Factors affecting the doses of roxadustat vs darbepoetin alfa for anemia treatment in hemodialysis patients

• Published in: Therapeutic apheresis and dialysis 2021-10, Vol.25 (5), p.575-585
• Main Authors: Akizawa, Tadao, Yamaguchi, Yusuke, Majikawa, Yoshikatsu, Reusch, Michael
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; anemia; Anemia - drug therapy; Anemia - etiology; chronic kidney disease; darbepoetin alfa; Darbepoetin alfa - therapeutic use; Dose-Response Relationship, Drug; Double-Blind Method; Female; Glycine - analogs & derivatives; Glycine - therapeutic use; Hematinics - therapeutic use; Humans; inflammation; Isoquinolines - therapeutic use; Japan; Male; Middle Aged; Original; Renal Dialysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; roxadustat; Treatment Outcome; Young Adult
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/1744-9987.13609

Roxadustat is an oral hypoxia‐inducible factor prolyl hydroxylase inhibitor for the treatment of anemia in chronic kidney disease (CKD). Emerging evidence suggests that roxadustat may be beneficial for patients who inadequately respond to erythropoiesis‐stimulating agents (ESAs). This post‐hoc analysis of a Japanese, double‐blind, randomized, phase 3 study in hemodialysis‐dependent CKD patients treated with traditional ESAs assessed the impact of factors associated with ESA hyporesponsiveness on roxadustat and darbepoetin alfa (DA) doses required to maintain target hemoglobin. Endpoints included mean of average doses of roxadustat and DA per administration in the last 6 weeks (AAD/6W) by prior ESA‐resistance index (ERI), iron repletion (transferrin saturation; ferritin), and high‐sensitivity C‐reactive protein (hs‐CRP). Of 415 enrolled patients, 303 were randomized (roxadustat, n = 151; DA, n = 152). Weight‐adjusted AAD/6W increased with increasing ERI for roxadustat (ERI