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Abstract: PO0468

A Contemporary View of Erythropoietin-Stimulating Agent Switching: Determining a Dose Conversion Ratio (DCR) from IV Epoetin Alfa to IV PEG-Epoetin Beta and SC Epoetin Beta to Preserve Haemoglobin Control in Haemodialysis Patients

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • White, Lee, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
  • Williams, Rhys, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
  • Gumbleton, Mark, Cardiff University, Cardiff, South Glamorgan, United Kingdom
  • Jenkins, Justine, Cardiff University, Cardiff, South Glamorgan, United Kingdom
  • Llyr, Greta, Cardiff University, Cardiff, South Glamorgan, United Kingdom
  • Galloway, Laura A., Cardiff University, Cardiff, South Glamorgan, United Kingdom
  • Brown, Christopher, Cardiff University, Cardiff, South Glamorgan, United Kingdom
  • Mikhail, Ashraf I., Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
  • Brooks, Owain, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
Background

Recent studies, such as PIVOTAL, in haemodialysis show the benefit of adequate iron repletion, including reduction in ESA dose. This study aims to determine the DCR to maintain Hb stability in a contemporary HD cohort, switch from IV epoetin alfa (Eprex®), to sc epoetin beta (Neorecormon ®) or IV PEG-epoetin beta (Mircera®).

Methods

This observational study from a UK single-centre analysed Hb stability and ESA requirements in 260 HD patients on IV epoeitin alfa, who switched to sc epoetin beta (n=118) or IV PEG-epoetin beta (n=142). Data from a 3 mth Baseline period were compared to a 9 mth post-switch Evaluation period. The DCRs were are calculated using Evaluation dose / Baseline dose. The target Hb was 100-120g/L. Iron requirements were determined from TSAT, Ret-He and Ferritin.

Results

The mean Hb, Hb in target, ESA dose, frequency and DCR were:

For IV PEG-epoetin beta group 109g/L, 75%, 10418 iU/wk, 3/wk, at baseline;109g/L, 81%, 181mcg/mth, 1/mth, at evaluation; resulting DCR 1mcg:249iU.

For sc epoetin beta 111g/L, 74%, 9717IU/wk, 3/wk, at baseline; 111g/L, 88%, 7528 iU/wk, 2/wk, at evaluation; resulting DCR of 0.8.

At these DCRs the Hb stability was maintained throughout the study. Sub-group analysis for baseline Hb in the PEG-epoetin beta group were 1:255 (Hb in range), 1:239 (Hb below range), 1:253 (Hb above range).

Conclusion

These data show that the DCR of 0.8 for epoetin IV to sc, with a reduction in frequency for sc, is in keeping with published literature and product license. The DCR of 1mcg:249iU for PEG epoetin-beta IV: epoetin alfa IV is higher than the typical 1mcg:200iU reported in the literature.
These dose conversion data will benefit clinicians wishing to switch ESA, and provide insight into the bio-equivalencies and reduced administration frequencies into any logistical or costing model.