekly, several studies reported that the epoetin alfa is still effective in achieving and maintaining hemoglobin target levels in CKD patients when given subcutaneously up to every four weeks. This prospective, open-label, randomized, multicenter study of 39 adult patients receiving one of four different dosing regimens gives some scientific basis to support the practice of extended dosing schedules. [ full review ]
October 1, 2008
This Phase III clinical trial by Spinowitz et al described the effects of the intravenous iron product, ferumoxytol, in CKD patients. Intravenous iron is recommended for patients with CKD, but is infrequently used before a patient initiates dialysis. It is very likely that if this agent is approved for use in CKD, ferumoxytol will be eagerly incorporated as part of the armamentarium of CKD anemia management. [ full review ]
October 1, 2008
In this review by Da Silva et al, relative or absolute iron deficiency may play an important role in heart failure patients as indicated in bone marrow studies by the low levels of iron available for erythropoiesis, despite normal ferritin and iron studies from the peripheral blood. The authors contend that by determining the effectiveness of different combinations of clinical therapies, clinicians will be able to develop specific treatment strategies. [ full review ]
September 4, 2008
An examination of IV iron administration (as compared to no iron or oral iron) in conjunction with darbepoetin alpha in treating chemotherapy-induced anemia confirms its effectiveness in this population, but is unlikely to change current clinical practice until the safe utilization of ESAs is demonstrated. [ full review ]
August 14, 2008
The DRIVE studies explored the efficacy of intravenous iron (ferric gluconate) to improve hemoglobin levels of hemodialysis patients receiving epoetin doses. [ full review ]
July 10, 2008
Recently, a study hypothesized that the changes in white blood cell (WBC) count and serum albumin levels—along with other experimental biomarkers such as monocyte chemoattractant protein 1 (MCP1) and malondialdehyde (MDA)—could predict EPO sensitivity. [ full review ]
July 10, 2008
The Study of Anemia in Heart Failure Trial was designed to test the efficacy of using a long-acting ESA, darbepoetin alfa, to treat patients with heart failure in a multicenter (65 centers), double-blind, randomized, placebo-controlled, phase II study. [ full review ]
June 4, 2008
The study described below evaluates VTE and mortality rates of ESA use in phase 3 trials comparing ESAs with placebo or standard of care treatment to treat chemotherapy-associated anemia in cancer patients. Data were extracted from trials reviewed in the Cochrane Collaboration (January 1, 1985 - April 1, 2005) and MEDLINE and EMBASE databases (April 1, 2005 - January 17, 2008). [ full review ]
April 3, 2008
Role of Erythropoietin Treating Anemia in Chronic Heart Failure [ full review ]
April 3, 2008
Impact of Delayed Erythropoietin Treatment in Critically Ill Patients [ full review ]
March 6, 2008
Costs and Outcomes of ESA Treatment for Non-dialysis Patients [ full review ]
March 6, 2008
Anemia Management with Erythropoietin in Diabetic Patients [ full review ]
March 6, 2008
[ full review ]
February 7, 2008
Partial Trial Stabilizing Hemoglobin Levels in Cervical Cancer [ full review ]
February 7, 2008
Symptom Assessment Scale Helps Clinicians Treat Anemia of Cancer [ full review ]
November 7, 2007
[ full review ]
October 9, 2007
Clinical Guidelines and Evidence-based Management of Anemia in Cancer Patients [ full review ]
September 1, 2007
Improved Patient Outcomes in Appropriate Clinical Settings [ full review ]
August 4, 2007
Study Shows For-Profit Facilities Give Higher Doses of Epoetin [ full review ]
August 4, 2007
Restrictive Hemoglobin Strategy May Safely Reduce Transfusion Requirements [ full review ]
June 1, 2007
Epoetin alfa study of quality of life outcomes in lung cancer patients with disease-related anemia halted after unplanned safety analysis: Highlights the need to monitor overall survival [ full review ]
June 1, 2007
Darbepoetin alfa and epoetin alfa achieved similar rates of transfusion independence in critically ill patients [ full review ]
June 1, 2007
IV Ferric Gluconate Provides Greater Increases In Hemoglobin And Hemoglobin Response [ full review ]
June 1, 2007
EORTC Guideline Update for Erythropoietic Protein Use in Cancer Patients with Anemia [ full review ]
Last Updated: November 19, 2009
