Abstract: FR-PO0209
Differences in Anemia Improvement Effects Between Hypoxia-Inducible Factor-Prolyl Hydroxylase (HIF-PH) Inhibitors and Erythropoiesis-Stimulating Agents (ESAs) in a Japanese Database Study
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Kuragano, Takahiro, Hyogo Medical University Department of internal Medicine Division of Kidney and dialysis, Nishinomiya, Hyogo, Japan
- Ueta, Kiichiro, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
- Nishimura, Kenichi, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
- Ishii, Manabu, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
- Hashimoto, Toshio, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
- Oku, Akira, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
Background
Since 2020, hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors have been accessible for clinical use in Japan. Unlike erythropoiesis-stimulating agent (ESA)s, HIF-PH inhibitors can be taken orally, furthermore, HIF promotes not only erythropoietin production but also the efficient use of iron for erythropoiesis by regulating gene expression involved in iron utilization. Despite these potential benefits, real-world evidence on the use of HIF-PH inhibitors after their introduction is limited.
Methods
This retrospective cohort study made use of data from the Medical Data Vision database (April 2008–March 2024). Two patient cohorts were studied: Cohort 1 included those starting renal anemia treatment (HIF-PH inhibitors or ESAs) between
2021 and 2024, and Cohort 2 included patients who had received ESA in 2020. Data from Sub-cohorts 1 and 2 with known iron repletion status were also examined. The study examined treatment initiation, switching rates, and hemoglobin (Hb) trends
Results
Cohort 1 included 9,253 patients. The proportion of patients starting HIF-PH inhibitors increased annually, from 15.1% to 54.8%. Use of HIF-PH inhibitors showed trends to maintain higher Hb levels than ESAs. This trend was particularly notable in patients with functional iron deficiency (ferritin>100ng/mL and TSAT<20%), the proportion of patients with severe anemia (Hb<10g/dL) was lower in the HIF inhibitor(3%) than in the ESA (32%) after 12 month. Across subgroups stratified by CRP, albumin, eGFR, and Hb levels at baseline, HIF-PH inhibitors consistently had higher Hb levels and lower percentages of patients with a Hb level of <10 g/dL compared to ESA.
In the Cohort 2 (n = 1,998) there was no change in Hb levels in the ESA continuation group, on the other hand, after switch from ESA to HIF-PH inhibitor, Hb level increased and the proportion of patients with severe anemia (Hb<10g/dL) was decreased from 42% to 15%.
Conclusion
HIF-PH inhibitors reduced the proportion of patients with severe anemia more than ESAs, and this tendency was more pronounced in patients with functional iron deficiency. Across subgroups stratified by CRP, albumin, eGFR, and Hb levels at baseline, HIF-PH inhibitors consistently had higher Hb levels and lower percentages of patients with sever anemia compared to ESA users.
Funding
- Commercial Support – This study was sponsored by Mitsubishi Tanabe Pharma Corporation.